Cancer service reform is one of Celtic Tiger's silent successes


Prof Tom Keane’s tough criticism of coverage in media of health issues is worth bearing in mind, writes NOEL WHELAN

IN THE midst of the fiscal banking and employment crises, any discussion about the benefits that Ireland gained from the boom is likely to descend into something akin to that iconic scene in Monty Python’s Life of Brian, where the John Cleese character asks an audience “What have the Romans ever done for us?”

He is met by a shout out of achievements, which he angrily dismisses because they do not conform to his original thesis.

Like the roads built by Rome, the network of motorways funded by our Celtic Tiger are self-evident but, given the understandable anger at our country’s plight, acknowledging any other achievement is likely to remain controversial for the foreseeable future. With even a little detachment, however, the transformation in our cancer care services will emerge as one of the remarkable successes of the last decade.

Even before he completed his two-year stint as interim director of the National Cancer Control Programme, Prof Tom Keane rightly attracted much of the credit for this achievement. In time Mary Harney, and indeed Prof Brendan Drumm, will also be recognised for their part in this initiative by persuading the British Columbia cancer agency to lend us Prof Keane for two years, by ringfencing funding support and by providing political cover for the controversial reorganisation of services that Keane managed to effect largely on time and within budget.

On leaving Ireland to return to Canada earlier this year, Keane was shortlisted to replace Drumm, who is due to step down as chief executive of the Health Service Executive (HSE) next month. If press reports are to be believed, Keane emerged as favourite in the selection process, only to decline the position apparently because commitments he sought about resources could not be given because of the state of the public finances.

One of Keane’s strengths was his straight talking, not only about cancer care but about health issues generally. He was blunt about the need for specialist cancer treatment centres at centralised locations. He was forceful on the need for a meaningful debate about the cost of drugs and in particular whether the State should spend millions of its limited health budget on drugs that might deliver a marginal improvement in life expectancy.

Keane was also blunt in his observations about how the Irish media covered health issues.

We now know Cathal Magee, the former managing director of Eircom, is to replace Drumm and, for the time being at least, Keane will not play any role in our health services. It is timely therefore to revisit some of his observations on the coverage of health issues in Ireland, not least because they may help set the media context in which the new HSE chief executive will begin his work next week.

In a farewell interview with Susan Mitchell in the Sunday Business Post last January Prof Keane bemoaned the shallowness of the debate about healthcare in the Irish media.

“Appropriate engagement requires time,” he said, and it is clear from the interview that he felt that too little time and space are given to real debate on health issues in Ireland. Pointing out that he himself was prepared to be quite transparent and open about where things were at in the health services, he added that “30-second soundbites never really do it justice”.

The Canadian media, by comparison, Keane said, was interested in “much more in-depth stuff”. In a tone that echoes a complaint many of us have about political coverage, Keane argued that the Irish media “feed each other . . . a morning radio [show] does something and it ends up on the evening news . . . you wouldn’t see that in Canada. It’s bad, because things that are factually incorrect get repeated”.

Keane also argued that the Irish media concentrated on the negative and on a disproportionate number of human interest stories, distorting the reality that once patients access the healthcare system, most are happy with their care. Burnt by this experience, he felt people working within the service were distrustful of the media and feared being misrepresented.

In an interesting insight into the way the Irish media covered or sourced health-related stories, Keane told Mitchell how he was amazed at the extensive use of freedom of information requests by the Irish media. “My entire e-mail system has been trawled so many times here,” he said. “I never had a single request in Canada. I’m not even sure the [cancer] agency did.”

Keane was, however, measured in his view of media coverage of his work and that of the health services generally.

In an interview this time last year with, he rejected the characterisation of public or media concern about the rationalisation of cancer services as “hysterical”.

He said, however, that the level of public concern had been “totally distorted by the media”, instancing how, while the initiative had closed cancer units in 24 hospitals, almost all of which were uncontroversial, much of the media focus had been on Sligo. He expressed the hope that the Sligo decision would in time be seen by people in the northwest as the right one.

Witheringly, he added: “Maybe it’s the media’s job to find controversy but as far as I am concerned most of what we are doing is not controversial.”

Keane’s views are only those of one healthcare professional but they have the merit of being those of an outsider. He is someone who has no need to pander to medical, sectoral, political or media interests here, but who clearly has the interests of Irish patients at heart.

We may not have ongoing access to Keane’s expertise, but as we begin another phase in the complex, convoluted and imperfect process of reforming our health service his observations are worth bearing in mind.