Local politics and the desire to have all services in all hospitals is compromising the most effective delivery of regional cancer care, an independent report has found.
The report, from Deloitte & Touche, published yesterday, found the development of services had not been in line with current policy which indicates that cancer services should be provided by multi-disciplinary teams in regional centres of excellence.
It said cancer-related surgery was being undertaken by general surgeons "who perhaps perform only small numbers of similar operations on an annual basis" in many health board areas.
This was not monitored to any degree, despite the fact that "a minimum or adequate patient caseload is required to maintain standards of quality care".
Speaking at the publication of the report, which evaluates the success of the National Cancer Strategy of 1996, the Minister for Health, Mr Martin, said: "We must face the reality that we cannot continue to expect that we can deliver the highest quality of cancer services across over 30 acute hospitals."
Asked if this indicated local hospitals would lose cancer services, in addition to A&E in line with recommendations in the Hanly report, Mr Martin said the international evidence was that better clinical outcomes were achieved in hospitals with specialist staff, high volumes of activity and access to appropriate diagnostic and therapeutic facilities.
"Best results in treatment are achieved where patients are treated by staff working as part of an integrated multidisciplinary specialist team. I am convinced that this core principle must inform the current organisation of services and how we plan future services across the various modalities of cancer care."
The overall objective of the 1996 strategy, which is now being updated, was to reduce the death rate from cancer in the under-65 age group by 15 per cent in the 10-year period from 1994. This was achieved in 2001, three years ahead of target, the report found.
While the report noted many improvements in the service, including the appointment of more than 80 extra consultants and 245 clinical nursing staff to treat patients with cancer, it also found key gaps.
It found waiting times for radiotherapy were in excess of clinically acceptable parameters and there was evidence all patients who needed radiotherapy were not getting it.
The service should be expanded so that all patients have equal access, it said.
However, in terms of expansion, it agreed with the recently published Hollywood report on radiotherapy services that the treatment should be provided from a small number of centres only.
There should be transfer protocols in place to facilitate patients accessing these services, it added.