The hollow rhetoric of 'centres of excellence'

national | anti-capitalism | feature Tuesday June 10, 2008 16:18 by Marie O'Connor

Unmasking the national cancer strategy

Protest to save St. Lukes hospital,
a leading cancer care hospital in Dublin

The government is pursuing a policy of centralising health services into a small number of regional centres. The policy has been advanced under the title of "Centres of Excellence". But there is no evidence for the 'robotic centralisation' of acute hospital services, including cancer. But if you want to cut the the public health system––to make room for private ‘providers’––‘centralisation’ is a lethally effective way of doing it. And funneling all patients into a small number of large units facilitates the collection of specimens ...

Related Links: Previous indy.ie coverage

The news that St Luke’s Hospital was going to close was first heard from a property developer, I was told. Some time later, in July 2005, Mary Harney made the official announcement. Since then, there have been ongoing protests, all ignored by a Government increasingly out of touch with the people.

But whether or not property developers knew before the rest of us that Luke’s was to close, there is no doubting this Government’s intention to privatise cancer care. We have been trading in health care since 1953, when public hospitals were first allowed to divide their beds into public, private and semi-private. But is it only in the last 17 years that we have seen the galloping privatisation of our health services. Cancer care has been singled out as one of the profitable areas.

Trasnational companies have long identified chronic diseases as money-making. Here in Ireland, a British consultancy firm with long experience of advising on public-private partnerships in the NHS produced a report on the north-east in 2006. Teamwork advised shutting the region’s five public hospitals. Few saw the shadow of privatisation that loomed behind this outrageous recommendation.

Teamwork prepared the ground for private entreprise by dividing the health service into compartments that corresponded to niche markets long identified by corporations as profit or loss making.

This skewed report, a charter for privateers, has been adopted by the Government as the template for our health system. Our services are now to be structured along lines that suit the bottom line of companies that trade in patients.

But back to cancer. Chronic care was one of those compartments identified by Teamwork in its report. St Luke’s, for example, is a private not for profit hospital. For almost 50 years, it provided radiotherapy services to the nation. Now those services, widely acknowledged to be among the best of their kind, are to be terminated, and likely replaced by for profit providers.

‘A very nice little number for the private sector’ was how Anne Counihan described public-private partnerships in health. Anne Counihan knew what she was talking about: she was then CEO of the National Development Finance Agency.

The closure of St Luke’s is part of a bigger picture. The profit motive has entered the scene.

For some years now, in many countries, particularly in the US, cancer patients have been traded as commodities, like oil and gas, on the open market. The Government has decided to go down this route. The national cancer strategy, for example, involves a ‘deal’ that will cost taxpayers in excess of €400 million for facilities that include four large treatment centres to be built under public-private partnerships. Patients that would have been treated at St Luke’s will now go to two of these centres in Dublin.

There will be no more publicly provided radiotherapy in this country. In Donegal, Noelle Duddy, and Cooperating for Cancer Care North West, have been battling for years to get a public radiotherapy service. Now, a private hospital set to be built in Letterkenny plans to provide the service, under contract to the HSE, naturally. UPMC, the University of Pittsburgh Medical Centre, is tipped to provide the service.

The largest employer in Pennsylvania, UPMC is so big that its annual revenue amounts to almost half our national spend on health. UPMC is under contract to provide radiotherapy to public patients in Dublin, at the Beacon site, and in Waterford, at the Whitworth site.

Of the many American health care companies doing business in Ireland, UPMC was the only one to put its hands up last year and admit that it had paid fraud fines to the US Government. Ten years ago, the corporation paid $17m. to settle allegations under the False Claims Act. The US Justice Dept. charged that UPMC had defrauded government health insurers and unlawfully charged for using devices in heart surgery, such as stents, that had not been approved by the FDA. Six years ago, UPMC paid another fine, $2m, again under the False Claims Act.

UPMC now runs the Beacon Hospital, and is set to run the new co-located hospitals in Beaumont, Cork and Limerick, all hospitals in which it has a 25 per cent stake.

But back to cancer care. The latest round of privatisation saw the outsourcing of women’s smear tests last year to ‘clear a backlog’. The tests went to Quest labs in Chicago and Houston, Texas. Quest is another US company with a background in fraud. From 1996 – 2004, Quest paid nearly $300 million to the US Justice Dept to settle fraud charges. These included criminal as well as civil charges: they centred on defrauding government insurers and unnecessary testing.

UPMC formed a partnership with Quest in the US on lab services.

And our Government has just given Quest the national contract for smear tests for a period of 2 years. This will probably lead to the loss of 23 specialist laboratory staff in St Luke’s, and in other hospitals in Dublin and around the country. But as well as leading to significant job losses, stripping out the labs in our public hospitals is bad for patient care. It makes a nonsense of what has been held up as the gold standard––triple assessment. If you are a doctor treating a patient, you can hardly go and have a chat with an electronic signature on a smear test result. And that signature may well belong to a pathologist who has never seen the specimen.

It is common practice in US labs to attach the electronic signature of a doctor to smear test results, even where that pathologist has never seen the slide. Only if the technician spots a problem is the slide referred to a pathologist––this is the standard laid down by the American College of Pathologists. Slides in US labs are reviewed by technicians who may only have 3 months’ training––unlike medical scientists here. In Irish laboratories, every member of staff who looks at a slide has a primary, and, in many cases, a postprimary degree.

Spiralling lawsuits against a lab in Magee Women’s Hospital in Pittsburgh––owned by UPMC––focused attention on the human lab testing industry in US. Standards in the industry are reported to be low. Huge volumes have not prevented botches in cancer testing. Mixed up and misread samples have resulted in unnecessary deaths from cancer, and unnecessary cancer treatment, including surgery and radiation. These are the risks the Government is prepared to run––for the sake of a tender that they say is three times cheaper. What if the quality is three times worse?

Double standards in cancer care need to be exposed. Mary Harney, for example, has publicly boasted of UPMC’s electronic link to a private cancer centre in Pittsburgh, but she has firmly ruled out the idea of a network that would allow public hospitals in Sligo and Castlebar to link to University College Hospital Galway.

There is no evidence for the robotic centralisation of acute hospital services, including cancer. But if you want to cut the the public health system––to make room for private ‘providers’––centralisation is a lethally effective way of doing it. And funneling all patients into a small number of large units facilitates the collection of specimens–– ‘clinical material’ for company R&D––and, the hope is, corporate profits.

Some of the best health services in the world, as in The Netherlands and British Columbia, provide decentralised cancer care. We could learn from them, if we were prepared to prioritise patient needs over business interests.

Cancer misdiagnoses have been made in a number of hospitals in Ireland, including large public teaching institutions and small private for profit clinics. No fewer than three of the eight hospitals designated as cancer ‘centres of excellence’ have made mistakes. Human error can never be eliminated.

It is high time we saw through the hollow rhetoric of ‘centres of excellence’. And it is high time the national cancer strategy was unmasked for what is is––a national privatisation strategy.
© Marie O’Connor