Waterford Regional Hospital, a supposed ‘centre of excellence’ for breast cancer treatment, has been found to be failing patients on several fronts.

An unpublished report says it failed to meet 36 out of 48 minimum national standards. According to today’s ‘Irish Times’, the assessment at Ardkeen was carried out by the statutory Health Information and Quality Authority on October 2nd last at around the time female patients from three other hospitals in the southeast region – St Luke’s in Kilkenny, South Tipperary General, Clonmel and Wexford General – were being transferred to Waterford as part of a centralised services plan.

Comparing WRH against national quality assurance standards specific to breast cancer treatment (looking at facilities and organisation rather than individual medical staff) the HIQA inspectors deemed it to be meeting just eight of the 48 criteria, with four ‘uncertain’.

The standards are designed to define “the features of a well-functioning specialist breast disease centre”.

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.

Also, while 95 per cent of biopsies are meant to be “image-guided”, WRH did not have the necessary scanning device.

The standard that 95 per cent of patients should be given a date for surgery within three weeks wasn’t being met, while as regards radiology four of the five benchmarks were not being reached.

Furthermore, the report found the hospital was failing in the central aim of ensuring that each radiographer performed at least 20 mammograms a week. In terms of radiation oncology, Ardkeen came up short on all seven stated criteria.

The reasons for these failures would appear to be a lack of resources. Critically, instead of two specialist breast cancer surgeons, the hospital had just one, with another shared between other duties.

Also, there were no ring-fenced beds for breast cancer patients, and WRH was unable to guarantee an appointment within two weeks to a patient urgently referred by a GP.

A HIQA spokesman told the ‘Irish Times’ that they are “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.”

‘Work in progress’

Waterford Regional Hospital says the situation had improved markedly since the assessment was carried out more than six months ago, and that the project remains a “work in progress”.

Speaking on this morning’s Pat Kenny Show on RTÉ Radio One, Ian Wilson, Consultant General and Breast Surgeon, who is Regional Director of Cancer Services, said “these are cancer centres – they will hopefully become excellent with time.”

Asked how many of the 48 boxes would they be able to tick were the HIQA to re-examine the hospital today, he said: “I can’t give you a straight answer on that… we will tick most of them and those we would not be able to tick we are working on being able to tick them.”

Quibbling with some of the findings (it was “just not true” to say there had been no guided biopsies, and the consultant had carried out 149 surgeries in 2008 – it was just that data wasn’t available on the day of the inspection), Mr Wilson added: “The reality is that these things don’t happen instantaneously.” Twelve to fourteen new staff had been taken on to operate the centre and a second radiologist is expected to be appointed this summer.

However, the leaking of the report comes just a week after the new Clinical Director at Ardkeen, Dr Rob Landers, admitted that the proposed new co-located private hospital at WRH is now likely to never happen, while the provision of radiotherapy to public patients at WRH isn’t scheduled to be delivered until 2013.

City Councillor David Cullinane of Sinn Féin says the report must be published in full immediately given the question-marks it raises about the hospital’s capacity to properly treat cancer patients from across the region.

Labour’s Cllr Seamus Ryan, a member of the South Regional Health Forum and a former SEHB chairman, says it’s totally unacceptable that there’s such a glaring lack of resources at WRH.

The whole ‘centres of excellence’ strategy – Waterford being one of eight such sites nationwide – has been driven by Minister for Health Mary Harney and overseen by Professor Tom Keane. It’s designed to deliver a ‘world-class’ integrated treatment system.

Many will wonder how the Waterford centre, excellent or otherwise, could have been established, and services transferred here, without even baseline standards being in place.

At the time of the centralisation of services last autumn, HSE Hospitals Network Manager for the South East Richard Dooley said: “In line with the national strategy on breast cancer treatment, this move has the full support of cancer care clinicians, as it aims to ensure the best possible outcome for patients. Serving the South East region, a team of expert professionals in the field of breast surgery are now housed on one campus at Waterford Regional Hospital.”

However, there were murmurings of disquiet among staff about Ardkeen’s ability to cope with the extra caseload given its resources.