Many issues facing cancer survivors

[Posted: Fri 29/02/2008 by Deborah Condon] Courtesy of Irish Health .com

Survivors of cancer face many life challenges, particularly if the disease was diagnosed when they were a child or adolescent.

A major conference this weekend will focus on these challenges, which include the psychological impact of the disease and issues such as infertility.

According to the Irish Cancer Society (ICS), which organised the conference, people who are diagnosed with cancer at a young age can suffer from long-lasting psychological problems. These can lead to them ‘holding back in new and challenging situations and participating less actively in life’.

Speaking ahead of the conference, Professor John J. Spinetta of San Diego State University in the US, said that for a very small percentage of cancer survivors, where the disease was diagnosed when they were young, the negatives associated with this can last ‘a very long time’.

“These negatives can return with intensity at various difficult times in life. But for most survivors, they gradually disappear. Follow-up studies of survivors 10 and 20 years after treatment find them as fully functioning, resilient, autonomous adults, focusing on the life-enhancing”, Prof Spinetta explained.

In fact, studies have shown that for the great majority of survivors of childhood and adolescent cancer, there is a deep and abiding sense of having learned lessons of resilience and thriving from the experience.

“Our task as parents and healthcare professionals is to enhance this view of healthy psychological resilience among our adolescents during the course of their treatment for cancer and afterwards. We need to help them learn coping skills and strategies as they go through their cancer treatment. But along the way let us also give them the freedom to be normal teenagers, Prof Spinetta said.

However one of the potential long-term effects of cancer treatment is infertility. In males, chemotherapy and radiotherapy can reduce or damage the sperm-producing cells of the testicles meaning that fewer sperm are made once cancer treatment has finished.

In females, treatment can reduce the number of eggs in the ovary, effectively making the menopause occur too soon, or additionally, if the womb has been exposed to radiation, this can affect its ability to support a pregnancy.

“Although the ability to preserve fertility of boys who have gone through puberty by means of sperm banking is well established, corresponding strategies for girls to bank their eggs are still considered to be experimental. The only viable fertility preservation option for women is to create and store embryos with in-vitro fertilisation (IVF) prior to cancer treatment if there is time to do so”, explained Dr. Allan A. Pacey of the University of Sheffield in the UK.

However, as this option also requires the women to have a partner to provide the sperm, this often prevents young women and teenagers from taking advantage of this option, Dr Pacey said.

The Human Assisted Reproduction Ireland (HARI) unit based at the Rotunda Hospital in Dublin offers semen cryopreservation (sperm banking) for cancer patients. However this is only offered to males from aged 16 years and upwards. HARI also offers oocyte cryopreservation (egg banking) to cancer patients, but this is only offered to females from aged 18 years of age.

Patients have to be referred to HARI by the consultant at the cancer care centre where they are being treated and banking has to take place prior to treatment. Both sperm and eggs can be banked for up to 10 years, although the storage period can be extended. HARI however recommends that eggs are used by the time the woman is 40 years of age.

The latest data available from the National Cancer Registry shows that there were 78 new cases of cancer in females aged 10-19 in 2005 and 62 new cases in males of the same age that year. For more information on cancer or any of these issues, call the ICS helpline at 1800 200 700.

Thalidomide may treat ovarian cancer

[Posted: Thu 28/02/2008] Courtesy of Irish Health.com

Thalidomide, the infamous drug that caused thousands of birth defects in the late 1950s and early 1960s, is now showing promise as a safe and effective treatment for women with recurrent ovarian cancer, according to US researchers.

The drug was given to pregnant women in the 1950s and 60s to combat morning sickness. However it resulted in major birth defects in their children. In recent years, research has indicated that it may be effective in the treatment of some cancers, including multiple myeloma, a cancer of the bone marrow.

According to principal researcher, Dr Levi Downs Jr of the University of Minnesota Medical School and Cancer Centre, for some women, ovarian cancer has become a chronic disease.

“The standard chemotherapy regimens can put recurrent cancer in remission, often more than once. However when the cancer resists the standard treatments, we need new options for treatment”, he explained.

His study looked at the effectiveness and safety of using a combination of thalidomide and topotecan, a type of chemotherapy often used for ovarian cancer. This was then compared with the use of topotecan alone in the treatment of recurrent epithelial ovarian cancer in patients who had received prior treatment.

Epithelial ovarian cancer is a disease in which cancer cells form in the tissue that covers the ovary.

Seventy-five women took part in the study and each was given either the drug and chemotherapy, or the chemotherapy alone.

“We found that patients who received topotecan plus thalidomide showed an overall response rate of 47%, compared to 21% in patients who received only topotecan. In patients receiving topotecan plus thalidomide, 30% achieved a complete response, meaning the cancer went away, compared to 18% for patients only getting topotecan”, Dr Downs Jr explained.

The study also found that patients getting the drug and chemotherapy had a longer cancer-free period after treatment, compared to those receiving chemotherapy alone.

“What all of this means is that while thalidomide may not cure ovarian cancer, it may broaden the treatment options available to physicians and provide more hope to women diagnosed with the cancer”, Dr Downs Jr added.

Ovarian cancer kills around 225 Irish women every year. Because the symptoms of the disease often mimic other conditions, it is often not diagnosed until it has reached an advanced stage. Symptoms can include pelvic or abdominal discomfort, unexplained weight loss or gain, unusual vaginal bleeding and pain during sexual intercourse.

