Continuation of service arrangements in place since 2009: Saolta.

Sligo News File Online.

General Hospital SligoSligo Regional Hospital /Saolta University Health Care Group have confirmed that Sligo patients recovering from a breast cancer diagnosis and treatment (surgery will continue attending University Hospital Galway for their follow up surveillance mammography. 

This, they have stated, is a continuation of the service arrangements that have been in place since 2009 and is supported by the National Cancer Control Programme as the most effective way of providing quality assured follow up services to patients who have undergone treatment for breast cancer.

Sligo patients will continue to receive chemotherapy locally at Sligo Regional Hospital as part of their treatment programme.

The Symptomatic Breast Cancer Service.
A comprehensive symptomatic breast cancer service is provided to patients from the west of Ireland at the Symptomatic Breast Unit based at Galway University Hospitals with a satellite service at Letterkenny General Hospital. This service is provided on the basis of clinical need and without regard to county boundaries.

The National Cancer Control Programme (NCCP) have set national standards against which all symptomatic breast services are measured: the Galway/Letterkenny service has consistently delivered on these standards ensuring that the best possible service is provided to patients in this part of the country. 

Galway/Letterkenny service is at the top of the league tables for quality of service: for example, 98% of referrals triaged as urgent by the cancer centre were seen within 2 weeks across both sites and 88% of routine referrals seen within 12 weeks.

In addition, Saolta conducted a survey of patient satisfaction, including 783 patients from Sligo: the overall results showed that 85% of patients rated the service as excellent and 13% as good. Therefore, both the NCCP’s key performance indicator assessments and patient satisfaction rating are extremely positive in relation to services provided in the West.

In 2009, when the symptomatic breast service transferred to Galway, it was envisaged that Sligo patients (those that had breast surgery in Sligo) or those who had surgery in Galway could avail of the option of surveillance mammography in Sligo. 

However Sligo Regional Hospital did not have sufficient numbers of trained mammography staff to maintain an onsite follow-up service. 
A commitment was given that the necessary staff would be provided but it did not prove possible to deliver on this commitment due to the difficulty in recruiting mammographers (despite numerous recruitment campaigns-there was worldwide shortage of mammographers).

In September 2012, University Hospital Galway took the decision to send two radiographers to be trained as mammographers but these were needed as part of the core service. At no stage did the level of mammographers reach that required to re-establish a service in Sligo. 

The Hospital Group remains committed to this training programme in order to ensure an adequate number of appropriately trained staff are retained within the Group.

Following evaluation within the Group, it was agreed that re-establishing a Sligo service would no longer be feasible due in the main to the following reasons:-
• Potential for fragmentation of the breast service.  There is a concern that this would not be in the best clinical interest of patients.  Given it is now more than 5 years since the cessation of the Sligo service, many women who already are receiving follow up in Galway would continue to avail of this option.   There is no longer Consultant Radiology backup in Sligo and therefore any woman requiring further investigation from a mammogram would need to travel to Galway for this service, with a potential for further delay in intervention.   
• In order for radiographers trained in mammography to continue to perform their role, they must meet quality assurance standards and minimum numbers of examinations per annum. There are insufficient numbers of surveillance follow up patients that would require mammography in Sligo Regional Hospital to maintain a radiographer’s skill set.

The vast majority of women who require mammography from Sligo and the surrounds attend a locally provided service, (i.e women between the ages of 50-64, through BreastCheck, the National Screening Programme). The service plan for next year includes an extension of this up to 70 years of age. 27,920 women attended the BreastCheck service in 2013

Cancer Services in Sligo
Approximately 500 inpatients, 5,200 daycases and 2,700 outpatients are treated between both Haematology and Oncology services across the catchment area of Sligo, Leitrim, South Donegal, West Cavan and parts of Mayo in Sligo Regional Hospital. 
The service in Sligo is committed to consistently achieving high quality evidenced based care for the management of cancer patients and patients with non-malignant blood disorders. It focuses on all stages of a patients’ journey: prevention, screening, and diagnosis, treatment, palliative and supportive care.

Some cancer surgery is provided in Sligo, whilst patients who require specialist cancer surgical treatments travel to either Galway or Dublin. 

Follow-on care including the administration of chemotherapy is provided in Sligo. In addition, on-site weekly Radiotherapy outpatient clinics are provided from Galway University Hospital whilst patients continue to travel to Galway for radiotherapy treatment.  

The service strives to achieve individualised, holistic and patient centred care to all patients and their families with the establishment of  strong links within Sligo Regional Hospital services, the North West Hospice Palliative Care Service, local community services and other designated Cancer Centres and in particular Galway University Hospital.   To this end, formal weekly Multi-Disciplinary Team meetings have been in place between Sligo Regional Hospital and Galway University Hospital for the past 4/5 years for a number of cancer subspecialties.  These include Lung, Urology, Breast, Lymphoma, and Gastrointestinal Multidisciplinary Team Meetings where staff discuss individual patients and their treatment plans on both sites. 

It is very important to note that patients from all parts of the west continue to receive an excellent service across the hospitals in the Saolta Group.  Integration across the hospitals within the Saolta Group and improved patient pathways remain a key focus in our efforts to provide a quality and safe service.