Warning that cancer funding move would put services at risk

Senior management in the HSE sought to remove more than €7 million in funding from the National Cancer Control Programme earlier this year and re-direct it to hospitals.

The proposed move led Dr Susan O’Reilly, national director of the National Cancer Control Programme, to warn HSE director general designate Tony O’Brien that the funding move would “seriously” compromise the delivery of cancer services and the development role of the programme.

The funding had been provided to hospitals by the National Cancer Control Programme in 2012 on a one-off basis to pay for a number of initiatives.

For this year, however, it wanted to allocate the money to several of its own priority projects but found that senior HSE management had planned to transfer the funding on a recurring basis to the hospitals.

Details of the dispute over the cancer funding are in official documents relating to the HSE budget this year, which have just been released.

Dr O’Reilly argued that as a result of the proposed move, some non-designated cancer hospitals “will now receive significant additional recurring funds which are unrelated to ongoing cancer priorities”.

"As a consequence, some designated cancer centres will still expect additional funding for agreed cancer priorities for which funding will no longer be available. I believe that this approach undermines the approach of the National Cancer Control Strategy."

Many projects affected
Dr O'Reilly said that among the funds proposed to be transferred to hospitals was more than €3 million which had been earmarked by the National Cancer Screening Service for the cervical-check and colposcopy services this year. Also included was more than €2.1 million which it wanted to spend on its colorectal and diabetic programmes in 2013.

She said the HSE wanted to divert €750,000 from the budget of the St Luke’s Radiation Oncology Network to hospitals.

She said this money was required to fund the opening of an additional two linear accelerators (high-tech equipment for delivering radiation oncology services) in Dublin later this year.

“It had also been proposed to use €220,000 of this funding to support the Treatment Abroad Service to fund intracranial stereotactic radio-surgery in Beacon [Hospital] prior to the commissioning of the service in Dublin.”

Dr O'Reilly said other projects that could be affected by the HSE move included a €500,000 allocation to the Irish Cancer Society to pay for a travel scheme established when cancer services were centralised in eight centres around the State.

Other funding was to go towards appointing a new oncologist in Beaumont and the Dublin north-east region.

In her memo to Mr O’Brien, Dr O’Reilly said the inability to fund this position would lead to significant delays for cancer patients requiring chemotherapy in this area.

Other funding, under threat by the HSE plan, was to have been used to pay for a new consultant post specialising in onco-plastics in Cork which would support reconstructive surgery for patients following cancer treatment.

At the end of March the HSE changed tack and Mr O’Brien set out an interim and long-term solution to ensure that cancer funds were used “to support agreed national priorities”.

He directed that the hospitals which were normally funded for colposcopy by the National Cancer Screening Service were to be told that the additional money that had been allocated to their base funding for this year was effectively to be seen as a pre-payment for the work they would do in 2013. No further money would be made available to them this year and the money would revert to the National Cancer Screening Service in 2014.

Phased funding cut
A similar approach was to be taken in relation to colonoscopy funding with hospitals to be advised that the additional money in their allocation was to be considered as an advanced payment.

Mr O’Brien said that hospitals would receive only an additional fee-per-item payment once they had carried out work equating to the funding already provided to them.

He said the HSE corporately would allocate €500,000 to meet the cost of the service level agreement reached with the Irish Cancer Society for 2013 but that the National Cancer Control Programme “should begin a phased reduction in this funding”.

Mr O’Brien agreed to provide €375,000 from HSE corporate funds to facilitate recruitment to the radiotherapy programme.

He also directed that the National Cancer Control Programme should fund the recruitment of the consultants planned for Beaumont and Cork from savings generated by unfilled posts in its national screening programme.