Radiotherapy centre was regarded as one of the five ‘highest priority’ projects

Following a request under the Freedom of Information Act, the Department of Health, Social Services and Public Safety has furnished the Sentinel with a number of documents which include the early drafts of the controversial statement made by then Health Minister Michael McGimpsey on the last day of the Assembly.

There are a number of documents dated March 14 2011, labelled as Draft Ministerial Capital Announcement for 15 March 2011.

The department also provided times of when the original draft was produced, and subsequent re-drafts.

The first version of the ‘Draft Ministerial Announcement for 15 March’ is timed at 14:01 and clearly states that the radiotherapy unit at Altnagelvin is amongst the five highest priorities and that the minister is announcing construction can begin.

What the statement says is: “Of the £851m allocated to my department:

*£250m is already committed on projects that are underway

* £400m is required for essential on-going annual capital expenditure such as maintaining existing services, the replacement of critical clinical equipment and emergency vehicles, the purchase of pandemic flu vaccines and investments in decontamination and ICT.

* This would leave just over £200m for the next 4 years to address all new investments required.

“Under these circumstances I no longer have the funding necessary to proceed with many important projects that are needed to improve the quality, safety, effectiveness and efficiency of services. I have had to do a very difficult balancing exercise to decide on a programme of work for the next 4 years.

“There are a number of projects which I feel I have no alternative but to progress despite the enormous constraints on both capital and revenue that I face. Even these essential projects can not be delivered as soon as I would have wished in order to make them affordable within the budget allocations and as a result other much-needed projects will not now be able to start.

“Today I am announcing that, subject to normal business case processes, construction can commence on the following schemes.

“Amongst these the five highest priorities are

* The next phase of the Ulster Hospital redevelopment

* The new satellite radiotherapy unit at Altnagelvin

* The new regional Women’s Hospital at the Royal

* The new enhanced local hospital at Omagh

* And a new acute psychiatric facility at the Belfast City Hospital.”

Another number of additional projects would also proceed as they were seen as “vital to strengthening and reconfiguring the HSC estate”. These included a new A&E Department and Ward Accommodation at the Antrim Hospital, new Operating Theatres at Craigavon Hospital, and new Health and Care Centres in Ballymena and Banbridge.

In the drafts timed 14:53 and 16:19 the radiotherapy unit remains among the five highest priorities.

In the statement drafted at 16:19 the headline still read ‘Draft Ministerial Capital Announcement for 15 March 2011’, and this changed to ‘16 March’ on a draft timed at 18:29.

However in the draft ministerial announcement timed at 18:29, there are now no highest priorities identified. Instead the statement announced that, subject to normal business case processes, “construction can commence during the budget period on the following high priority schemes

* The next phase of the Ulster Hospital redevelopment which will replace the current Ward Block

* The new regional Maternity Hospital at the Royal

* The new enhanced local hospital at Omagh

* A new acute psychiatric facility at the Belfast City Hospital.

* A new A&E Department and Ward Accommodation at the Antrim Hospital

* New Operating Theatres at Craigavon Hospital

* And new Health and Care Centres in Ballymena and Banbridge.”

The statement now said: “There is also a critical need to provide additional radiotherapy services at Altnagelvin Hospital but the final affordability of this is dependent on the outcome of discussions with the new Government in the Republic of Ireland, who will be contributing towards the costs of this project, and the ability to identify additional revenue costs associated with the development of this specialist unit.

“These projects will take up the vast majority of the available capital for new schemes. The remainder of this budget will be used to facilitate a number of smaller critically needed projects.”

The DHSSPS has also provided (under FoI) an email from Margaret McIvor at the Western Trust timed at 14:36 on March 14 to a Michael McGinley.

It followed a telephone conversation the previous Friday and asked Mr McGinley to find attached “a few paragraphs I have written from information provided by staff from the Belfast Cancer Centre during a recent presentation”.

