Patients treated in the private sector may not be covered by the new cancer strategy, writes Dr Muiris Houston, Medical Correspondent
Despite a prolonged delay in announcing the actual number and location of specialist cancer centres, yesterday's National Cancer Control Programme contained no surprises.
The location of the eight centres had been well flagged; the issue of where patients in the northwest would be treated is now confirmed, with Letterkenny General Hospital linked to the centre at University College Hospital Galway.
The arrival of Prof Tom Keane from the British Columbia Cancer Agency is most welcome. As the two-year interim director of the programme with the HSE, it will be his experience and leadership that will ultimately decide the success or failure of future cancer care in the Republic.
The eight centres in the State will manage and treat cancers of the breast and bowel (colon). Less common cancers will be treated at specific cancer centres only, based on their particular expertise and to ensure they have a sufficient throughput of cases needed to ensure a good quality outcome.
What will it mean in practice for patients? The initial hospital assessment of a suspected tumour will involve multidisciplinary teamwork, designed to maximise diagnostic accuracy and to plan the best treatment model for each patient. Where surgery is required to remove the cancer, it will take place in the specialist centre, as will radiotherapy.
However, it is likely that at least some chemotherapy will be administered in smaller hospitals nearer the patient's home, following protocols laid down by the specialist centre.
Patient support and palliative care will also be provided at a local level.
With the annual number of cases of cancer in the Republic set to double to almost 29,000 by 2020, implementing cancer care pathways will guarantee quality and improve survival rates from the disease.
However, a major caveat remains. The 2006 National Cancer Forum report recommended that the Health Information and Quality Authority establish a national framework for quality in cancer control.
The report stated that "a statutory system of licensing and accreditation should apply to both public and private sector services".
But, despite the serious deficiencies highlighted in breast cancer care at Barringtons' private hospital in Limerick this year, it was made clear yesterday that the new cancer supremo will have no remit over cancer services provided exclusively in the private sector.
In effect, this means that both Minister for Health Mary Harney and the HSE have sanctioned a reverse two-tier system of care for cancer patients. While public patients will benefit from the new cancer control strategy, those who choose the private sector will be treated in a system with no explicit quality control mechanisms.
The message to patients is clear: despite the push from Government and in particular the Minister to privatise medical services in the Republic, neither the Department of Health nor the HSE are, as yet, willing to assume responsibility for the quality and safety of services provided by the private sector.