Speeches

Address by Mr Micheál Martin, T.D., Minister for Health and Children on the launch of the Clinical Guidelines for two Cancers

Introduction

Ladies and Gentlemen,

I am very pleased to join you this afternoon to launch the clinical guidelines for breast and melanoma cancers. I would like to thank the management of the hospital and the Southern Health Board for inviting me here.

Guidelines

The guidelines being launched here for the treatment of specific cancers were developed under the leadership of Prof Redmond as Regional Cancer Director. They are the culmination of four years of hard work involving Cork University Hospital, the Mercy University Hospital and the South Infirmary/Victoria Hospital. The production of these guidelines is the output of clinical co-operation involving the three principal public hospitals. The achievement would not be possible but for the significant work of Doctors Eamon Rogers and Micheál O´Riordán at the Mercy University Hospital and Doctors John Kelly and Sean T O´Sullivan at the South Infirmary/Victoria Hospital.

Clinical guidelines provide systematically developed statements to assist decision making about appropriate health care in specific clinical circumstances. Guidelines help ensure consistency in the quality of care received by the patients. Clinical guidelines also promote effective interventions that have the potential to reduce morbidity and mortality. They offer explicit guidance for clinicians about how to proceed. They also reinforce the importance and methods of critical appraisal and call attention to ineffective practices.

Clinical guidelines are especially important in multi-modal management that cancer patients now require. They have a major role to play in delivering a quality healthcare system. The city-wide, multi-disciplinary approach to the development of these guidelines is an example of the process required in a modern quality health service. The development of these guidelines also demonstrates the commitment of those involved to continually update their practices and to share the information as widely as possible. The Guidelines will further enhance the service available to patients with a cancer diagnosis in the areas of breast and malignant melanoma.

Cancer

Cancer is a major challenge to our health service: one in three individuals will develop cancer in the course of their lifetime; each year in this country more than 21,000 people will develop cancer and almost 8,000 people will die from the disease. While cancer can affect all ages, it is most prevalent in the over -65s. The significance of this is heightened by the fact that ours is an ageing population. The impact and cost of the disease on our society is enormous and the increasing incidence of cancer will continue to impose considerable pressure on our healthcare systems over the coming years.

We are constantly striving to improve the quality of care and the outcome for cancer patients. The control of cancer can only be effective if care is planned and delivered in a systematic and integrated manner. The key elements of an effective cancer control strategy are prevention, screening (where appropriate), early detection, diagnosis, treatment and of course rehabilitation and support.

Cancer Strategy

The 1996 National Cancer Strategy has led to substantial investment in cancer treatment services and significant improvements in the organisation and delivery of the services.

The Strategy provided for an integrated hierarchy of specialist services involving primary care, regional and supra-regional hospitals. Best practice suggests that effective and efficient cancer services require the input of multi-disciplinary teams. International research has consistently demonstrated that better outcomes are achieved in larger centres through the centralisation of resources, skills and expertise, facilitated by a critical mass of patients. The development of clinical guidelines will help to standardise best practice in the area, resulting in a more patient centred approach to cancer treatment.

Revenue Funding

This Government has shown its commitment by significantly increasing the level of investment provided. Since 1997, there has been an additional cumulative investment of more than €550 million in cancer services nationally. In the Southern Health Board region there has been a cumulative additional investment of more than €57 million in cancer services during the same period.

The benefit of this investment can be seen in a number of areas including approval for the appointment of an additional 10 consultants by the Southern Health Board. These appointments include 2 Consultant Oncologists, 3 Histopathologists, a Radiologist, 2 Radiation Oncologists, a Haematologist and a Surgeon with a special interest in breast disease.

Since 1997, approximately €95 million euro in capital funding has been allocated specifically for the development of cancer related initiatives including €60 million for Radiation Oncology.

Symptomatic Breast Disease

The development of two centres of excellence for symptomatic breast disease here in Cork city, in line with the recommendations in the report on the Development of Services for Symptomatic Breast Disease, is at an advanced stage. Breast cancers make up a high proportion of all cancer in younger women and the majority of women will continue to be treated by the symptomatic service.

New Cancer Strategy

The National Cancer Strategy 2004 is currently being developed by the National Cancer Forum under the chairmanship of Professor Paul Redmond. This strategy will build on the progress already made and will set out key investment areas to be targeted in the coming years. Significant progress has been made under Paul’s leadership and I know that he is as anxious as I am to have the work completed over the coming months. I understand that the Forum is examining a framework for evidence-based practice in cancer control nationally. The objective is to have a process and structure in place that will enable evidence-based guidelines to be developed, implemented, updated and adapted for cancer control nationally.

Radiotherapy Services

Following the publication of the Report on the Development of Radiation Oncology, I announced a development and investment programme for radiation oncology services nationally. I have approved the purchase of two additional linear accelerators for the radiotherapy unit here at Cork University Hospital and I have provided the necessary capital investment of €4 million. I have also approved the appointment of a project team to prepare a brief for the expansion of capacity here from four to eight linear accelerators. The improved service will commence early next year. I wish to acknowledge the significant effort of clinical, nursing, management and technical services staff in delivering so effectively on this much needed development in radiotherapy.

Two new posts of radiation oncologists have now been approved by Comhairle, the second post was approved this week at a Comhairle board meeting. This was achieved following significant efforts by staff here, in Comhairle and in my Department. I am asking the Board here and in the West and Mid-West to continue the momentum and to recruit the additional four radiation oncologists as soon as possible.

BreastCheck

BreastCheck, provides screening services to women in the 50 to 64 age group. It has achieved considerable success since its launch in the Eastern and Midland regions four years ago. Last year, I announced the national expansion of the programme to cover the Western and Southern regions. As many of you may be aware, the Clinical unit for the Southern region will be at the South Infirmary/Victoria hospital with 3 associated mobile units covering the counties of Cork, Kerry, Limerick, Tipperary South Riding and Waterford. BreastCheck and the hospital are now preparing a detailed brief in relation to this development. The service will provide breast screening for more that 70,000 women in the southern region. The necessary capital resources – €9 million – to progress this project are being discussed by my Department and the Department of Finance in the context of the capital investment framework over the next four years. This deliberation should be completed shortly.

Conclusion

I would like again to acknowledge the dedication of the staff in the three hospitals involved in the production of these guidelines. The development of the clinical guidelines will assist all the staff here in their efforts to provide the best possible service to cancer patients in the city. I am especially pleased to launch the guidelines as a model for inter hospital collaboration that serves as a model for other parts of the country.