Details of these findings are published in the journal, Cancer

Last Updated: 25/02/2008 16:46 Courtesy of the Irish Times.ie

Labour Court finds HSE job freeze broke agreement

Killian Doyle

The Labour Court has ruled that the Health Service Executive (HSE) breached the terms of the national agreement, Towards 2016, in the manner it introduced a recruitment freeze last year.

The HSE introduced the recruitment ban last September as part of its "Financial Break-Even Plan" to deal with a €200 million financial overrun. The freeze was lifted on January 1st.

Unions representing over 100,000 healthcare staff brought an action to the Labour Court last month, arguing that the HSE breached the terms of Section 28.13 of Towards 2016, which states that "unions will be informed in advance of all new workplace-related initiatives which have a significant effect on staff, the reasons for them and the proposed implementation date."

The joint complaint was submitted by Impact, Siptu, the Irish Nursing Organisation, the Irish Medical Organisation and a number of other unions.

They claimed there was no prior consultation before the freeze was introduced unilaterally.

The HSE had argued that the measures had been in response to a financial overrun across the organisation and did not involve any changes to the terms and conditions of existing staff. Therefore, the HSE said, it was under no obligation to consult unions prior to implementing the initiative.

In its ruling today, the Labour Court noted that the unions had argued that the HSE cutbacks introduced "can have profound consequences for the overall quality and effectiveness of health service delivery and for patient outcomes".

The Court said it "has no doubt that the initiatives giving rise to this dispute did have a significant effect on staff".

It also recognised that the HSE's move "had the effect of reducing the number of staff available to provide a service to patients and this, in turn, placed available staff under additional pressure". Staff were also affected by

overtime and promotions being curtailed and some staff who wished to resume work after career breaks had their returns delayed, it said.

"In the Court's view, the combined effect of these factors brought the initiative within the ambit of Section 28.13 of Towards 2016 and the HSE should have consulted the unions before the final decision was taken to implement these measures," it said.

"The Court recommends that the HSE should assure the unions that should the need for a similar initiative arise in the future full and adequate consultation will take place."

A spokesman told ireland.com that the HSE "fully accepts" the Labour Court recommendation and would continue to work with the unions to improve the health service.

Brendan Mulligan of the HSE Employers' Agency said tighter controls were now in place to ensure the HSE stayed within budget and within its employment ceiling this year. "That is just good management," he said.

The Irish Medical Organisation welcomed today's ruling, with director of industrial relations Fintan Hourihan saying the cutbacks were having "profound consequences" for the health service, leading to "chaotic situations" for frontline staff. Mr Hourihan warned that the situation would worsen in 2008 because the HSE not been provided with sufficient funding to provide the same level of service as last year.

"The HSE has been given no additional funding to cope with the increasing pressures being placed on the health services or to provide for factors such as ongoing inflation in current and capital expenditure," he said. Impact claimed last month the HSE has imposed "even tighter restrictions" since it lifted its three-month recruitment embargo.

Impact, which represents 28,000 health service staff, said a HSE circular issued earlier this month "effectively abolished" vacant positions that were unfilled when last year's recruitment freeze was imposed. Jobs that became vacant during the three-month freeze are also to go unfilled.

Donal Duffy of the Irish Hospital Consultants Association said HSE management need to appreciate the impact of their decisions on patient care.

"The service needs to do more than simply balance the books, which was the HSE objective on this occasion," he said.

Oesophageal cancer...hard to swallow

By Eilish O'Regan Monday February 25 2008 Courtesy of Independent.ie

IRELAND has the highest incidence rate of oesophageal cancer in Europe for men and women, affecting between 350 and 400 people a year.

This is more than the numbers killed in road traffic accidents yearly. The prognosis for oesophageal cancer is poor, with 90% of people dying from the disease once they get it.

Thus, the ability to recognise the symptoms of this disease is vital as it allows for early diagnosis and successful treatment.

Two main symptoms include food 'sticking' on swallowing and unexpected weight loss.

For more information, visit www.lollipopday.ie

Two-year wait for free breast screening

By Eilish O'Regan Monday February 25 2008 Courtesy of Independent.ie

The extension of free breast screening to women up to the age of 69 is not expected to happen for another two years.

Health Minister Mary Harney said the first priority is to screen women in the 50-64 age group in the west and south.

In a Dail reply to Fine Gael TD Michael Ring, she said the expert advice from BreastCheck and the National Cancer Forum is that, following the national extension of the programme, the upper age limit should be extended to women aged 69.

VHI withholds payment in hygiene row

[Posted: Fri 22/02/2008 by Deborah Condon] Courtesy of Irish Health.com

The VHI has agreed to the request of a Dublin women who asked the insurance company not to pay the bill for the treatment of her husband at St Vincent's University Hospital because of her concerns over the hospital's hygiene standards.

Bridie Connolly's husband died from cancer last year. She told irishhealth.com she had serious concerns about the levels of hygiene at St Vincent's when her husband was a patient there, and because of her concerns, asked the VHI not to pay the hospital for her husband's treatment there.

The VHI has confirmed to irishhealth.com that it has not paid the claim, while St Vincent's has stressed that it has been rated one of the top hospitals for hygiene in a recent major audit and that queries raised by Ms Connolly had been dealt with at the time by hospital management.

