The Health Information and Quality Authority has today published its national report into the quality and safety of symptomatic breast disease services in Ireland and eight local hospital reports of the designated centres. The Authority has identified that significant progress has been made in providing high quality and safe services, though improvements are needed to make this sustainable. 

Director of Healthcare Quality and Safety with the Health Information and Quality Authority, Jon Billings, said: “Significant progress has been made in the physical establishment of the eight designated centres. The centres have been found to be meeting the key requirements of the National Quality Assurance Standards for Symptomatic Breast Disease Services. This represents a major shift in the capability and capacity of the health system to deliver safer and better care for people with symptomatic breast disease, as compared to the position in the autumn of 2007”.

“In the past, the absence of multidisciplinary review and decision making for the care of patients has been identified as a contributory factor in investigations, conducted by the Authority, into the delayed diagnosis of breast cancer for a number of patients. All of the eight centres now have clear arrangements in place for multidisciplinary care for all patients.”

The Authority found that some centres had well established clinical and managerial governance systems in place and others were at an early stage of development and in need of ongoing evaluation and support. However, all centres have in place the fundamental requirements for safe, quality care which include:

• triple assessment (where diagnosis is jointly based on three clinical specialty opinions)
• multidisciplinary teams
• core staffing
• appropriate equipment
• standardised data collection and management systems.

In addition, many of the required access targets were being met by the centres. During 2009, some centres fell below the required performance in relation to offering appointments for 95% of patients triaged as urgent within two weeks. While it is unacceptable for these standards not to be met, where this was the case, the monitoring of this performance by centres prompted a number of examples of remedial action to ensure the standards were being met.

The national report also found that:

• all designated centres have governance arrangements in place specifically to oversee the delivery of symptomatic breast disease services
• all centres have put in place arrangements for informing and involving patients in their care
• the collection and management of data is now happening in all centres
• more than the minimum recommended volumes of patients are being seen in all centres and the investment in additional staff has allowed all centres to have in place the core recommended staff

Nevertheless, some centres, particularly those consolidating after recent major service change, need time and support to establish successfully if patient safety and service quality are to be maintained and delivered on a stable and sustainable basis. The Authority’s report concludes that there needs to be increased cooperation and collaboration between the centres. The report says this should be the next priority of the Health Service Executive (HSE). “In securing and allocating resources to ensure that all centres are above the levels needed to deliver multidisciplinary care, the National Cancer Control Programme, working with the designated centres, has successfully created a platform from which to build and improve for the future,” Jon Billings commented. “However, the real benefits for cancer patients will come from greater cohesion and integration between clinicians in the eight centres through the sharing of good practice and information.” The national report makes 18 recommendations and the HSE should nominate a National Director to oversee the development and implementation of an action plan for these recommendations. Regular progress reports on the implementation should be reported to the Board of the HSE and published. The Authority has also made recommendations in the detailed local reports on the eight designated centres and has requested each centre to develop and publish robust local implementation plans for these. The Authority will be meeting periodically with the centres, and monitoring progress, in the implementation of these recommendations. In three of the centres where governance and information systems were at an early stage of development, the Authority will be conducting further on-site reviews during 2010 to assess progress. These centres are:

• Cork University Hospital
• Mid-Western Regional Hospital Limerick
• Waterford Regional Hospital.

Read the reports.

Further Information: 

For further information please contact:
Marty Whelan, Head of Communications and Stakeholder Engagement
01 814 7481 / 086 2447 623
mwhelan@hiqa.ie