Address by Minister Micheál Martin, T.D., at the publication of the Report on the Development of Radiation Oncology Services in Ireland
Ladies and Gentlemen, I am very pleased this morning to officially publish the Report on the Development of Radiation Oncology Services in Ireland. The Government has accepted the recommendations of this Report. The development of radiation oncology services on the lines recommended in this Report is the single most important priority in cancer services in the acute setting.
Firstly I would like to acknowledge the dedicated work of the Expert Group and in particular its Chairman, Professor Donal Hollywood. I wish to acknowledge his leadership and commitment and that of the Group and to express my appreciation and that of the Government for their efforts. The Report is a most authoritative analysis of radiation oncology and provides a detailed plan for the future development of radiation oncology services nationally.
I am pleased to welcome Professor Paddy Johnston here this morning and to acknowledge his role in the development of radiation oncology on the island. Professor Johnston is Consultant Medical Oncologist at Belfast City Hospital and has played a key role in the restructuring of radiation oncology services in Northern Ireland. Radiation oncology services at a stand alone centre will be transferred to the site of Belfast City Hospital, a major academic teaching hospital.
Cancer is the most frequent cause of premature death in Ireland and approximately 7,400 cancer deaths occur annually.
- 19,000 new cancer cases are recorded annually and one in three individuals develop cancer in their lifetime.
- As our population is aging it is expected that about 7,500 to 8,000 new cases of cancer will occur up to 2015.
- Excluding non-melanoma skin cancer, the number of cases will rise by approximately 5,000 in that period.
- In addition, important advances in clinical radiation oncology require patients to have rapid access to pre-operative radiation therapy. Like all cutting edge technologies, further advances will become part of routine clinical practice in the near future.
Response to the Report
Professor Hollywood has outlined in his presentation the significant deficit that currently exists in relation to meetingthe radiation oncology needs of cancer patients. The provision of radiotherapy requires significant medical, scientific and support expertise and resources, in addition to extensive capital investment. That is the reason I established the Expert Group to ensure that we effectively plan the current and future development of this element of cancer care.
The Report also recognises that major developments have taken place in recent years in Dublin, Cork and Galway.
- St. Luke´s Hospital has seen considerable renovation and upgrading. In excess of €25million has been invested in St. Luke´s, enabling the purchase of significant additional equipment including six new linear accelerators.
- Almost €15 million has been invested in Phase 1 of a substantial new building project development at Cork University Hospital for Radiation Oncology Services which was completed in 2002. This involved the commissioning of two new linear accelerators as well as other equipment.
- A new Radiotherapy Department is currently being commissioned at University College Hospital Galway. This centre will provide services to the Western, Mid-Western and North-Western areas. In excess of €100 million has been allocated to this project which is shortly due for completion.
The Government has considered the Report. The Government agrees that a major programme is now required to rapidly develop clinical radiation oncology treatment services to modern standards.
Furthermore, the Government has agreed that the first phase of such a new programme should be the development of a clinical network of large centres in Dublin, Cork and Galway. These centres will collectively have the staff and treatment infrastructure to permit a rapid increase in patient access to appropriate radiation therapy and will form the ´backbone´ of the future service expansion.
I agree with the Report’s conclusion that this is the best model to rapidly provide a radiation oncology service. The rationale for this initial programme is as follows:
- It best provides a structure and service model that will enable the rapid development of radiation oncology
- It best supports the development of new radiation treatment technologies
- It best supports the development of multi-disciplinary teams and the integration of radiation oncology with other modalities of care such as surgery and medical oncology.
If appropriate radiation oncology services are not available, then outcomes for cancer patients may be compromised. That is why I am now setting out a detailed programme of development and investment in these services.
Short-term capacity expansion
In the short term, I have approved the purchase of two additional linear accelerators for the Cork centre and the necessary capital investment amounting to €4m to commission this service as rapidly as possible.
I also intend to prioritise the necessary resources to ensure that the radiation oncology centre in Galway is in a position to treat patients, commencing in Spring 2005.
We currently have 8 linear accelerators nationally. These developments in Cork and Galway will provide an additional 5 linear accelerators. This is a significant increase that will ensure when fully developed that an additional 2,000 patients are treated per year. Five additional Consultant Radiation Oncologists will be employed in the provision of these services. These Consultants will provide outreach services to neighbouring counties in the North-West, South-East and the Mid-West.
Medium Term Capacity Expansion
The development control plan for Cork University Hospital provides for the expansion of existing capacity from four to eight linear accelerators. I have now approved the appointment of a project team to prepare a brief for the rapid expansion of current capacity.
I have also requested the Western Health Board to prepare a development control plan for UCHG to cater for expansion from three to six linear accelerators in the medium term. I will also give early approval to the establishment of a project team to plan for this expansion.
The Report recommends that there should be two treatment centres located in the Eastern region, one serving the southern part of the region and adjacent catchment areas and one serving the northern part of the region and adjacent catchment areas.
