Cancer boss says put health staff at ‘coal face’

IRELAND’S national cancer control chief yesterday insisted a key to getting quality in healthcare was to put doctors and surgeons at the “coal face” of the system.

Prof Tom Keane dismissed the value in promoting medical professionals to management posts while outlining “radical changes” he had overseen when previously working for Canada’s cancer care system.

The head of the National Cancer Control Programme said there had been a “brutal redesign” of cancer care in British Columbia, where he had worked.

“Every single manager had to resign,” he said, explaining how managers were then forced to reapply for jobs.

It was decided that many top surgeons or doctors did not need supervision, which saw more staff put back on the front line, Prof Keane said.

Promoting good medical personnel to supervisor or management jobs had not proved good value, he said when attending a meeting at the Royal College of Physicians.

“Highly-skilled oncology nurses and doctors don’t need to be told what to do every day when they come to work. If there are guidelines in place, you don’t need supervisors at multiple levels,” he said.

Ireland had a lack of information or data when it came to planning its cancer care strategy, added the health chief who is charged with organising cancer care in eight centres of excellence.

“There is a dearth of data on many of the issues in Ireland, that attempts to produce debate based on opinion, which [then] tends not to be resolved and that makes difficulties in making decisions.”

Planning for Ireland’s cancer care could not be based on conjecture, said the Dublin-born doctor.

“It makes planning of services more difficult,” he said, specifying the need for more information on what stage cancer patients presented to services and the diagnosis they were given.

An extra €1 million will be spent this year on monitoring the outcome of cancer care treatments to help inform future services.

Prof Keane described how British Columbia, in east Canada, had roughly the same population size as Ireland. Its health care was almost entirely public and funded from provincial taxes.

But there had been a radical review of its cancer programme in 1995.

Cancer there now had generally low mortality rates due in large part to good screening.

A significant resource was placing community cancer services closer to patient’s homes, he added.

British Columbia’s Government now looked at investments in cancer care being linked to achievements and this incentive was something the Department of Health and the Health Service Executive in Ireland could try, he suggested.