Before Mr Connolly’s cancer was diagnosed, he was on a six-bed ward. According to Ms Connolly, she and her family had a number of concerns about the hygiene levels in this ward.

“The hand basin outside the toilets was blocked for eight days. The hand basin in the ward meanwhile was next to a dialysis patient. When this patient was getting dialysis, which could take a couple of hours at a time, access to that hand basin was blocked as the machine is quite large”, she explained.

After her husband was diagnosed with gastric cancer, he was transferred to an oncology ward. Ms Connolly said that one of the toilets that her husband was expected to use in this ward did not have a seat on it.

While in this ward, Mr Connolly contracted a hospital acquired infection - Clostridium difficile, also known as C.diff. This is a potentially serious bacterial infection that affects the intestine. Symptoms range from diarrhoea and abdominal pain to a life-threatening inflammation of the colon.

“He contracted C.diff the day before he was due home. He was then transferred to what was supposed to be an isolation ward. It was filthy. There was a bowl of vomit in the sink and dirty paper towels in his press”, Ms Connolly said.

She claimed that the cleaners who came into the isolation ward did not clean the room properly.

“A cleaner used to come in and just run a mop up and down the room. I asked her one day to clean around my husband’s bed and she said ‘may I’. I said to her, ‘it’s an isolation ward, you have to clean everywhere’. It is like they did not know how to clean”, she said.

Following the death of her husband in March, Ms Connolly said that she asked the VHI not to pay her husband’s hospital bills ‘as the conditions were sub-standard’.

A spokesperson for the VHI said that while it cannot comment on the specifics of individual cases, it can be confirmed that ‘we have not paid the claim in this instance. Each case is considered on a case-by-case basis and investigated’.

Responding to the claims, a hospital spokesperson said that the numerous queries raised by Ms Connolly ‘were dealt with at the time by senior hospital management’.

“We would be happy to engage further with Ms Connolly at any stage. St Vincent’s University Hospital has been rated among the top hospitals in the hygiene audit published by HIQA”, the spokesperson said.

He said in relation to the blocked sink which Ms Connolly referred to, a request for it to be unblocked was ‘made and completed on January 19 (2007)’.

Regarding the lack of access to the sink in the ward, ‘there was a patient in that room requiring specialised treatment, which necessitated the presence of a nurse and a doctor to administer the treatment and also a large piece of equipment by his bedside. The treatment lasted approximately five to six hours per day’.

In relation to the broken seat in the toilet, it was ‘reported to technical services on February 10, 2007 and was repaired by them on February 12, 2007’.

The spokesperson added that the cleaning procedure following patient transfer ‘is per the hospital policy’.

“All rooms are cleaned twice a day. Following patient transfer, cleaning contractors clean the bed space, curtains are changed and nursing staff clean the bed, locker etc…”, he said.

Research backs theory that vitamin C shrinks tumours

Wednesday February 20 2008 Courtesy of Independent.ie

New research suggesting that vitamin C can be effective in curing cancer will renew interest in the "alternative" treatment for the terminal disease.

Three cancer patients who were given large intravenous doses over a period of several months had their lives extended and their tumours shrunk, doctors reported yesterday.

A 49-year-old man diagnosed with terminal bladder cancer in 1996 was still alive and cancer-free nine years later, having declined chemotherapy and radiotherapy in favour of regular infusions of vitamin C.

A 66-year-old woman with an aggressive lymphoma who had a "dismal prognosis" in 1995 was similarly treated and is still alive 10 years later. A 51-year-old woman with kidney cancer that spread to her lungs diagnosed in 1995 had a normal chest X-ray two years later. The findings were confirmed by pathologists. Although they do not prove the vitamin cured the cancer they do increase the "clinical plausibility" of the idea, the researchers say.

Vitamin C therapy was first promoted by Linus Pauling, the Nobel prize winner, 30 years ago. Dr Pauling's claims sparked the continuing boom in sales of vitamin C, but attempts to confirm his findings failed and high-dose vitamin C became an "alternative" therapy.

The latest study, published in the Canadian Association's Medical Journal, could trigger renewed interest in Dr Pauling's claims. Studies show that vitamin C is toxic to some cancer cells but not to normal cells. The problem has been delivering a high enough dose. The researchers say attempts to replicate Dr Pauling's work failed because they used oral doses of the drug which is rapidly excreted. However, injections achieve blood levels 25 times higher that persist for longer. At these very high doses, the blood level of vitamin C is high enough to selectively kill cancer cells.

Several clinical trials of vitamin C therapy are about to start, including one at McGill University, Montreal, the authors say.

Doc-patient relationship is 'unique'

[Posted: Tue 19/02/2008) Courtesy of Irish Health.com

The doctor-patient relationship is one of the most important relationships there is and it needs to be ‘nurtured and protected’, a leading breast cancer expert has said.

Speaking at a recent Irish conference on younger women with breast cancer, Dr Maria Weiss, a breast cancer oncologist and founder and president of breastcancer.org, said that the doctor-patient relationship is unique – it has business, emotional, personal and intimate components.

A well nurtured and well managed relationship can help a patient to overcome the fear of a cancer diagnosis, she explained.