The Report states that is has not been possible to identify the precise locations for proposed expansion in the Eastern Region. The Group did not consider that it was feasible for it to undertake the detailed comparison and assessment of individual sites that would enable an authoritative and detailed analysis of optimal hospital locations.
I have now asked my Department´s Chief Medical Officer to advise me of the preferred hospital site on which a radiation treatment facility (with 8/9 linear accelerators as recommended in the Report) should be located in north Dublin. This facility will also deliver services to the North Eastern and North Western regions. This decision will be taken in light of the guidelines set out in the Report which include such criteria as sufficient patient population, maximum patient access, availability of existing related clinical specialties and support services.
In determining his preferred choice, Dr. Kiely will apply the guidelines established by the Group. He will request interested hospitals in the region to submit their case to him as to why radiation oncology should be sited at their hospital. Based on the advice from the Chief Medical Officer, who will be supported by my Department´s Hospital Planning Office, I will decide on the location of the services.
I wouldn’t underestimate the work required by hospitals to engage in this process and indeed some will require external assistance, especially in relation to location and site options. While I have applied a tight deadline to this process, it is only reasonable that they be given adequate time to put forward their submissions, given the importance of this decision for the hospitals involved. I have set a deadline of February next year for a decision. As soon as the site is selected, I will request the hospital to establish a project team to prepare a detailed design brief for the new services.
The timescales for the planning, design, construction and commissioning of radiation oncology treatment centres are significant. The fast track approach which I will be adopting will take 18 months to design and plan, 2 years to construct and a further year to commission these highly specialised facilities and equipment.
These developments will be a major priority within my Department’s overall capital framework for 2004 onwards.
I have outlined here this morning the first phase in the development of the backbone of radiation oncology services located at university teaching centres in Dublin, Cork and Galway, providing a truly national service. I have also outlined the requirements on these centres to continue to develop services for cancer patients in neighbouring counties.
In addition, the Government has also decided that in the further development of services, consideration should be given to developing satellite centres at Waterford, Limerick and the North-West. The Report also refers to further consideration of satellite facilities. Such consideration will take into account the international evaluation of satellite centres, the efficacy of providing this model and the need to ensure quality standards of care.
St. Luke´s Hospital
The Group accepts that St. Luke´s Hospital does not meet all of the guidelines it has established for a future radiation oncology centre. The Group considers that there are two options for St. Luke´s : either it extends to provide the extensive surgical and medical services or its radiation oncology services are transferred on a phased basis to a major teaching hospital on the South side that has all of the relevant medical and surgical services recommended by the Group.
For my part, I have always regarded St. Luke´s as more than a health care institution. It has set the standards in radiation oncology; its expertise is and will remain at the forefront in the development of radiation oncology service into the future. Its staff were key players in developing this Report. This decision will be taken following consultation with key authorities, including the Board and staff of St. Luke´s Hospital and I will be meeting them shortly to discuss the Report and to assure the Board that the ethos and strengths of St. Luke´s must remain as key drivers nationally. How best to ensure this happens will be a key objective of mine. In the meantime, I am fully committed to ensuring that the excellent standards of care at St. Luke´s continue to be supported.
Professor Hollywood earlier referred to the patient study´s findings in which distance to travel for treatment was ranked thirteenth in order of importance. Highest level of patient care was considered to be the most important aspect of service. I see this study as significant in that it challenges from the user’s perspective what is often presented as the three most important aspects to the organisation of service. These are, of course, location, location, location! I fully endorse the Report’s findings that equity of access to the highest quality radiation oncology facilities is a right of all cancer patients.
Equal access for equal need
In developing this supra regional model, I will require radiation oncology centres to provide services on an equitable basis which will ensure that patients of equal need will have equal access. Geography will not be a barrier to equal access. Proximity to a centre, while clearly a benefit in terms of convenience for local patients, will not be a deciding factor in providing services.
I will also require radiation oncology centres at major teaching hospitals to provide outreach services to hospitals in adjoining regions. This is currently the case and as more radiation oncologists are appointed it will be necessary to ensure that there is an equitable spread of outreach services. I will establish measures to ensure that radiation oncology centres operate in practice in accordance with these principles.
National Radiation Oncology Co-ordinating Group (NROCG)
I am now establishing a National Radiation Oncology Co-ordinating Group. It is my intention to develop a national integrated network of radiation oncology. The twin objectives of equitable access regardless of location and an effective national quality assurance programme need to be supported by a co-ordinating mechanism. This is recommended in the Report.
The Group will comprise clinical, technical, managerial, academic and nursing expertise from different geographic regions. I am delighted that Professor Hollywood has accepted my invitation to chair this Group. I will ask the Group to advise on the improved access to existing services and those coming on stream in Galway and Cork. It will also have a co-ordination role in the teaching and training of expert staff in radiation oncology centres.
I welcome this Report. It marks a significant milestone in radiation oncology services nationally and its guidelines and recommendations are essential in the development of these services for cancer patients over the next number of years. Once again, I would like to extend my thanks to Professor Hollywood and his Expert Group.