Cancer centre fails 36 out of 48 national standards

AN UNPUBLISHED report into services at one of the designated “centres of excellence” for breast cancer has found it is failing to meet 36 of 48 national standards.

The assessment of Waterford Regional Hospital, which is the centre for the entire south-eastern region, was carried out by the statutory Health Information and Quality Authority on October 2nd, at about the same time patients from three other hospitals in the region were transferred to Waterford. The authority benchmarked Waterford Regional against the national quality assurance standards for breast cancer treatment. The standards – referring to facilities and organisation rather than the abilities of individual medical staff – are intended to define “the features of a wellfunctioning specialist breast disease centre”. The hospital was found to be meeting just eight of the 48 criteria, with four uncertain.

Of the six criteria used to measure the delivery of breast cancer surgery, not one was being met. There was no evidence that each consultant was treating between 50 and 150 new patients a year – a central aim of the whole “centres of excellence” strategy. While 95 per cent of biopsies are supposed to be “image-guided”, Waterford Regional did not have the necessary scanning device.

The standard that 95 per cent of patients should be given a date for their operations within three weeks was not being met. In the field of radiology, four of the five benchmarks were not being reached. The hospital was failing in the central aim of ensuring that each radiographer performed at least 20 mammograms a week. In radiation oncology, Waterford Regional was found to be failing on all seven of listed criteria.

It is clear from the report that many of these failures are connected to a lack of resources. Instead of two specialist breast cancer surgeons, the hospital had one, with another shared with other duties. There were no ringfenced beds for breast cancer patients. The hospital was unable to guarantee an appointment within two weeks to a patient urgently referred by a GP. These findings are likely to raise fundamental questions about the implementation of the “centres of excellence” strategy. Waterford Regional is not thought to be significantly worse than the other seven centres. The core of the strategy, which has been championed by Minister for Health Mary Harney and overseen by Prof Tom Keane, is the idea that the eight designated centres will deliver a world-class integrated system of treatment.

A spokesman for the Health Information and Quality Authority said yesterday: “The authority is currently working with the National Cancer Control Programme whose role it is to implement the standards and to ensure that ongoing progress is being made by each centre to address any identified gaps, in order to be deemed fit for purpose and compliant with the standards prior to becoming specialist centres before the end of 2009.”