“Many people don’t stop to consider that their life is literally being put in another person’s hands. It’s really important to keep in mind that the patient-doctor relationship is just that, a relationship. It needs to be nurtured and protected”, Dr Weiss said.

She offered advice on how to better nurture this relationship:

-Think ahead about what you will say, particularly if the appointment is about a serious condition. Write out a list of questions.
-Do not let the doctor do all the talking. It is essential that you speak up if you do not understand what he/she is saying.
-Takes notes or use a tape recorder. Most doctors will not mind if you explain that you want to remember the conversation.
-Consider bringing a friend or loved one as a second listener, but set ground rules. For example, they can only ask questions if you give them a cue to.
-Do not give up if all your questions are not answered during one appointment. Instead, ask for another appointment, follow up by telephone or email or make an appointment with another member of your medical team.
-Say thank you from time to time.

The conference was organised by Action Breast Cancer (ABC), a programme of the Irish Cancer Society. Over 100 younger women with breast cancer attended and a range of issues were discussed, including fertility, sexual functioning, treatment-induced early menopause and dependent younger children.
According to ABC clinical coordinator, Jenny Nestor, the issues younger women with breast cancer face are ‘fundamentally different’ to older women who are postmenopausal.

“As the incidence of breast cancer continues to rise, we want to highlight to women that we are here to assist them through their breast cancer journey and will provide the latest medical information, psychosocial support and practical help”, Ms Nestor added.
According to the latest figures available from the National Cancer Registry, in 2005, there were 2,379 new cases of breast cancer, of which 366 were in women under the age of 45.

In 2000, there were 235 women under the age of 45 diagnosed with breast cancer – this represents a 55% increase in five years.
For more information on breast cancer, call the ABC helpline at 1800 30 90 40.

Stress may up cervical cancer risk

[Posted: Mon 18/02/2008] Courtesy of Irish Health.com

Daily stress may reduce a woman’s ability to fight off the common sexually transmitted infection (STI) that can cause cervical cancer, the results of a new study indicate.

Human papilloma virus (HPV) is a very common virus that can cause warts on many different parts of the body. There are over 70 types and most are considered harmless. However HPV that is spread during sexual intercourse can go on to cause cervical cancer.

“HPV infection alone is not sufficient to cause cervical cancer. Most HPV infections in healthy women will disappear spontaneously over time. Only a small percentage will progress to become precancerous cervical lesions or cancer. An effective immune response against HPV can lead to viral clearance and resolution of HPV infection. But some women are less able to mount an effective immune response to HPV”, explained Dr Carolyn Fang of the Fox Chase Cancer Centre in Philadelphia.

The researchers set out to determine whether stress could lead to alterations in the immune system, thereby making the body less able to clear the virus effectively.

They examined the link between stress and the immune system’s response to HPV among women who had precancerous cervical lesions. The women were asked about their perceived stress in the past month and major stressful events that had occurred in their lives, such as divorce, the death of a loved one or the loss of a job.

The researchers said they were surprised to discover no significant link between major stressful life events and the immune system’s response to HPV16 – the most common subtype of the virus. This, they said, could be due to the amount of time that had passed since the event occurred.

“Our findings about daily stress told a different story however. Women with higher levels of perceived stress were more likely to have an impaired immune response to HPV16. That means women who report feeling more stressed could be at greater risk of developing cervical cancer because their immune system can’t fight off one of the most common viruses that cause it”, Dr Fang explained.

Details of these findings are published in the journal, Annals of Behavioral Medicine.

HSE may seek drug suppliers overseas

Martin Wall and Deaglán de Bréadún, Courtesy of The Irish Times on line, Monday 11th Feb.08

The Health Service Executive (HSE) has warned it may tender internationally for the supply of drugs and medicines to pharmacists if existing wholesalers fail to absorb the cost of planned reductions in profit margins.

The HSE has written to the three main wholesalers - United Drug, Uniphar and Cahill May Roberts - in recent days seeking clarification on whether local pharmacists could end up having to pay more than the amount reimbursed by the State under a controversial new pricing system to be introduced next month.

The Irish Times has learned that the HSE advised the Department of Health and Minister for Health Mary Harney that it is "actively considering" alternatives to the current service - which costs around €280 million annually - if such a guarantee is not provided by the wholesalers.

The HSE said that the alternatives included seeking tenders internationally for companies to provide the service either on a regional or national basis, or to enter into new arrangements with manufacturers to distribute their products to pharmacists and hospitals.

It is understood that the HSE indicated it had also been approached by some courier companies about the business.

The move represents a potential further escalation in an already-bitter dispute over the HSE's plans to reduce its drugs bill by €100 million by reducing wholesale margins by 9 per cent. The HSE and the Government have argued existing margins are more than double the level in other European countries.

Pharmacists have warned they could end up being reimbursed for less than the wholesale cost by the HSE and that hundreds of outlets could face closure.

Pharmacists have also warned that medical card holders would have to pay for their drugs from next month and seek refunds from the State unless the HSE abandoned attempts to introduce new contracts containing the new pricing system before then.

A well-organised lobbying campaign by pharmacists, as well as fears expressed by patients, has resulted in Fianna Fáil backbenchers putting strong pressure on the Government over the HSE's plans.

The HSE has stated that it had "understandings" with the wholesalers that community pharmacists would not be left out of pocket under the new pricing structure. However, it is unclear as to how such "understandings" came about.

