Analysis:Patients should know that some private hospitals are not meeting Hiqa criteria, writes Dr Muiris Houston
With women openly questioning the quality of breast cancer services in the State, there is a growing crisis of confidence in the health system's ability to provide a reliable and trustworthy service.
Following the revelations about Portlaoise hospital, the quality of breast services in the public system is under the microscope; however, the management of at least 10 women treated in the private sector at Barringtons' hospital in Limerick is the subject of an ongoing inquiry, with breast cancer services at the hospital suspended.
The Irish Times asked the major private hospitals in the State to clarify whether they were now operating to the standards laid down by the National Quality Assurance Group for Symptomatic Breast Disease Services.
The hospitals were specifically asked if they offered triple assessment to women with symptomatic breast disease: did they have a designated breast cancer surgeon who carried out all breast cancer surgery; and did they conduct weekly multidisciplinary meetings to discuss the results of mammograms, biopsy findings and the clinical examination of patients with suspected breast cancer.
In Dublin, the Mater Private and St Vincent's Private hospital said they follow the guidelines fully. It may be significant that both share a campus with a BreastCheck unit, the facility that offers a screening service to women aged between 50 and 64 who do not have symptoms of breast disease. In any event, the service they offer women concerned about possible breast cancer symptoms is in line with best practice.
The Mount Carmel Medical Group runs three private hospitals; in Sligo, Kilkenny and Dublin. The Sligo unit does no breast work. At Aut Even hospital in Kilkenny there is no formal multidisciplinary teamwork or formal triple assessment. In Mount Carmel hospital in Dublin, a spokesman said all mammograms are read by a single consultant who exceeds the recommended number of 1,000 mammograms a year. But there is no weekly multidisciplinary forum at which suspected cases of breast cancer are discussed.
The Bons Secours Medical Group operates four private hospitals in the Republic. Its flagship hospital is in Cork city; it has two specialist breast surgeons, two full-time medical oncologists and other support staff. All symptomatic breast patients undergo triple assessment and a multidisciplinary team meeting is held every week.
The Bons Secours in Glasnevin, Dublin does not offer a mammography screening service. It has two consultant breast surgeons who hold public appointments at Beaumont Hospital and other part-time consultants in medical oncology. It does not hold formal team meetings to discuss breast cancer services at the hospital.
The Bons Secours Hospital in Tralee does offer a mammography screening service with three radiologists double reading the films. However, it does not have a specialist breast surgeon or pathologist and says it no longer offers breast cancer treatment.
The Bons in Galway does not offer breast surgery on site. It says cases seen by consultants there are referred to University College Hospital Galway for treatment and discussion by multidisciplinary meeting. It does offer a mammography screening service with one part-time radiologist. A spokesman was unable to confirm the number of films read by the specialist.
Also in Galway, the Galway Clinic says it complies fully with the national quality assurance guidelines, providing triple assessment and weekly multidisciplinary meetings.
A spokesman for the Hermitage Clinic in Lucan, Dublin, said it was building up its symptomatic breast disease service at present but that the service will be fully integrated into the public health system. It intends to meet Health Information and Quality Authority (Hiqa) standards and cases from the hospital will be discussed at the weekly multidisciplinary meeting in Beaumont.
The Beacon Clinic said: "Plans are under way to open a specialised breast clinic within Beacon hospital cancer centre." According to a spokesman a triple assessment approach will be an integral part of the service. And he said that breast cancer surgery there will be carried out only by fully qualified breast surgeons.
The flagship Blackrock Clinic has ceased offering symptomatic breast services entirely.
So where does this leave potential patients? There is a significant disparity between private hospitals; some are operating to the specified national standard while others are not fully compliant. In the absence of a formal role for Hiqa in the private hospital sector, the advice is: caveat emptor.