Prof Tom Keane's cancer control strategy will focus on prevention and early care, he tells Dr Muiris Houston, Medical Correspondent.
The offices of the National Cancer Control Programme are located in the city's growing Chinatown around Parnell Street in Dublin. Coming from Vancouver, which boasts one of the largest Chinese populations in North America, Tom Keane should feel at home.
But for all this country's new-found multiculturalism, the Republic's first director of cancer control will find our health service has not matured to the same degree. He faces a culture that is suspicious of healthcare reform and one that is complicated by a public/private mix that poses significant challenges to equity and fairness in the delivery of healthcare.
So what vision has Prof Keane brought from one of the world's most egalitarian health systems? "From a patient's perspective, the person needs to see all the clinical personnel who know about your type of cancer and who will diagnose it correctly and ensure that you will get the most appropriate treatment. The difference is between what is happening at a local level and a national programme . . . In British Columbia, the focus is the entire population of the province and the mandate is to provide a cancer-control programme . . . You're talking about a programme that is aimed at people who don't have cancer, people at high risk of cancer, people who have cancer, people who are cured of cancer and people who need ongoing cancer care.
"The patient journey is from the walking well who don't have cancer right through to people receiving palliative care. The entire life history of cancer is being dealt with on a population basis."
HOW WILL HE deal with the inequalities, as illustrated by the Susie Long case, that currently exist in cancer care? "There should be comparable treatments, comparable quality and comparable outcomes - and this will all be monitored: access, quality of care and the outcomes that are being achieved." He intends to bring together all the elements of cancer control, such as the National Cancer Registry and the National Cancer Screening Service, into the National Cancer Control Programme.
And how will he deal with the public/private divide in Irish healthcare? "I believe that patients who access care in a private or a public facility in Ireland should access it at the same standard." But he rules out a direct supervisory role for the cancer-control programme over private hospital facilities, preferring to rely on a licensing system to ensure uniform quality for patients.
What about funding? Following this week's Budget, Minister for Health Mary Harney's spokesman said the €35 million allocated to cancer services represented a 71 per cent increase on the equivalent spending last year. Will this be enough? Perhaps surprisingly, Prof Keane is not sure. Despite his well-flagged arrival - he spent four months here earlier this year - he is still waiting for some hospitals to define their current spending on cancer services. Because he believes the majority of funding for the eight new specialist cancer services already exists within the health system, he is effectively hamstrung until all the acute hospitals tell him how much they are spending on cancer.
"Ultimately, the money will be ring-fenced from the Health Service Executive," he says of the future, but in the short term he doesn't rule out approaching the Minister for some additional funding for 2008. "There are issues around gaps and deficiencies. I plan to get an inventory of what is required . . . In the next three months I will know."
Keane, who reports directly to Prof Brendan Drumm, chief executive of the HSE, did not seek funding guarantees from either Drumm or Harney before he took up his post.
WHAT WILL HE say to those people who have been demonstrating in Sligo and Castlebar in an effort to retain a full range of cancer services locally? "There will be no interaction with the people protesting," he says firmly. Keane will speak to local communities but he is adamant that the cancer-control strategy is not for renegotiation. "I have been asked to implement this strategy and I am not reopening it for further discussion." And the new cancer chief says he has already met with Dr Jimmy Devins, the Minister of State at the Department of Health who has publicly supported the Sligo campaign, and told him, "I don't want to revisit the programme". He diplomatically declines to say how the Sligo TD reacted.
But he does recognise the important of transport when it comes to the realignment of cancer services to eight specialist centres. And he is already in discussions with the Irish Cancer Society (ICS) to see if it might replicate a system operated by its equivalent in British Columbia. "The British Columbia Cancer Society owns a fleet of cars, staffed by volunteer drivers, in what amounts to a taxi service [for cancer patients]," Keane says. "I am exploring what role the ICS could play in transport."
HOWEVER, THE PROVINCIAL government in British Columbia does not provide free transport for patients, although it does subsidise transport costs for particular groups such as the Inuit and other First Nation peoples. So a patient living in the far north of Vancouver Island (roughly the equivalent of a Tory Islander) will fly at their own expense to the cancer centre in Vancouver. They may get financial assistance from the BCCS. "But we try to ensure they make just one trip and to have all appointments pre-booked. In a way they have preference over patients from city areas," Prof Keane says.
While he doesn't see the cancer-control programme becoming a transport agency, he envisages spending money from his budget on patient transport. And what about concerns that the current HSE patient transport policy has regional inconsistencies and is subject to budgetary cutbacks? "The criteria about who gets transport will be well-known and transparent. I would want it to meet a standard."
If there is a significant delay in agreeing and implementing a new hospital consultant contract, how would this affect the development of cancer centres? "It is a deal-breaker if it doesn't progress," Prof Keane says bluntly. Might that mean an abrupt return to Canada? "No, I will not walk away. I recognise there will be bumps on the road but I am here for two years." And he acknowledges there will be industrial relations issues around the redeployment of health professionals, but he hopes the system "will not lose people" as it develops.
Prof Keane decided to come to Ireland for both personal and professional reasons. He is contractually obliged to return to the British Columbia Cancer Agency at the end of 2009. By then, he hopes to have restored confidence in cancer services here by working closely with other oncology professionals. There is no denying his commitment; time will tell whether our notoriously dysfunctional health system will allow him complete the badly needed reforms.