Ms McIvor tells Mr McGinley that even with an increase from eight to ten linear accelerators in Belfast by 2013/14, demand was still rising at such a rate that it was “essential” for radiotherapy services in the North West to transfer to the new unit by 2016.

Her email said: “In 2009/10 the radiotherapy activity at the Cancer Centre, Belfast was 61,876 fractions, provided by 8 linear accelerators. This activity is predicted to reach 62,781 fractions by the end of 2010/11. When this activity is compared with a total capacity of 61,760 per year (7,720 fractions per linac by 8 linacs, as per a recent review) it is clear that the Cancer Centre has maximised its capacity within its current funded resources.

“A business case is currently being considered by HSCB/ PHA to meet increases in demand at the Cancer Centre until the Altnagelvin Radiotherapy Unit opens. On the basis of historical activity increases only, ie a 5% increase in demand per year, the number of linear accelerators needs to increase from 8 to 9 machines as soon as possible, and not later than 2012/13. By this time, it is predicted that approximately 70,000 fractions will need to be delivered for cancer patients in Northern Ireland. At a capacity per machine of 7,720 fractions, this equates to 8.97 linear accelerators.

“A further increase to 10 linear accelerators in the year 2013/14 is required to meet further growing demand, to enable the planned replacement programme of the existing machines to proceed (an essential requirement to improve the technological capabilities of the service) and also to provide the infrastructure to train the workforce of the Altnagelvin unit.

“Radiotherapy demand at this point, again on the basis of historical activity, is predicted to be approximately 72,500 fractions, increasing to approximately 76,500 in 2014/15. By 2016, it is essential that radiotherapy services for patients in the north-west will transfer to the new unit at Altnagelvin to meet service demands up to 2020.”

This email was timed at a stage when Altnagelvin radiotherapy unit was still marked as one of the five highest priority projects: however the satellite unit was later that day removed from the list of priorities on which work could start.

And in the final statement delivered on the last day of the Assembly, Mr McGimpsey announced that construction could start on those ‘high priority’ schemes identified in the announcement drafted at 18:29 on March 14 - just hours after the original draft statement regarded the satellite radiotherapy unit as one of the “five highest priorities”, which there was “no alternative but to progress despite the enormous constraints on both capital and revenue”.

But in his final version the Minister now said about the Altnagelvin project: “I remain committed to the future development of the Altnagelvin radiotherapy unit. However the present budget proposal seriously undermines the ability to deliver this because of the absence of revenue funding and the reduction in capital resource available to my department.

“Revenue is critical to the project. Decisions were to be taken in 2011-12 to commence the necessary specialised training of staff for them to be fully trained and available when the project opens in 2016. These include oncologists, radiologists and radiographers. The current budget does not enable the decision to be taken.

“This project is also dependent on the new Government in the Republic of Ireland; we must ensure they are still committed to contribute towards the costs of this essential scheme.

“I remain totally committed to ensuring that people with cancer in Northern Ireland have access to the radiotherapy services they need. Therefore I will ask the Board to put arrangements in place to introduce the two new radiotherapy machines at Belfast City Hospital over the next two years. They will help provide the capacity that is needed in the short to medium term, while the longer term service issues are being resolved.”

The documents also show that Mr McGimpsey received assurances of financial backing from the Republic in February, though the latest assurance - from the newly elected Government - came a few hours after he had already delivered his statement to the Assembly.

The Sentinel put a number of questions to the Department of Health, including: whether Ms McIvor’s information would have been given to the Minister; why the unit was regarded as a highest priority at 16:19 yet, despite Ms McIvor’s communication, it was demoted and lesser projects elevated above it by 18:29; whether Mr McGimpsey was personally involved in the drafting and re-drafting of these statements; and whether previous assurances from the Republic, including the assurance given in February, would not have been enough for the Health Minister to proceed.

In response to our queries, a DHSSPS spokesman said: “As with most significant announcements a series of drafts were produced by officials. However, it was the final version which represented the points the Minister wished to communicate to the Assembly.

“The letter of assurance was received in February from the outgoing Government of the Republic.”