There is a crisis of confidence affecting breast cancer services in the State. Inquiries into treatment practices at Barringtons' Hospital in Limerick and a review of thousands of mammograms and breast ultrasounds at the Midlands Regional Hospital, Portlaoise have understandably led to widespread public concern.
Starting with the case of Rebecca O'Malley in Cork earlier this year, a series of misdiagnoses and questionable treatment practices has led to a real fear about the quality and safety of our health service. It is clear from international experience and research that patients with breast cancer are at least 20 per cent more likely to survive if they are treated in specialist centres operating to best practice guidelines. This means that the 2,700 women on the island of Ireland diagnosed with breast cancer annually must be treated in larger centres dealing with at least 150 patients each year; in addition, these specialist centres must operate a multidisciplinary model of care based on a triple assessment of the patient.
Such centres were first proposed for the Republic in 2000 by breast cancer expert, Prof Niall O'Higgins; while progress has been made on some of his recommendations, the National Quality Assurance Group for Symptomatic Breast Disease Services concluded earlier this year that "the nomination and designation of centres should be announced without further delay and resources allocated immediately to support each centre". Some four months later, the Health Service Executive (HSE) has announced that a decision on the location of specialist breast centres will be made public in two weeks' time. Given the inexcusable delay on this issue, the public can be forgiven for questioning this promise. For the sake of its own credibility, the HSE must not give in to pressure to fudge the decision.
Senior managers appealed last week to be allowed to manage the health service, a reference to the many vested interests attempting to influence decisions on health care delivery. But they themselves must show leadership and take responsibility for changing the system to make it more effective and safer for patients. Healthcare begins and ends with the patient.
However, it would be a mistake to assume that a decision on the location of the eight specialist breast cancer centres was the end of the matter. Cancer patients living remote from a centre of excellence must have their need for rest, dignity and family support addressed in a holistic manner; clinical activity in the private health system must be subject to the same scrutiny by the Health Information and Quality Authority as the public sector; and the lessons learned from the breast disease controversy applied to all other common cancers. Finally, we must acknowledge the important role of the whistleblower in bringing recent substandard practice to light and ask: are the appropriate processes and structures in place to allow the voices of concerned health professionals to be heard.