Cancer care

DEDICATED CARE Early detection and intervention can help save lives in cases of cancer.

The politics of health care centres of excellence

DeFacto
Liamy MacNally

Eleven million people will die from cancer throughout the world this year. It is the greatest killer of our generation. Billions of euro, dollars and every other denomination are spent on research to find a cure.
While HIV/AIDS might grab the headlines, the silent killer lurking in the bodies of one in four of the people who read this article is cancer. In the hierarchy of diseases cancer is not ‘new’. It is not media friendly and does not have the ‘celebrity status’ that HIV/AIDS attracts. Such an acute problem coupled with such great resources still cannot find a cure. Numbers increase every day. In 2005 22,800 new cases of cancer were diagnosed in Ireland. Similar figures are expected for last year and this year. 
THE CURRENT CRISIS
The emerging difficulties at Barrington’s Hospital and in Portlaoise signal the start. Other cases will follow. One only hopes and prays that what will unfold will not be a tide of disaffection and dissatisfaction. One wrong diagnosis is one too many. The difficulty for health managers in the Department and in the HSE is trying to make clear and sensible decisions in the midst of the fog of a crisis. The more knee-jerk will be the reaction if the crisis deepens. Major decisions made during a crisis do not usually reflect best practice. Just as sudden prayers make God jump, so too will quick solutions have an adverse, long-term effect on people who are ill. ‘Arrest the usual suspects’ is not the philosophy to be adopted.
The crisis has given those who are in positions of power an ideal time to state things that sound unpalatable. Every day since the crisis broke we have heard calls for ‘major centres of excellence’ to be established. While that may well be the solution, one wonders when this solution emerged. Centres of excellence are seen as best practice internationally and have been so for years. It has not been the practice in Ireland. Report after report has stated that this is the way forward yet the recommendations from any of these reports have not been implemented because of politics. The politics of fear rules over the politics of care. With the publication of the O’Higgins Report seven years ago came a deluge of political fallout. Professor Niall O’Higgins suggested 12 centres for cancer treatment throughout the country. University College Hospital in Galway would serve Mayo. That idea was replicated throughout the country. We were not having it and neither was any other county with a hospital that was left in the wings. People wanted local treatment centres. Arguments were made that people who already have cancer do not need the added stress of travelling to a centre of excellence that might be up to 150 miles away. It was a fair argument and it won the day. The politicians buckled and the reports receded into the distance of dust-gathering tomes on a bookshelf. 
CENTRES OF EXCELLENCE
The centre of excellence argument is back on the agenda thanks to the emergence of a crisis. The dust has been blown back and the reports are, once again, seeing the light of day. This time is more opportune for politicians because the election is firmly at their backs. Hard decisions are made easier in the slipstream of an election. While they will glean praise for making ‘hard decisions’ it will soon emerge that such decisions made in isolation are useless. Centres of excellence can, and will, work only if the necessary supporting health infrastructure is in place, and it is not.  The ongoing Patient Transport fiasco is one example. Such centres only work as centres of excellence if such supports are in place. While there is proof that survival rates can be improved by more than 20 per cent if centres of excellence are implemented, the support structures need to be in place. It begs the questions why the Government never made this a convincing argument previously. Healthcare has been reduced to a political football by inept people masquerading as politicians who care.
Unfortunately, for those affected by cancer, especially women with breast cancer, other major issues will probably get lost in the whirlwind of solution-seeking, headline-grabbing politicians. The mass media will get caught up in this maelstrom, only delaying the debate on all the relevant issues. 
PATIENT VOICES
While politicians seek again to ascertain their dominance in decision-making, other voices must be allowed to speak, especially those who have been ignored over the years. While politicians, departmental and HSE officials have remained silent over the years while services buckled, the voices of those who have suffered on the frontline will have to be heard. In the sphere of cancer, women’s voices are to the fore and must be listened to. One has only to think about Breast Check to see how women have been betrayed by successive governments and health administrations.
The inequality we have experienced in infrastructural provision has been matched by inequalities in health services infrastructure.  For Celtic Tiger Ireland to admit that a citizen on the east coast has a better chance of surviving cancer than a person on the west coast is criminal. It is touching on treason because it betrays the State’s greatest asset, its citizens. Successive governments and health officials stood idly by while Breast Check and other health services were not rolled out. Rolling out various health programmes has been the catch cry of the HSE for years. Promises, promises! Breast Check is still not fully implemented. 
PROSTATE CANCER
Breast cancer is the most ‘public’ of cancers and is top in the cancer hierarchy. There are other cancers, including prostate cancer in men. Just as there is no cervical cancer screening service for women in the country or no breast screening for women in the northwest, there is no prostate screening for men anywhere in the country. Around 500 men die from prostate cancer annually. Add to this the lack of colon screening, which many medics say is a requirement for anyone over 50. This dearth of screening services is the fruit of ineffective and worthless health care management.
Put this alongside the unwillingness of the Health Minister to answer Dáil questions on health issues (she refers them all to the HSE) and the current cap on HSE recruitment and it only makes the already ridiculous scenario even more laughable, except that it is not funny. And for one reason, such ineptitude means more people will suffer longer. All of this short-term thinking means that health costs more in the long run because people are not receiving the care when they need it most, at the start of their illness.
Then we have the difference between the public and private patient. The east-west principle applies. The private patient equates with the east while the public patient equates with the west, the ones with less chance of survival and longer waiting times.  If the current review of the Constitution reflects the reality of life in this country, it would record the differences between east and west, between public and private, and declare that George Orwell is right, some people are more equal than others.