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Cancer service improvements

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Written by Paul Mulholland Friday, 05 March 2010 14:59

The Health Information and Quality Authority (HIQA) recently published a comprehensive review into the symptomatic breast disease services in the eight designated cancer centres.
The Report of the National Quality Review of Symptomatic Breast Disease Services in Ireland found that fundamental requirements for safe care and treatment of breast cancer are now in place in all the eight centres.

It states that all the centres have clear arrangements in place for multidisciplinary care for patients.

“There is no doubt that in the past and certainly in past investigations that the Authority has done into symptomatic breast disease, such as the Rebecca O’Malley investigation, the absence of appropriate multidisciplinary review and triple assessment was cited as a significant factor in those misdiagnosis stories,” HIQA’s Director of Healthcare Quality and Safety, Mr Jon Billings told IMN.

“And the fact that that is now in place everywhere, I think we would say, is probably the most significant step forward.”
Mr Billings said that improvements in the provision of multidisciplinary care has taken place alongside better governance arrangements and the gathering of more robust data to measure performance.

“Those things taken together give you a much more stable and reliable basis than before for providing a service,” he said.
However, the report also found issues surrounding access to services in the first half of last year.
Urgent referrals should be seen within 10 days, according to the current standards.

Yet, the report shows that four of the cancer centres  were not meeting this target for urgent referrals from January to August 2009.
However, the Authority found that in late 2009, at the time of the on-site review, all centres demonstrated that they were meeting this standard.

With regard to non-urgent referrals, the HIQA standards state that early referrals should be seen within six weeks and that routine referrals should be seen within 12 weeks.

The report shows that  seven of the eight centres (except for Waterford Regional Hospital) were not meeting the six-week target and that six out of eight centres (Beaumont Hospital, Dublin, and Cork University Hospital (CUH) were the exception) were failing to meet the 12-week target.

“Access targets are there to ensure that patients, urgent and non-urgent are treated in a timely manner,” Fine Gael health spokesperson Dr James Reilly said in a statement on the report.
“If patients cannot obtain timely access the consequences could be fatal.”

The National Cancer Control Programme (NCCP) says that improvements have occurred since the HIQA review was conducted. Figures published in December by the Programme show that nationally, the target was exceeded – with 96 per cent of non-urgent cases now being seen within a 12-week period in comparison to June when 80 per cent of these patients were seen within the timeframe.

The target is also being exceeded regarding urgent referrals, with 98 per cent of women now being seen within the two-week timeframe.
Mr Billings also remarked that by the end of last year, the centres were meeting the standards.

“A number of centres have had challenges in meeting access standards at one point or another during last year,” he said.
“And some of the centres, and I think Waterford is an example, were still getting people in … and bringing their capacity up to where it needed to be but that has been relatively recently. I think the important thing, from what we observed anyway, was that centres were monitoring their performance in this area and were able to identify when they were dipping below the standards and put remedial arrangements in place such as additional clinics or whatever.”

The review also points out that four centres – the Mater, Dublin; Mid Western Regional Hospital (MWRH), Limerick; St James’s Hospital, Dublin and  St Vincent’s University Hospital, Dublin – were not meeting the 20 day standard for patients who required surgery.

The Mater only had a 50 per cent compliance rate (the target was 90 per cent). The report noted that at the time of the review that the locum consultant surgeon did not have a formal theatre access time and the SBD service had no ring-fenced surgical inpatient beds available.

Other areas that HIQA examines in the report are clinical governance, and data collection and management. While all centres had governance and information systems in place, some centres were at different stages than others. As a result, the Authority will be conducting further on-site reviews during 2010 in CUH; MWRH, Limerick; and Waterford, which were at an early stage of development regarding the systems when the review took place.

“There was a need to get standardisation of data collection and data management,” Mr Billings said.

“Some of the centres didn’t have the infrastructure for gathering data, they didn’t haven’t the actual IT to do this in the recent past. They are now getting all those things in. So although the eights centres as a whole are being brought up to a level, there is no doubt for some of them it is somewhat of a more recent development. And, therefore, there is a spectrum of maturity in terms of data management between long-established centres, which have had data management systems for many years  and those which have only recently gone into that area. We have highlighted this in the report and made recommendations that the NCCP and the HSE in general need to keep an eye on making sure that centres that are particularly new at that aspect of providing the service, continue to develop and get support where they need to.”

Again, progress has been made recently on this issue, according to the NCCP. Each of the three affected centres was provided with new data management systems in the second half of 2009. The Programme states that HIQA would not have been in a position to fully evaluate those systems at the time of their audit.

Mr Billings says that the NCCP has succeeded in building the foundations of a modern cancer service, in line with best international practice, across the eight centres. The emphasis in 2010 should be on achieving greater integration between the centres and further improvements in service delivery. The report states there needs to be greater cohesion between designated centres, more sharing of good practice and a clear programme to harmonise clinical practice and performance monitoring including reviewing delayed diagnoses and in the longer term, survival outcomes for patients.

“Some of the centres, particularly those that have been recently dealing with significant service transition, need to be kept under evaluation and supported to ensure that the benefits are sustainable,” Mr Billings concluded.
“Nationally, the NCCP needs to move on to focus more on deriving the national benefits from having a national service rather than the local benefits of having eight centres.”

Interim Director of the NCCP, Mr Tony O’Brien, welcomed the publication of the report.
“The report forms a core part of the work of the Programme over the next year,” Mr O’Brien told IMN. “Work will continue in 2010 to ensure that standard operating procedures and proper governance arrangements are being adhered to in line with the recommendations.

What constitutes professional misconduct?

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Written by Mr Tom Hayes Tuesday, 02 March 2010 12:28

There is an understandable fear amongst many medical practitioners of being subject to a formal complaint and investigation by the Medical Council. Under the Medical Practitioners Act 2007, the Medical Council regulates the conduct of medical practitioners by acting as a quasi-judicial statutory body to which all complaints can be made.

Whatever happened to hospital co-location?

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Written by Priscilla Lynch Friday, 19 February 2010 15:29

In the latest article in the Whatever happened? series, where we examine high profile health-related projects, reports and schemes which have stalled or been abandoned in recent years, Priscilla Lynch and Paul Mulholland examine the controversial co-location hospitals initiative

Legislating against ‘legal highs’

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Written by Lloyd Mudiwa Monday, 15 February 2010 12:34

The Department of Health has finally moved to reassure the public that it is working to introduce regulations to outlaw a range of products sold as “legal highs/herbal highs” in “head shops” across the State amid growing public concern and burgeoning media coverage about their health risks.