Last week in a note for Fianna Fáil deputies, United Drug said there was "no question" of wholesalers being able to make up for the 9 per cent reduction in margins.

"We only make net margins of 1-2 per cent, and so don't have an extra 9 per cent to play with," the note said.

© 2008 The Irish Times

Crisis ahead as half of GPs to retire
17 February 2008 By Susan Mitchell Courtesy of The Sunday Business Post on Line>
#

A new contract for GPs is vital if local services are to have a hope of meeting the coming shortfall in hospital care.
Frustration over the failure to produce a new General Medical Scheme (GMS) contract is beginning to mount, with grass roots unrest growing around the country.
GPs in Wicklow are the latest to vent their annoyance at a lack of movement by the Irish Medical Organisation (IMO) and the Department of Health on talks about a new agreement for treating GMS patients.
A strongly-worded letter from the Wicklow GP branch of the IMO has expressed dismay at the impasse in GMS negotiations. It comes at a time when the HSE is considering removing 4,000 beds from the acute system and shifting care to the community after recommendations in the recent PA Consulting acute bed capacity review.

So, where has it all gone wrong?

While health minister Mary Harney has pushed hard to secure an agreement with hospital consultants, many believe she has not shown great enthusiasm for major infrastructural investment in primary and community care, which could save money on the increasingly expensive and difficult to access hospital system.
 

The 2001 National Health Strategy stated that ‘‘primary care needs to become the central focus of the health system’’, but the development of primary care teams is well behind the original schedule set out by the Department of Health.
The 500 primary care teams in development are a long way from providing services to patients and Harney has already expressed concern over the speed of recruiting teams.
Either way, any plans to reorganise and expand GP services and primary care will hinge on the GP contract. IMO GP leader Dr Martin Daly said the IMO was anxious to start negotiations on a new contract to modernise primary care services, but the HSE had thwarted those efforts.
The HSE has claimed it has legal advice that collective negotiation of professional fees is a breach of the 2002 Competition Act and this is the main barrier to progressing the long-delayed GP contract.
Daly dismissed this as ‘‘a smokescreen for inactivity. The HSE was due to produce a draft contract in April 2006,well before the competition law issues arose’’.
The HSE said the GPs didn’t help their own case when they tried to secure payments of €2,700 for each of their negotiators who attended a HSE meeting.
Meanwhile, the department has begun to examine the possibility of setting up an independent body to recommend fee scales for GPs and other professionals.
Harney said the body could be similar to the Review Body on Higher Remuneration in the Public Sector, which makes recommendations to the government on top-level pay in the public sector.
Harney said she would like to see GPs who provided an expanded range of services paid differently in the future. Many of her comments echoed proposals made in a 2006 discussion document on a new GP contract.
The HSE wants to introduce more flexible working arrangements, including a service whereby GP care would be available everywhere on a 24/7 basis. It also wants all GPs to operate at least one early surgery and another surgery opening until 8pm once a week.
 

The HSE has already proposed a ‘standard’ GP contract encompassing what it feels are basic GP services and an ‘enhanced’ contract covering additional work.
The standard contract would cover areas such as the management of acute and ongoing illnesses; health promotion and illness prevention; flexible consultation hours; the availability of GPs on a 24/7 basis; maternity and infant care; flu and pneumococcal vaccinations and childhood immunisations.
The enhanced contract would include all of the above, but would also involve using GPs to provide comprehensive chronic disease prevention services in areas like diabetes and heart disease, and offering minor injury and surgery clinics to supplement those currently found in hospitals.
GPs are eager to provide many of these services. Daly said the existing contract was outdated and encouraged treating illness, rather than preventing it.
‘‘The current scheme is completely misplaced. There is no provision for chronic care or for preventative medicine. When it’s done, it’s done on a pro bono basis, but there is no contractual agreement,” said Daly.
 

‘‘We have been promised a new contract since 1999, yet no document has been produced.”
The Irish College of General Practitioners (ICGP) is also angered by the HSE’s decision not to fund an increase in GP training places, particularly when the removal of so many hospital beds would depend on radically boosting community, primary care and general practice services.
GPs in the north-east recently warned of a crisis facing the region’s general practitioners, with many considering restricting new patients and some already doing so. In an open letter which predated leaked proposals to scale back acute hospital services in the region, three IMO GPs warned that the ‘‘region’s health service is at breaking point’’.
The problems in the north-east are not new or peculiar to that area. It has been predicted that patients will soon face waiting lists for GPs in some parts of Dublin. A serious dearth of training positions is leading to excessive pressure on existing GPs in parts of the country.
Only 120 places were made available this year, but 250 need to be trained every year to meet the demand. Daly said this would have serious repercussions as IMO surveys had indicated that almost 50 per cent of GPs were likely to retire over the next seven years.
The HSE blamed budget pressures for the decision to reverse an earlier promise to increase the number of places.
But back to the contract. The IMO has warned the HSE it will not accept any changes to the GP contract without extensive negotiation and consultation.
Last month, the HSE announced it was seeking submissions for health facilities that would accommodate the delivery of primary care teams in conjunction with local GPs at over 100 locations around the country.
Daly said the IMO felt that private healthcare companies and building consortiums had an unfair advantage over ordinary GPs in the submission process. He said the IMO had identified GP premises as an area where the government needed to consider tax incentives.
‘‘The cost of setting up a practice is financially onerous, particularly since the change in planning laws. We have tax incentives for hotels, car parks, private hospitals and nursing homes. All other support services are incentivised,” he said.
HSE chief Professor Drumm has insisted the HSE has not abandoned the GMS contract talks and it did not go looking for an opinion from the Attorney General on the Competition Act.
Daly said GPs could be used more effectively and that the primary care strategy ‘‘simply won’t happen without a new GP contract’’.
 

