ANALYSIS:Harney's cost-cutting pragmatism raises the bar for the HSE to make best of scarce resources, writes DR MUIRIS HOUSTON
THE SURPRISE announcement by Minister for Health Mary Harney, reversing her decision, to commence a national cervical cancer immunisation programme is a welcome piece of good news for the health sector. And the partial go-ahead for a national bowel cancer screening service will arguably be of even greater public health benefit, because of the much larger number of cancers involved.
Coming just days after a draft Health Service Executive (HSE) service plan for 2010 indicated a probable 10 per cent reduction in the number of patients treated in our public hospitals this year and with the health budget €1 billion less than a year ago, the prospect for additional health projects was as icy as the prolonged period of freezing weather we have just experienced. So where is the additional funding coming from?
Credit must first be given to the Health Information and Quality Authority (Hiqa), which identified a number of savings within the National Cancer Screening Service (NCSS), which we are told will pay for the first two years of preparatory work for the colorectal cancer screening programme. Training advanced nurse practitioners, who will carry out the additional colonoscopy tests which some of those screened will require; developing about 12 new centres where these tests will be performed; and ensuring the public understand how the postal test kits work, are just some of the tasks to be completed by 2012. Sources last night confirmed approximately €2 million would have to be found from within existing NCSS budgets to complete the preparatory work.
In the region of €6 million of additional funding will be required in 2012, when the first of 400,000 people aged 60-69 will be offered screening for colorectal cancer. Unlike breast cancer screening, which created geographic inequalities because of the way it was rolled out, the colon cancer programme will be available nationally from the beginning. And while there will be some disappointment the original target group of all 55-74-year-olds will not benefit immediately, about 50 per cent of the 2,200 people diagnosed with bowel cancer in the Republic every year are aged between 60 and 69.
Colorectal cancer kills in the region of 1,000 people here every year. Cancer of the cervix kills about 80 women annually.
So while much media attention in the coming days will focus on Ms Harney’s decision to offer free human papilloma virus (HPV) vaccination to some 30,000 girls who are now in their first year of secondary school, the introduction of bowel cancer screening will save many more lives in the long term.
Of course, the cervical cancer vaccine initiative is welcome: it brings preventive medicine in Ireland on a par with many of our European neighbours and stops the two-tier divide whereby those from higher-income families were able to benefit, while girls in lower socioeconomic groups would not have had the private wherewithal to pay for the vaccine. But the new vaccine – which is active against some 70 per cent of all cervical cancers is not a panacea: CervicalCheck, the national cervical screening programme which screened over one-quarter of a million women in 2009, will remain the principal plank upon which a reduction in deaths from cancer of the cervix will be achieved.
In terms of costs, the Minister appears to have cut costs as a result of direct negotiations she had with the two pharmaceutical companies who market HPV vaccine in the State. The original plan to vaccinate 75,000 young girls was to cost €16 million. Now, she says €3 million will cover the cost of vaccinating some 30,000 first-year students.
The cancer control programme which Ms Harney has championed since she became Minister for Health is much stronger following yesterday’s announcements.
Should she leave Cabinet in a forthcoming reshuffle, she is assured of at least one satisfactory legacy.
But it is hard not to contrast her “loaves and fishes” approach to cost-containment and service provision with that of the HSE’s unsatisfactory plan for 2010.
The Minister must insist on the same innovative approach being taken in the wider health system by Prof Drumm and his top managers.