Tánaiste and Minister for Health and Children, Mary Harney, T.D. announces National Network for Radiation Oncology Services
The Tánaiste and Minister for Health and Children Mary Harney, T.D. today announced the Government’s approval for a national network for radiation oncology services to be put in place by 2011. This will mean an investment in 23 additional linear accelerators to bring the total up to 36.
The network will consist of:
- four large centres in Dublin at St. James’ (13 linear accelerators) and Beaumont (7) hospitals, Cork (7, up from 4) and Galway (5 up from 3);
- two integrated satellite centres in Waterford (2) and Limerick (2);
- arrangements with the Northern Ireland health authorities for services for patients in the North West in Belfast City Hospital initially with further work to pursue the joint provision of a satellite centre for the North West linked to Belfast; and
- arrangements to ensure the continuity of St. Luke’s expertise and ethos in the service.
The capital investment involved will be approximately over €400 million with most of it being funded through the PPP.
Making the announcement, the Tánaiste said,
‘‘The government is determined to continue to build up our cancer services, so that we have world class services available and accessible to patients in each region of the country.
‘A third of the population will suffer some form of cancer in their lives. Over a half of all cancer patients should receive radiation oncology as an integral part of their treatment. This national network will achieve that objective by 2011.
‘Underlying this decision is my strong conviction that what matters most is not bricks and mortar, or complex machines, but the expertise that uses this equipment. The future of clinical practice is in networks of teams of cancer specialists, that operate at a scale sufficient to allow experts to sub-specialise. This will enable patients receive the best possible diagnosis and care based on experience of dealing with a lot of similar cases.
‘This plan will deliver that expertise to all cancer patients, by arranging for services to be provided by multi-disciplinary teams covering surgery, chemotherapy and radiotherapy. ‘This was at the heart the recommendations of the report on ‘The Development of Radiation Oncology Services in Ireland’ approved by the Government in September 2003.
‘We are going to start immediately to put in place additional capacity at St. Luke’s Hospital, as we organise a transition to new facilities providing for multi-disciplinary care at St. James’ Hospital and at Beaumont Hospital. ’
‘The government recognises that, as well as facing the trauma of cancer treatment, many patients have to face arduous, long journeys for radiation treatment. This is not what anyone wants for cancer services in our country or in any region of it.
‘With the inclusion of Waterford and Limerick in this network, and the arrangements being made in the North West, we will be keeping patients’ travel times as low as possible while delivering top quality care for patients throughout the country.
‘It is important for maintaining the quality of care standards that the satellite locations are fully integrated with the main centres. This way the same quality of care will be delivered in each location. It also means that clinical staff will keep up the same levels of expertise by working in both the main centre and the satellite.
‘It is part of the government’s policy for health that as many services as possible are delivered in each region. This will require networks and team-working by consultants. This is the model into which new cancer consultants will be recruited.’
Expertise of St. Luke’s Hospital
‘The government and I are anxious to build on the expertise and ethos of St. Luke’s. Many thousands of Irish patients and their families from every part of the country have experienced high quality cancer care at St. Luke’s. It is held in great affection by the Irish people.
‘We are taking specific actions to involve St. Luke’s centrally in this overall plan, and in particular, in relation to the facility at St. James’, which I propose will contain the St. Luke’s name. For example, the Chief Executive of St. Luke’s will lead the management team of the new facility at St. James’s. In additional to radiation oncology expertise, the Director of Physics at St. Luke’s, Dr. Brendan McClean, will be centrally involved in setting the specifications of the PPP for the whole network. The Chairman of St. Luke’s, Mr Padraic White, will chair an implementation oversight group to report to me on progress on the overall plan.
‘In recognition that St. Luke’s hospital will be central to the governance of the new facility at St. James’, I will pursue discussions with the Boards of both Hospitals about its governance and a re-configuration of the Boards in advance of 2011, with the twin goals of ensuring continuity of expertise and ethos in the care of cancer patients and the effective integration of multi-disciplinary patient care at the one site. I am confident the transition will be managed with great sensitivity and skill by the two hospital boards to achieve those objectives.
‘The plan envisages the provision of the full network of services in 2011. This is an ambitious target.
‘I recognise the need for additional capacity nationally by 2008. For that reason I have approved two additional linear accelerators now for St. Luke’s. I am committed to providing four additional linear accelerators in the East by 2008. I will be asking that the PPP specification will include this as an output.
‘The PPP will be organised under new proposals for a centre of excellence for PPPs brought forward by the Minister for Finance. This should help speed up delivery.
‘The PPP will be a single design, build, finance, manage and partially operate project. Clinical staff will continue to be recruited under public sector arrangements. With the PPP, we are procuring the means by which public service clinicians will deliver public health services.
‘I am confident that the bundling of the sites into one contract with a large capital value will have the advantage of offering greater synergies, innovation, transfer of risk and assurance that all centres will be compatible in order to deliver modern multi-modality integrated cancer care.’
“A sixth of the population will require radiation oncology services. This network is the fastest, most cost-effective and most innovative way of building up top quality cancer services at the same time throughout the country.
‘I look forward greatly to its implementation.’
Details of the National Radiotherapy Network
The plan will consist of the four large centres in Dublin, Cork and Galway agreed by Government and scaled to the approximate size identified in the Report on ‘The Development of Radiation Oncology Services in Ireland’ (the Hollywood Report). 23 new linear accelerators will be put in place to bring the total up to 36.