Local care strategies and schemes
What is the Primary Care Strategy?
The Primary Care Strategy, which was originally published in 2001 when Micheal Martin was Minister for Health, promised a ‘‘one-stop shop’’ where patients could access an expanded range of health services in the community.
Central to the strategy was the creation of primary care teams staffed by GPs, nurses, occupational therapists, physiotherapists and other healthcare professionals. It aimed to reduce A&E attendances and pressure on hospital beds. The strategy is stuck at pilot phase, with just ten teams in place.
At the current rate of development, the HSE will not reach its target of developing between 400 and 600 core teams as required for two-thirds implementation of the strategy by 2011.
 

What is the Primary Care Reimbursement Scheme?
Under the Primary Care Reimbursement Scheme, GPs provide services to medical card and doctor-only medical card holders, with access to GP care free of charge.
Those GPs in the scheme (formerly known as the GMS) enter into contracts with the HSE to provide services. Under the medical card scheme, the majority of doctors are paid an annual capitation fee for each eligible patient. The rate of payment is determined by the age and gender of the person and how far they live from their GP. A number of additional fees, supports and allowances are also payable to GPs under the scheme.
In October 2005, a doctor-only medical card was introduced which covers patients above the income threshold for a full medical card.

New screening unit to aid cancer care

[Posted: Fri 15/02/2008 by Niall Hunter, Editor Courtesy of Irish Health .com

A new €2 million imaging and screening facility that will help improve patient care and accelerate drug discovery in cancer and other diseases has been launched at St James's Hospital in Dublin.

The new facility, at TCD's Institute of Molecular Medicine (IMM) at St James's, provides extremely advanced imaging of human cells. It has the capacity to generate hundreds of times more scientific information which will result in radical improvements in the diagnosis and treatment of disease.

Dr Yuri Volkov of the IMM said high content imaging technologies have become indispensable tools in the advancement of our understanding of how the human body works at cellular level.

He said the scale and speed of the new technology at St James's has the capacity of providing up to several hundred items of data from the one cell sample and can potentially increase the speed of diagnostic tests by 100 to 200 times for patients.

The new analysis method focuses on how the human genome functions and its role in causing disease.

According to the IMM, it is currently researching how cancer will respond to protective therapies by assessing the functions of each individual gene in the human genome, in a process called 'gene-silencing'.

Using the new high content imaging process, IMM scientists recently made the groundbreaking discovery on how the hepatitis C virus escapes the body's immune defence systems.

The Institute says high content analysis also enables it to quickly locate tiny particles in several cell types at a time and to monitor each individual cell's response to prospective 'nano-bullets' for rapid and targeted drug delivery.

Fears of funding problem with consultant deal

[Posted: Wed 13/02/2008 by Niall Hunter, Editor] Courtesy of Irish Health.com

The Irish Hospital Consultants Association says it is concerned that the HSE may be seeking to delay finalising the new consultant deal for as long as possible as a result of its budgetary difficulties.

A new consultant contract appeared to have been agreed in all but the fine detail nearly three weeks ago.

However, both consultant organisations, the IHCA and the IMO, now say there are a number of issues which still have to be nailed down and have criticised the fact that there is still no detailed document available on the terms of the agreement to put to their members.

Both bodies have been critical of what they feel is the the HSE's lack of urgency in seeking to finalise the agreement.

A four-hour meeting between health management and the consultants yesterday afternoon failed to make much progress on finalising the agreement, and the two sides are to meet again next Wednesday.

IHCA Secretary General Finbarr Fitzpatrick told irishhealth.com that consultants still did not have the full picture regarding the agreement and there were still a number of issues which needed to be settled.

He said the IHCA may now have to cancel its planned national council meeting on Saturday as there would be no detailed document to put to it for consideration.

Asked whether he felt the deal was now unravelling, he said while he did not feel this was the case, but the IHCA was concerned that the momentum that had been built up following the agreement three weeks ago had now been lost.

Mr Fitzpatrick said it was also feared that the HSE might not have the funding available to put the deal fully in place this year, and that this could be the reason behind the delay in finalising the agreement.

He pointed out that under the agreement, new consultant posts would have to be created and increased salaries would have to be paid to existing consultants who switch over to the new contract.

In addition, consultants remaining on their existing contracts are due to get a 7.3% pay rise under the deal.

IMO Industrial Relations Director Fintan Hourihan said there remained a not insignificant number of loose ends to be tied up with the new deal and there was still disagreement on important issues like practice plans for consultants.

He said it was felt the process had now been dragging on far too long and a final detailed document was needed which could be signed off by consultants and employers.

Cancer biggest cause of insurance claims

[Posted: Wed 13/02/2008 by Niall Hunter, Editor, Courtesy of Irish Health.com

Malignant cancers remain the most common cause of specified illness and death in Ireland, according to a new analysis from the Irish Life insurance company.

