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ANNEX A
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You say that you would need £24m to spend on Cancer services, what do you envisage
would be the breakdown if you were to be funded to this extent?
(Mr Berry)
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We would increase the training programme for medical staff and appoint extra
consultant oncologists, including medical oncologists. Extra funding would be
made available to aid nursing development, including the staffing of a day hospital
treatment centre. The current spend per annum on drugs of £3m needs to be increased
to £5m. Oncology services in the community setting would be developed with GPs
and community nurses receiving specialised training to enable them to provide
cancer treatment, introducing, for example, oncology community nurse posts. Part
of the funding would be used for clinical research to help develop practice as
well as making the Cancer Centre at the Belfast City Hospital well respected both
in the UK and internationally, therefore enabling it to attract high quality staff.
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Do I understand that there are insufficient finances to fund the Campbell plan?
Why was financing not agreed before the plan was issued? Are the causes of cancer
being investigated as well as ways of encouraging women to attend for screening?
(Ms Armitage)
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The plans set out in the Campbell report are for a high quality way forward
but the finance to develop a patient-centred service is not available. The model
is good but the funding support was not agreed. It cannot achieve its aims on
current funding levels of £13m to £17m. Extra funding for screening programmes
is also required.
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I understand that in the Republic of Ireland the incidence of cancer is falling.
Are there lessons that could be learnt here? Would more screening programmes help?
(Mr Kelly)
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A Data is gathered differently in different countries but I would dispute the
fact that the incidence of cancer is falling in ROI. To my knowledge, the only
countries where the rate is falling are Finland and the US, and this is largely
due to the success of screening programmes. In N. Ireland the uptake on breast
screening programmes is on average 70%, with this figure reducing to less than
50% in some of the more disadvantaged areas of Belfast More education on the benefits
of this type of screening is needed, although the mortality rate from this type
of cancer is falling because of the screening programme. Screening for cervical
cancer is carried out in the primary care setting and there is some evidence to
show that screening for colon cancer, which is a very expensive process, can,
in effect, be cost effective because this type of cancer is curable if diagnosed
early enough.
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With a population the size of N. Ireland, would it not be more cost effective
to have all patients seen by a specialist at the cancer centre for diagnosis,
with treatment then carried out in the cancer units or locally? Can we afford
research on the finance available? Would it not be better to spend it all on treatment?
(Mr McFarland)
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Local access is important to N Ireland people and, as only 1 in 20 people test
positive for cancer, to screen everyone at the cancer centre would be impossible.
Cancer units will treat most cancers, with only the rare or specialised cancers
being treated at the cancer centre.
The simple answer on research is that if there is not a quality research unit,
there will not be a medical school to train the staff needed to provide treatment.
A large percentage of the money used to fund research is obtained externally,
not from DHSS&PS. The recently established HPSS Research and Development Office
will assist in winning external funding and thus encourage trained staff to return
to N. Ireland.
The population of N Ireland, because it is stable and has mainly good relationships
with GPs, is ideal for genetic research and accordingly attracts researchers and
funding from other countries, for example the US.
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What is the current complement of oncologists in post?
(Ms Ramsey)
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Currently there are fourteen oncologists in post, although three of these are
academics. We would hope to increase this number to between twenty-five and thirty
over the next five to ten years to enable us to cope with treatments, which are
becoming increasingly complex and specialised and major advances in technology.
In the US and most European countries oncologists see only one third of the number
of patients treated by doctors here.
A Patients Forum has been established recently at Belfast City Hospital.
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You say that 85% of your research funding comes from outside sources, should
the Committee investigate funding available? Do you attract funding from the National
Lottery? Are you supportive of PFI? Do you agree that although cancer treatment
is good, communication with patients is poor? What are your major concerns?
(Ms McWilliams)
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The HPSS R&D Office is developing a co-ordinated Research Strategy for
N.Ireland, an important element of which is a cancer research group which includes
representatives from QUB, UU, RVH and BCH. This initiative should be a vehicle
to distribute research funding from the Department. PFI is important in that it
allows us to develop initiatives with partners based outside N Ireland who can
provide access to technological development and assist us in planning for the
future. I agree that communication with patients is often poor. This is normally
due to pressure on staff because of the number of patients being treated. Waiting
lists are too long and operations are often cancelled at the last minute because
of the shortage of intensive care beds. We realise that we cannot have a hospital
in every town, but patients must have access to treatment as and when required.
We hope to develop programmes of care focussed on what is needed in specific areas
of the Province. One of our major concerns is the shortage of beds, with elderly
patients taking up beds which should have been reserved for cancer patients. People
are often waiting two to three months to access the system and consultants and
clinic time has been wasted when operations have to be cancelled. Another problem
is the continuing rivalry between RVH and BCH HSS Trusts and the solution might
be to combine both into one large Trust when consideration is being given to the
reorganisation of Trusts in N Ireland. Belfast City Hospital Trust has requested
additional funding for a plastic surgeon for breast reconstruction work so that
the waiting list can be cut and women can have the operation carried out without
having to pay for a private operation. This request has been turned down twice.
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It is reassuring to hear your interest in all patients especially those who
have to travel distances to receive treatment. As I understand that training oncologists
will take some years, can we not employ suitably qualified consultants from outside
N Ireland in the short term? In relation to colon screening, is this an example
of a service which could be provided on an all-Ireland basis?
(Mr Gallagher)
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We are competing in a small market and starting from a low base figure although
we have started to attract specialists from outside because of the development
of the Cancer Centre. We must, however, establish our own training programme and
develop leadership. N Ireland is now a more attractive place to live and more
people are returning. This will help in the short term.
Colon cancer screening is expensive but still cost effective because it saves
lives. We hope in the near future to develop a screening programme, and will be
bidding for funding at that time.
Health and Social Services Minutes 28 June
2000
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