A team of breast cancer consultants and specialist nurses at Cork University Hospital have clashed with senior management over services at the hospital.
In a letter from the Breast Multidisciplinary Team, dated 31 October, clinicians say there is a huge issue accessing bone scans currently "resulting in ongoing delays in initiating treatment for our cancer patients".
The letter, seen by RTÉ News, was sent to CUH Chief Executive Tony McNamara on behalf of breast clinicians, which include many consultant surgeons, radiologists, pathologists, oncologists and radiographers.
It said that the workload for the unit had increased but the resources available had decreased significantly.
The letter states that the maximum capacity of the unit is for 140 new patients a week, when all surgeons are present.
It said that the unit is currently in receipt of 150-160 referrals on a weekly basis, with a record 50 referrals to the unit on one day recently.
The clinicians have complained about reduced staff, unfilled posts and ageing equipment and that "the breast team feels demoralised".
The breast team held an emergency meeting on 25 October to discuss correspondence from Mr McNamara to the Health Service Executive’s National Director for Acute Operations.
Mr McNamara has proposed a quality improvement plan for the unit and new governance.
In a letter to the executive board, dated 1 October, Mr McNamara said there was inconsistency in the organisation, administration and clinical governance of the breast service and that it cannot continue.
The breast clinicians have rejected any suggestion that the team is under-performing, given the resources and increase in patients.
The team said there had been a 28% increase in patients seen by the symptomatic breast clinical at Cork between 2010 and 2016 and that one of the problems he said was a poorly designed referral form for GPs and "perceived easy access to the CUH breast service".
The letter adds: "No reasonable assessment of a scenario whereby there is a huge increase in numbers of patients being assessed with decreased resources could regard this as under-performance".
The clinicians said that that the more important indicators of performance are, access to high quality diagnostics, cancer detection rates, quality of cancer care and clinical outcomes.
They have described deterioration in the relationship between management and clinical staff at the breast centre and an "atmosphere of isolation, suspicion and lack of trust, along with poor communication."
The clinicians said an external review could be of merit and that several recent external inquiries into the HSE have focused on weakness in governance and its impact on patient care.
In a statement, CUH said the executive management board had been aware for some time of a number of issues pertaining to the delivery of the symptomatic breast service.
It said the hospital had invested significantly in the breast care team, with the support of the National Cancer Control Programme and the team provided a very high level of care to very many patients each year.
The hospital said it was working with the team to address the issues that will result in further improvements to the service.
It has asked the directors for cancer care and surgery to follow up with the breast team and report back to the board within a month.