In an analysis of the total life and specified illness cover payments made to customers in 2007, the company found that malignant forms of cancer accounted once again for 60% of the total, with heart-related illness accounting for a further 20% of claims.

An analysis of 2007 death claims, the company said, also reflects the dominance of cancer and heart conditions, with cancer accounting for 47% of the total claims, and heart-related conditions accounting for around 22%.

Adult accident claims made up 8% of the total claims; of this, 23% were accident-related claims , while alcohol was a contributory factor in 16% of all accident claims.

The largest single death claim paid out by Irish Life last year was just over €1 million in respect of a 50-year-old man who died of pancreatic cancer.

The largest single payment in respect of a female was €467,000 in respect of a woman who died of breast cancer.

The company commented that cancer still remains the biggest killer and the number of cancer-related specified illness claims continues to rise

Children's hospital to help bereaved

By Eilish O'Regan
Monday February 11 2008 ( Courtesy of Independent.ie)

There are up to 135 deaths a year among patients of Our Lady's Hospital for Sick Children in Crumlin, Dublin.

Now, the hospital is involved in a new programme to help families deal with the tragedies.

The plan includes communications training for staff dealing with bad news and examining how staff of different nationalities and religions respond to death. There will be special bags for children's belongings and more areas of privacy for families.

The plans are part of the national Hospice Friendly Hospitals Programme.

Scientists identify genetic cause of prostate cancer

By Jeremy Laurance Monday February 11 2008 ( Courtesy of Independent.ie)

Scientists have made a major advance in understanding the genetic causes of prostate cancer, opening a new front in the battle against the most common malignant disease in men.

Seven new genetic mutations have been identified that are present in over half of all new cases of prostate cancer, diagnosed in 35,000 men a year.

The discovery helps explain why the disease runs in families. Each individual mutation increases the risk by up to 60 per cent and when all seven are present together the risk is raised three-fold.

Prostate cancer is one of the most rapidly increasing cancers here but the existing blood test for the disease is unreliable. The breakthrough means a new genetic test for prostate cancer could be developed to identify men at high risk who could be targeted for regular screening and early treatment.

Two of the seven genetic mutations identified could lead to the development of new treatments and a more accurate blood test for the cancer.

Ros Eeles, of the Institute of Cancer Research in London who led the study, said that it was the culmination of 13 years work involving 10,000 patients and the analysis of three billion genetic variations.

"We are very excited. This is a big step forward. To have seven hits fall out of a genome-wide study is very unusual."

"These results will help us to more accurately calculate the risk of developing prostate cancer and may lead to the development of better targeted screening and treatment."

The study, funded by Cancer Research UK, involved collaboration between scientists in the UK and Australia and is published in Nature Genetics.

The advance marks the latest triumph for the new science of genetic profiling which is transforming understanding of the genetic basis of disease. Last May, scientists announced the discovery of four new genes which increase a woman's risk of breast cancer. Similar advances have been made in bowel and lung cancer.

Dr Eeles said: "These findings show genetic medicine is going to happen. We will be starting research this year on developing a genetic test [for prostate cancer] which could be available in three to four years. But we need to ask first who should provide it and how it should be done. It would be irresponsible for a genetic testing company to develop this and sell it over the Web."

Use of such a test would raise difficult ethical and practical issues. Any man identified as at high risk of developing the cancer would face a lifetime of regular screening tests to check if the disease was present, followed by treatment of uncertain effectiveness and with a risk of side-effects. The implications of undergoing the test needed to be carefully thought through before it was made widely available, Dr Eeles said.

One of the genes identified, LMTK2, codes for a signalling protein called kinase which is also altered in some other cancers and in Alzheimer's disease. This offered the prospect of a single treatment target for the two diseases.

Dr Eeles said: "Drugs against these types of kinase are already being developed. We may end up with a drug that targets Alzheimer's and prostate cancer as kinase is involved in brain signalling. This may be an area where we can have a double edged approach."

A second gene, MSMB, identified codes for a protein whose level in the blood falls as prostate cancer develops. This has raised hopes of developing a new, more accurate blood test.

'My brother bullied me to go to my GP'

Laurie Whelan, 79

Both Laurie Whelan's brothers developed prostate cancer in their fifties. That meant his own risk of the disease was about 10 times the average - but he had no idea of the danger he was in.

"It never occurred to me that their cancer had anything to do with me. It wasn't until my younger brother bullied me to go to my GP that I discovered it," he said.

Mr Whelan, a former laboratory manager in a London hospital, was eventually diagnosed.

The cancer was so advanced it was inoperable and he was treated with a combination of radiotherapy and hormone treatment. That was 10 years ago. Today, aged 79, he is still free of the cancer - but is now worried about the future for his three sons, who are all in their forties.

The eldest has been tested and found to be free of the disease but he and the younger two face regular screening tests for the rest of their lives.

As a result of his strong family history, Mr Whelan volunteered for the Cancer Research UK study which resulted in the identification of seven new genes linked with the cancer.

"I am delighted it has produced such exciting results," he said.

HSE recruiting ban means €6m health facilities are lying idle By Michael Brennan Political Correspondent Friday February 08 2008

 ( Courtesy of Indepenent .ie)

TWO multi-million euro state-of-the-art health facilities are lying idle because a recruitment ban is preventing the employment of people to staff them.

