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Comment: Cancer care promises must be kept
Sunday, September 28, 2008 By Alison O’Connor
I’m dreading the end of September because it heralds the beginning of October.

October - as you probably know, particularly if you are female - is the month that we dedicate to raising awareness of breast cancer. It seems like a bad joke that we are in need of any special reminders of this particular disease.

As someone with a history of the disease in the family, the awful consequences of a diagnosis are always on your mind. But friends with no such baggage assure me they too are almost afraid to turn on the radio or open a newspaper, for fear of what they’ll hear.

This is a subject, however, no matter how many avoidance tactics you employ (believe me I’ve tried), that there is no escaping. You wake to a discussion of it on the radio, it’s splashed across the front pages of the newspapers at the breakfast table. If it’s not being discussed on the morning talk shows, chances are it’ll turn up in the afternoon. After all that, there’s always Prime Time to look forward to, just before bed.

So the prospect of an official four weeks where even the glossy magazines will be devoting spreads to the disease is making my eyes water. You start to think that breast cancer is in the air.

According to John McCormack, chief executive of the Irish Cancer Society, the organisation has been inundated with women seeking reassurance. GPs and doctors involved in specialist clinics will tell you that each new controversy means an influx of concerned women, the vast majority of whom are what the medical profession refer to as the ‘‘worried well’’.

McCormack spoke during the week of specialist nurses spending up to an hour on the society’s helpline trying to help people who got biopsy results that showed they did not have breast cancer, but who no longer trusted the result after what has been revealed about the tragic cases of the late Ann Moriarty and Edel Kelly in Ennis General Hospital.

Those women won’t necessarily be reassured by the interview Professor Brendan Drumm, HSE chief executive, gave on Morning Ireland. He made no bones of the fact that other such cases do exist.

It’s a poor and bitter consolation to the families of the two dead women to realise that the misdiagnosis of their loved ones was the result of ‘‘horrific legacy issues’’ as cancer tsar Professor Tom Keane described it, and the ‘‘sub-optimal way in which we managed our services’’.

This we have to take on trust. It would certainly appear that Keane is doing exactly the job he was brought into do in relation to organising our cancer services. Drumm spoke of the ‘‘great personal commitment’’ of his colleague.

The really frightening thing is that our cancer services - and not just in relation to breast cancer - have been in pretty awful shape in a number of hospitals This was allowed to continue for decades - and even still, there are those who campaign for the retention of the status quo.

Backing up this madness have been politicians, not just local councillors, or even TDs, but also ministers. Not so long ago our current Taoiseach, then minister for health, pretty much sat on his hands when it came to the siting of cancer services in his own constituency. It was a turf war marked by the most unseemly wrangling between politicians, doctors and others which resulted in the splitting of the services between hospitals, against best practice.

How sad that these women treated in Ennis, and others like them, had to die before the point was truly hammered home that our old system was, at best, inefficient and, at worst, killing people.

The knee-jerk reaction to hearing of the rationalisation of health services in your local area is entirely understandable, given, firstly, the desire to have treatment as close to home as possible and, secondly, because it has always appeared as if pigs would fly before the government would actually fulfil whatever promise it made to create a better service elsewhere.

Drumm’s radio interview was remarkable in its honesty about why we’re in this situation and how it is unsustainable to organise healthcare for 4.2 million people across 40 hospital sites. It was astonishing that, out of those 40 sites, he said he could give examples of up to 15 hospitals where there were four doctors for every one patient admitted. The doctors who worked in these hospitals, because they see so few patients, are not getting the experience necessary or able to keep up to date with their skills.

He added that, in these hospitals, the A&Es had a low throughput of patients, there was rarely overnight surgery and perhaps on only two occasions a month were doctors required to ventilate a patient - one of the most complex things that can be done in a hospital.

Drumm made such a good case and inspired such confidence in the changes being undertaken that it made you wonder afterwards if you’d imagined all the cock-ups that we hear about every other day.

Part of the HSE’s overall problem since its inception has been its inability to communicate, be it with TDs who complain constantly about being unable to get answers from the organisation, or with the wider public who believe (accurately) that issues simply don’t get addressed unless a scandal breaks and it’s given saturation coverage in the media.

Drumm has an unenviable task, albeit with a large salary to compensate him, but he must work on improving the public’s trust in what he and his colleagues are attempting to do. By communicating directly, as he did last week, he gets to explain the exact consequences of continuing with the old system.

But if the public’s trust is further abused by promises not being fulfilled concerning alternative services being established and fully operational within the promised time frame, it all becomes pointless.

Back to the dreaded breast cancer. The truth is that there can never really be enough discussion about it, at least not until our centres of excellence are just that, and every woman of an age, regardless of her geographical location, is offered screening through BreastCheck. It’s a whole other irony that BreastCheck is successful, quality assured and has an excellent brand, but it’s only available in certain places.

And, if nothing else, the Irish Cancer Society desperately needs the funds raised to keep its helplines going.

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