In the first of a two-part interview, Paul Mulholland speaks to the Director of the National Cancer Control Programme, Dr Susan O’Reilly, about why she came to Ireland from Canada, and why improving cancer services is still a priority.
It is self-evident that different health ministers want to leave their mark on the health landscape in different ways.
Universal healthcare and the Special Delivery Unit (SDU) are for Minister James Reilly what co-location and the Nursing Home Support Scheme were for his predecessor, Mary Harney; major programmes that will define their political legacy.
One of the other significant reforms that took place during the tenure of Minister Harney was the formation of the National Cancer Control Programme (NCCP).
Spurred on by a seemingly never-ending number of misdiagnosis cases in the media, the NCCP was established in 2007 under the initial stewardship of Professor Tom Keane.
Despite some early political and local opposition, the Programme is seen as a success, and remains intact (although it is to be subsumed into the Department of Health sometime this year) at a time when Minister Reilly seems intent on demolishing other institutional structures established by the previous regime.
Yet, like all sectors in a tight financial climate, cancer services face tough challenges, especially given that there is to be no increase in the funding of NCCP in 2012.
So does Dr Susan O’Reilly, Prof Keane’s successor as Director of the Programme, believe that the reform of cancer services will remain a priority at a time when the Health Minister’s attention may be focused elsewhere?
“There is no question that cancer was a top priority in the years 2006 onwards up until now and it became a very high priority because of all the challenges around missed diagnoses and delayed diagnoses and poor outcomes in the country,” Dr O’Reilly told IMN.
“So a big focus was shone on cancer and, in addition to resources moving around between different facilities, there was new money put in. Are we as financially well-endowed now as in the early years? No, we are not. New money is hard to come by, that is true across all of the HSE right now. In the current Service Plan, the major investment in this current year is in areas of childcare, social programmes, mental health and disabilities.
“So I think what the Government is doing right now, is putting a lot of emphasis on where are the major problems they need to fix, and through the development of the SDU there is big emphasis on emergency services, diminishing the number of trolleys that patients are waiting on for emergency admissions and improving elective surgery wait time.
"I think as successive Governments look at where do they really need to shine a light on major problems, you do see some shifting on what are the major problems of the day.”
Having said that, Dr O’Reilly, who originally graduated with a degree in electrical engineering in her native Wales, before studying medicine in Trinity College Dublin, says she believes that cancer services remain a key issue for the Government.
She is optimistic about the Programme’s move into the Department of Health later this year.
She also points out that the National Plan for Radiation Oncology was one of only three health projects contained in Government’s capital funding review in November, and that the Health Minister is keen to roll out the new colorectal screening programme at the end of the year.
Dr O’Reilly is under no illusions about the obstacles faced by the Programme this year. Yet, one of the main reasons for her taking up the role of Director of the NCCP in September 2010 was her need for a challenge.
She says that although she was happy in her role as Vice President of Cancer Care for the British Colombia Cancer Agency, from where Prof Keane had been seconded, and had an enjoyable career, things were running almost too smoothly. The agency had already provided input into the formation and implementation of the Irish cancer strategy.
“Tom was very instrumental in persuading me that I would find Ireland an exciting challenge and I was very aware of the fiscal situation in Ireland. I didn’t feel in any way naïve about that.
"Although I am Welsh by origin and I had lived in Canada for 30 years, and had worked in the British Colombia Cancer Agency, I was trained in Ireland. I’m a Trinity College graduate, I lived here for eight years, I had my small children before or during that time, and I had friends and family here.
"So in reality it was a challenging and interesting opportunity for me, and I thought why not, after a lot of consideration. It was definitely worth the opportunity of leading a national strategy, and its implementation.”
Dr O’Reilly says that she was well briefed about the Programme and the Irish healthcare system before arriving in Ireland.
However, two elements that she found very different from Canada were the different governance structures of the various hospitals and the high proportion of private practice in Ireland.
“As expected, things are challenging, but, as I had anticipated, a lot of things are going very well,” she says.
“So I am actually quite pleased with the progress. Now having said that, could progress be even faster? Well I think if there was lots of discretionary resources available and no financial crisis, we could develop a little bit faster. But are we along the right trajectory, along the right direction of travel at the moment? I think we are.”
The NCCP was already well-advanced when Dr O’Reilly arrived. All breast cancer treatment had moved from 32 hospitals into eight major centres (plus additional satellites in Galway and Letterkenny).
The centralisation of other cancers, such as lung; rectal; prostate; and oesophageal was underway, and the National Radiation Oncology Programme was established.
Also, the integration of the National Cancer Screening Service into the NCCP took place just before Dr O’Reilly took up her role.
“So I had inherited all of those things partway. And there were a number of other things ongoing which Prof Keane had initiated that I was pleased to see coming to fruition when I was here. All of those were just excellent, so I need to give him a lot of credit for even things that were evolving after my arrival.”
Dr O’Reilly is keen to stress that, even though cancer is not dominating health stories in the way it once did, the work of the Programme is not near completion.
"We are only halfway there. We have done a huge amount with surgical services. There is a bit more to do with some of the other surgical services for example gynaecological oncology, head and neck cancer, sarcomas. There is a bit more to do around medical oncology developing into a fully fledged national programme, we have provided additional medical oncologists into the system and recruitment is ongoing.
"However, we need to be able to develop national protocols for drug treatment that are the highest possible level of consistency. We need to develop national policies on drug safety that are implemented.”
She adds that the very point in having a national cancer control system is to ensure that “your highly organised systems are really highly organised and that you plan for the future”.
“If you can’t get those two things right, you’re not doing a good job,” she says.
Part 2 of this interview continues next week
Image courtesy of Hiddedevries, Creative Commons