But HSE chief executive Brendan Drumm defended their non-use, saying employment ceilings could not be breached.

The new €4m accident and emergency department in Mercy University Hospital in Cork is currently not in use despite being completed a year ago and neither is a €1.8m CAT scanner purchased for Mallow General Hospital in 2006.

Professor Drumm said he supported the use of a CAT scanner in Mallow but that the hospital could not breach its employment ceiling.

Demand

In relation to the Mercy University A&E department, he said that the standard arrangement was to have one to two members of staff per patient, but that there was a significant demand for extra staff above this ratio.

"I'm sorry, but I can't justify that type of staffing."

The HSE chief had been asked to explain the situation at the Public Accounts Committee after Fine Gael TD Bernard Allen complained that patients in Mallow were being ferried by ambulance to Cork for CAT scans up to five or six times a day.

"How can you explain the lunacy of supplying a CAT scanner and go through interviews with two radiographers and then don't appoint them? That's mismanagement," said Mr Allen.

The Public Accounts Committee heard that the HSE dealt with 1,460,000 cases at A&E in 2006. According to Professor Drumm, around three quarters of public beds were given to public patients, with the remainder going to private patients.

Meanwhile, Prof Drumm yesterday vowed that health managers will no longer be allowed to use funds earmarked for new hospitals to balance their day-to-day budgets.

The budgets are used to pay for the standard running costs of the health service, including staff wages and cleaning.

Professor Drumm admitted for the first time that the practice of dipping into the funds to meet cost overruns had been widespread in the past but said that capital spending would be protected this year.

Negligent

"Every manager in the systems knows what their budget is and knows that they won't gain from not managing it," he said.

He told the Public Accounts Committee that health managers had previously depended on this "bail out" and were considered negligent in their local areas if they did not exceed their given budget.

The HSE, which has a capital budget of €700m this year and an overall budget of €14bn, is facing increasing scrutiny over its spending from the Department of Finance.

It is only allowed to approve new IT projects after getting sanction from the Department, although it lifted its recruitment freeze last month.

Professor Drumm told the Public Accounts Committee that he would be focusing on reducing the HSE's €85m bill for travel and meal expenses.

-

HSE accused of a systematic cull of medical cards lists

By Dearbhail McDonald Legal Editor Friday February 01 2008 ( Courtesy of Independent.ie)

VULNERABLE patients are being "systematically deleted" from the Government's medical card scheme.

The Irish Independent has learned that thousands of patients are being removed from the medical card list by the HSE because they are failing to return their review forms on time.

Medical cards are being deleted by the HSE prior to their actual review date -- in some cases they have been withdrawn a year before the official review date -- leaving patients who are entitled to free healthcare burdened with unnecessary costs.

Others are simply refusing to attend doctors' surgeries when they are sick, because they cannot afford to.

The first major study of the impact of the medical card review process has found that vulnerable patients, including those on low incomes, the illiterate, elderly and homeless, are being removed from the General Medical Services (GMS) list for non-return of review forms. The study, to be published in the 'Irish Medical Journal', has found that the gulf between eligibility for a medical card, and actual possession of one, is hindering access to healthcare for patients who need it most.

It found that 89pc of patients in a major Dublin practice were removed for non-return of review forms.

But interviews with a random sample of deleted patients revealed that 60pc had not received a review form from the HSE, even though all patients believed they were still entitled to a medical card.

Withdrawn

In addition, 60pc of patients were not informed by the HSE that their medical card had been withdrawn.

The vast majority of patients later re-applied and obtained their medical card, but in the period without medical cover -- up to a year -- a third could not afford to see their GP and paid "out of pocket".

"There is a hole in the bucket," said Dr Austin Carroll, an inner city Dublin GP who led the IMJ study.

Dr Carroll, who had 1,489 patients deleted from the medical card list in just over two years, said that a minor change to the medical card scheme (patients are now reviewed annually instead of every five years) has resulted in those who are eligible for free healthcare having their entitlement withdrawn.

"This study shows that a bureaucratic policy change has negatively affected access to health care," he said.

"And it is precisely the people who are more likely to need free healthcare are less likley to return their forms".

The rate of medical card removal by the HSE could explain why the Government, which has increased income guidelines in an effort to expand eligibility, has consistently failed to meet its own targets to increase the amount of people on the medical card list.

It is the first time the link between the Government's own target and its deletion policy has been made.

Last night the HSE was unable to provide its deletion figures, but the Government has insisted that the question of medical cards for vulnerable families is a priority.

Some 1,276,178 hold medical cards, according to the HSE and an additional 75,589 are GP Only card holders.

Date set for Dail Eireann protest over HSE cutbacks Oct 31, 4:27 am
A date has been set for people from all over the North West to protest outside the Dail over the recent downgrading of health services in the North West region.

It's expected that the demonstration will take place on Wednesday,

 November 21st.

This protest, follows last week's successful rally in Sligo, which saw almost 5000 people gather outside the Sligo Institute of Technology.

The protest was held in opposition to the recent downgrading of cancer care services at Sligo General Hospital and the rheumatology unit at Our Lady's Hospital, Manorhamilton.

(Courtesy of Ocean FM )