In addition to the four large centres, the Tánaiste also proposes to include satellite centres in Waterford (two linear accelerators integrated with Cork University Hospital) and Limerick (two linear accelerators integrated with University College Hospital Galway), conditional on their conformity to certain quality assurance requirements and on the following basis:
- satellites to be limited to locations which are geographically distant from a large centre but have a population which can support a requirement for a minimum of two linear accelerators;
- satellites to be integrated with one of the four large centres to ensure maintenance of standards, adherence to protocols, etc;
- radiation staff to be employed by large centres (subject to agreement and arrangements where there are pre-existing employment contracts); and
- radiation staff to rotate in and out of large centres to maintain and develop skills and knowledge.
The Tánaiste considers that the best option in terms of improving geographic access for patients in the North-Western Area is to facilitate access for those patients to radiation oncology services as part of North/South co-operation on cancer. The Tánaiste has already raised with the Minister for Health for Northern Ireland the issue of current and future requirements of patients in the North West being considered in tandem with the development of services in Northern Ireland. Following on from these discussions, it was agreed (i) that the issue of access in the short term to the radiation oncology centre at Belfast City Hospital for patients in the North-West will now be progressed at official level (the state of the art facility at Belfast City Hospital is due to open in early 2006) and (ii) to progress consideration of a joint initiative for the provision of oncology services in the medium term to patients in the North West of the island from one satellite centre in the North West linked to Belfast City Hospital.
The Tánaiste intends to ask the HSE and the National Development Finance Agency, as a matter of priority, to develop and progress public private partnership arrangements to design, build, finance, maintain and partially operate (DBFMO) the proposed services at Dublin, Cork (to include a satellite centre at Waterford Regional Hospital) and Galway (to include the upgraded facilities at Limerick, subject to discussions between the Limerick Hospital Trust and the HSE). All clinical staff will continue to be employed under public sector appointments.
There will be an initial increase in capacity in St. Luke’s Hospital to facilitate maintenance and appropriate development of the services in the interim. This will be procured using the traditional approach and will be funded from within the existing CIF for the health sector.
The Tánaiste has decided, based on the advice of the International Panel established to advise on same, that radiation oncology services in the Eastern Region should be located as follows:
- Eastern Region North: Beaumont Hospital (seven linear accelerators); and
- Eastern Region South: St. James’s Hospital (thirteen linear accelerators, including six transferred from St. Luke’s Hospital).
In relation to St. Luke’s Hospital, the Tánaiste and the Government are convinced that it is essential to retain the commitment, expertise, tradition and ethos of St. Luke’s Hospital and its staff as an integral part of the new national network. These are the true assets of St. Luke’s Hospital. Accordingly, the government have agreed to her proposals:
- that the radiation oncology staff and services at St. Luke’s Hospital will re-locate to the St. James’s Hospital facility on a managed and phased basis over the full transition period to 2011 and, in particular, the Chief Executive of St. Luke’s Hospital will lead the management of the facility at St. James’ Hospital;
- that the new facility should incorporate the name ‘St. Luke’s’;
- in recognition that St. Luke’s hospital will be central to the governance of the new facility, to pursue discussions with the Boards of both Hospitals about its governance and a re-configuration of the Boards in advance of 2011, with the twin goals of ensuring continuity of expertise and ethos in the care of cancer patients and the effective integration of multi-disciplinary patient care at the one site;
- to request the HSE to prepare a design brief as a matter of priority for the initial provision of two interim on-site modular (demountable) units on the site of St. Luke’s Hospital with the necessary support services to facilitate maintenance and appropriate development of the service. These linear accelerators represent additional capacity over and above the replacement requirements at St. Luke’s Hospital which will be considered in the context of the Estimates process.
- to request the senior physicist at St. Luke’s to work with the HSE/NDFA in setting the output specifications of the PPP for the national network;
- to ask the current Chairman of St. Luke’s Hospital to chair an implementation oversight group to report to her on progress of the whole network project;
- that the optimum use of the facilities at Highfield Road, Rathgar will be reviewed in the context of revised governance arrangements arising from (iii) above.
The Tánaiste considers that there needs to be extra capacity nationally by 2008, building up on a phased basis to full national capacity by 2011. The precise phasing will be addressed in the output specifications drawn up as part of the PPP process. She is of the view that at a minimum, four extra linear accelerators will be required in the Eastern Region by 2008, in addition to the two being provided through traditional procurement methods in St. Luke’s. Accordingly, she proposes to request the HSE:
- to reflect these requirements and timescales in the output specifications drawn up as part of the PPP process; and
- to report in January 2006 on progress in relation to PPP arrangements and, in particular, its ability to deliver additional capacity in Beaumont and St. James’s Hospitals by 2008 so that she can review the position at that stage.
The Tánaiste proposes that radiation oncology services for public patients will be provided solely within the national network, once fully established.
In line with Government policy of moving towards a full economic charging regime for private patients using public facilities, and in order to avoid unfair competition on price with private sector providers, the Tánaiste will bring forward proposals to Government at a later date for charging private patients for radiation oncology services.
In order to speedily implement this network, the Tánaiste will now:
- direct the HSE to put in place a National Management Mechanism to manage the delivery of this national plan for radiation oncology within the timescales outlined; and
- direct the HSE to develop and implement a National Radiation Oncology Human Resource Plan to support the delivery of the national plan;
- establish an implementation oversight group to report to her on the implementation of this policy for a national network; this group will be chaired by the current Chairman of the Board of St. Luke’s Hospital and would include representatives from the Irish Cancer Society, the Irish Hospice Foundation, the HSE and Department of Health and Children and others.