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September 17, 2014

‘Hollywood ending’ for radiotherapy plan?

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Greg Baxter heard good news about the progress of the national radiotherapy plan, when he spoke with Prof Donal Hollywood at the sixth International Cancer Conference.
The chairman of one of the most important strategy documents in the history of Irish healthcare stood before a mostly empty room in Dublin Castle last week (it was early, and the weather was excruciatingly nice) to deliver some of the best news that’s hit the health service in a long time. Prof Donal Hollywood, who chaired the National Expert Group on Radiation Oncology and is now directing the implementation of the group’s document – the so-called Hollywood Report – told the sixth International Cancer Conference that after all the scepticism and pessimism, things were on schedule.


Phase I of the radiotherapy plan, which involves the two Dublin sites at St James’s and Beaumont hospitals, will be complete by 2010. By 2014, the co-located radiotherapy facilities at University College Hospital Galway (UCHG) and Cork University Hospital (CUH), and their integrated satellite units in Limerick and Waterford, will be fully operational.
After his talk, Prof Hollywood, speaking with Irish Medical Times, said: “A lot of people thought it wouldn’t happen this soon, but we’re going to do it.” If Phase I, like Prof Hollywood said, is completed by 2010, radiotherapy capacity will double. When Phase II is finished, the HSE will have enough capacity to provide all radiotherapy in the country, which will effectively make private radiotherapy facilities redundant.
According to Prof Hollywood, Phase I will be procured and funded by the HSE, with the tender process beginning at the end of this month. The building phase will start in the first quarter of 2009, and the service will be fully staffed, equipped and operational by 2010.
Phase II will be developed under public-private partnership (PPP), and Prof Hollywood has stressed that the lack of PPP experience in the health sector should be acknowledged. Before Phase II begins, the State must ensure that it gets the right technical, legal and financial advice.
According to Prof Hollywood, PPP schemes can ‘be effective’ – but he pointed to motorways as an example of how they might go wrong.
h4. Ethical in nature
Prof Hollywood told the conference that the relationship between radiotherapy and the private sector was, at the moment, ethical in nature. “We have undercapacity there. It would be unethical not to use the private sector,” he said.
But in his presentation, he defined the emergence of the private sector in radiotherapy services as a ‘complexity’. Ultimately, a public radiotherapy service should be able to meet 100 per cent of the demand, he said. This is the only way to ensure some of the key fundamental goals of the Second National Cancer Strategy, which is Government policy: that there be equitably accessible, state-of-the-art treatment centres; and that Ireland should become an internationally-recognised location for education about cancer.
According to Prof Hollywood, the test of equitable public service is whether it can meet 100 per cent of demand, but quality of care is as important as equity of access.
He believes that in the area of radiation oncology, the public sector is more suited to ongoing excellence.
Public facilities have licensing and accreditation issues to face, they have proper and transparent measurements for quality, and ‘money will follow production’, he said.
“We can’t do that with the private sector,” he added.
While there are some minimum guidelines for the treatment of public patients in private facilities, there is no statutory mechanism to control quality standards, he said, adding that the goal, again, is to have world-class, internationally recognised teaching institutions as well as a safe, quality assured and equitable service.
Prof Hollywood’s good news – if he’s right – was delivered in a sobering context of the challenges Ireland faces in dealing with massive increases for demand in cancer services: the cancer caseload will increase by 107 per cent between 2000 and 2020, and currently 50 per cent of patients die within five years of diagnosis. Still, compared to a decade ago, Ireland has come a long way. Following the publication of the Hollywood Report, progress has been – relative to progress before the report – accelerating.
Although it was delayed, the Second National Cancer Strategy was published and became Government policy. The National Cancer Control Plan (NCCP) was launched, and within that, a National Programme for Radiation Oncology. A national director for the NCCP has been recruited — Prof Tom Keane. And eight centres of excellence have been identified.
With progress — particularly the designation of centres of excellence and the removal of cancer services from smaller hospitals — comes controversy. Prof Hollywood urged colleagues to accept the challenge of the public information deficit about the relationship between volume and outcomes in most cancers.
h4. Parochial feel
While attendance was low on the morning of Prof Hollywood’s speech — early on the conference’s second day — the annual International Cancer Conference continues to draw top oncologists from around the world to Dublin, and features some of the most prominent Irish consultants and scientists. Yet it’s impossible to ignore the fact that the pool of internationally recognised oncologists in Ireland is small — small enough to give the conference a misleadingly parochial feel.
Prof Hollywood spoke with optimism about the next generation of consultant oncologists and the fact that, of the new consultants being recruited by the HSE, a third of them will work in oncology.
As the radiotherapy plan developed, it was important to prioritise workforce planning above equipment, he said. “There is a disproportionate focus on equipment,” he told the conference.