Cancer care a symptom of a failing health policy

This is the way it works: do a bad job and you get promoted; do a good job and you get shifted. As Minister for Health, Brian Cowen has presided over a system in crisis. For this he has earned the glowing admiration of the Taoiseach and elevation to one of the most senior offices of State.

As Minister for Education, Micheal Martin has been an outstanding success; serious-minded, energetic and possessed of real vision.

Yet, in political terms, the manoeuvre makes some sense. If the Government is to have a real chance of being re-elected, it will have to convince the public that it is capable of providing a decent health service.

Getting Mr Cowen out and Mr Martin in suggests that Mr Bertie Ahern has at least a strong instinct for survival.

During the 1989 general election, Mr Charles Haughey, as Taoiseach, went on a phone-in programme on RTE and admitted that he did not realise the public felt so strongly about the run-down of the health service. Unless there is a massive change, Mr Ahern could find himself repeating those words on the campaign trail in 18 months.

More than any other issue, it is the health crisis which sums up the folly of the current let-the-good-times-roll complacency. In our clinics and hospitals, the reality of an unjust, socially-undeveloped State hits home.

As one of those who added to the crisis by ending up in the casualty department of Beaumont Hospital before Christmas, I've been of late perhaps more sharply aware of this issue than usual. I saw for myself that all the things which caused such outrage in the late 1980s - wards closed, not a single bed available, distressed old people lying all day on trolleys, excellent staff struggling under relentless pressure - are still with us.

And this isn't just about temporary emergencies resulting from a flu epidemic. Some of the most basic aspects of a modern health service, things which are taken for granted in the developed world, are not available to people without private insurance in this State.

The most disturbing example is the treatment of cancer, the second most common cause of death in the State, leading to some 7,500 deaths a year and touching almost every family.

ACCORDING to Mr Seamus O Cathail, consultant radiotherapist at Cork University Hospital, as many as 1,000 Irish people are dying unnecessarily of cancer every year because of inadequate treatment facilities, especially in the field of radiography. Preventable cancer deaths since 1996 may outnumber the death toll in the entire Northern Ireland conflict.

When Mr O Cathail said this on RTE radio last month, the reaction from health policymakers and Government politicians was that he should stop saying this out loud.

Yet no one has seriously challenged his figures. They are based on a comparison between treatment facilities and survival rates in the rest of Europe and those in this State.

In Europe, an average of 66 per cent of cancer patients get radiography treatment. In this State, the figure is an astonishing 16 per cent. Yet this is not because of different ideas about treatment. It is simply because we don't have the clinics, the machines and the staff.

There is no radiography unit in the west of Ireland. Facilities in Cork, which serve most of the south, cannot cope with demand.

In a letter published in The Irish Times on Christmas Eve, the chief executive officer of the Southern Health Board, Mr Sean Hurley, sought to reassure the public that urgent cancer cases in Cork were dealt with speedily. Yet, almost as an aside, he noted: "As there is a limited number of radiotherapy beds available, from time to time patients requiring a bed while receiving treatment may experience a delay (this may take up to two months)."

Mr Hurley's motivation in trying to alleviate anxiety is admirable. But what kind of system is it which needs to imply that "requiring a bed while receiving treatment" for cancer is some kind of exotic contingency or which consigns to parentheses a delay of two months in receiving life-saving medical help.

And it's absolutely clear that Mr O Cathail is not just some crank with an axe to grind. His courageous honesty in telling the truth about radiotherapy is backed up by reports on the broader picture of cancer treatment in the State.

Last November a survey of 734 Irish women cancer patients - part of the pan-European Caring about Women and Cancer study - found alarming delays in the treatment of women with breast and gynaecological cancers. A quarter of breast-cancer patients and over 40 per cent of gynaecological cancer patients have to wait more than a month after a clinical examination before they even get a diagnosis. The reason, according to Dr Mary Codd, of CAWAC, is "the fact that the service is bursting at the seams".

Prof Niall O'Higgins, of the National Forum for Cancer Services, confirmed that these findings were broadly representative of the situation in Irish hospitals.

AGAIN, last week the first national review of support services for cancer patients came up with damning findings. It is widely accepted that psychological and social support services which contribute to a patient's sense of well-being have a large impact on survival rates. However, the review found that such services were "haphazard and unstructured".

It also pointed out, quite shockingly, that many patients were never seen by a cancer specialist at all.

In 2000, in one of the world's richest countries, an official report found it necessary to recommend as an aspiration that every cancer patient should be treated and diagnosed by a doctor specialising in cancer.

There is a National Cancer Strategy which aims to improve this situation. Yet it is unclear that it will address basic problems, such as radiotherapy facilities. And its aim is extremely modest: a 15 per cent reduction in cancer-related deaths by 2004.

Halfway through the lifetime of the next government, in other words, we just might be as good as keeping people with cancer alive as our European neighbours are now. Unless Mr Martin can do better, that government is unlikely to be a continuation of the present one.

e-mail: fotoole@irish-times.ie