Health (Miscellaneous Provisions) Bill 2010: Second Stage

Thursday, 3 June 2010

Dáil Éireann Debate
Vol. 711 No. 3

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Minister for Health and Children (Deputy Mary Harney): Information on Mary Harney  Zoom on Mary Harney  I move: “That the Bill be now read a Second Time.”

I am pleased to have the opportunity to introduce to the House today the Second Stage of the Health (Miscellaneous Provisions) Bill 2010. The Bill has several purposes. Its main purpose is to give further effect to the Government’s cancer control strategy and, in particular, the development of radiation oncology services under the national plan for radiation oncology. The plan will result in the expansion of public radiation oncology services, integrated with surgical and medical oncology. It includes the integration of St. Luke’s Hospital, Rathgar, into the HSE’s national cancer control programme. Accordingly, this Bill dissolves the board of St. Luke’s Hospital and transfers the hospital and its staff to the HSE.

Deputies will recall that the Health (Miscellaneous Provisions) Act 2009 provided for the integration of the national cancer screening service into the national cancer control programme. Cancer screening is an intrinsic component of cancer control and integrating it into the cancer programme ensures that services and resources in the fight against cancer are co-ordinated. Similarly, the provision of radiation oncology services is an intrinsic component of cancer treatment. The Bill makes provision for the integration of St. Luke’s Hospital into the HSE’s cancer programme as in the case of last year’s legislation for the cancer screening service.

The Health (Miscellaneous Provisions) Bill 2010 also provides for the discontinuance of the infectious diseases maintenance allowance originally introduced in 1947. Currently, no person is in receipt of this allowance and there are in place a number of other schemes through which financial and other supports are provided to such persons. Finally, the Bill contains a number of minor technical amendments. First, it makes technical amendments to the Nursing Homes Support Scheme Act 2009 and the Health (Nursing Homes) Act 1990 to assist in the interpretation of these Acts. Second, it makes a technical amendment to the Health Act 2007 which relates to decisions taken under section 55 of that Act. Third, it makes textual amendments to the Medical Practitioners Act 2007 to correct typographical errors. I propose now to give an overview of the main policy areas of the Bill and then to set out its provisions in more detail.

The HSE’s national cancer control programme, NCCP, was established and approved by Government in 2007 to give effect to the National Cancer Control Strategy 2006. The strategy sets out the future framework for delivery of cancer treatment in Ireland. It also endorses the national plan for radiation oncology which had been approved by Government in 2005. [615] Implementation of the programme involves the transfer of diagnostic, surgical and radiation oncology services to designated centres, each with a critical mass of expertise, sufficient throughput of cases and a high concentration of multi-disciplinary specialist skills. This approach is supported by international evidence which demonstrates that the concentration of cancer services in large volumes in specialist centres produces superior outcomes.

The re-organisation of breast cancer diagnosis and surgery into the eight cancer centres has been the most high profile aspect of the work of the cancer programme to date. This has been a significant and a challenging task. Its completion late last year marked a major milestone for the cancer programme. HIQA’s assessment of the symptomatic breast cancer services in February this year found that all the fundamentals are now in place in the eight centres to ensure safe, quality care for patients, which is very positive confirmation of the progress that has been made.

Considerable progress has also been made on services for other cancers. An important development is the establishment in each of the eight centres of rapid access diagnostic clinics for lung and prostate cancers. These clinics will speed up access to diagnosis and multi-disciplinary decision-making for patients whose symptoms are indicative of these cancers. So far, we have six lung clinics and five prostate clinics and the remainder are due to be established this year.

Good progress is also being made on the re-organisation of surgical services for pancreatic and rectal cancer. There will be one national centre for pancreatic cancer surgery at St. Vincent’s Hospital in Dublin, while rectal cancer surgery will be carried out in each of the eight centres. The community oncology programme is a more low profile aspect of the cancer programme’s work but an extremely important one. The major focus of this programme is to create capacity and knowledge among health professionals in the community to promote best practice in cancer control. These initiatives are all part of the overall implementation of the cancer control strategy.

Demand for cancer services, including radiation oncology, will continue to increase in the coming years as the population ages. The 2003 report of the expert group, known as the Hollywood report, recommended the development of a clinical network of large centres. The national plan for radiation oncology was approved by Government in 2005 and was, as I have already stated, endorsed in the 2006 cancer control strategy. Its aim is to provide new or additional radiation oncology facilities in four cancer centres, namely, St. James’s Hospital, Beaumont Hospital, Cork University Hospital and University Hospital Galway. There will also be satellite facilities at the Mid-Western Regional Hospital, Limerick, and at Waterford Regional Hospital.

Implementation of the plan is under the governance of the cancer control programme and is well under way. Construction of new facilities at St. James’s and Beaumont Hospitals will be completed this year. When the new facilities come on stream, they will increase radiotherapy capacity significantly. We will have 12 linear accelerators in the public system in the eastern area as compared to only eight now. St. Luke’s Hospital, Rathgar, is the largest provider and the most specialist centre for radiotherapy in Ireland, with an international reputation. The two new facilities at Beaumont and St. James’s will come together with St. Luke’s Hospital to form the St. Luke’s Radiation Oncology Network. The new facilities will be under the governance of the cancer programme.

To facilitate the establishment of the St. Luke’s network, the then director of national cancer control programme, Professor Tom Keane, advised that there should be a single governance model and that therefore St. Luke’s Hospital should also come under the governance of the cancer programme. St. Luke’s Hospital board was established by statutory instrument in 1999 [616]as a voluntary hospital under the Health (Corporate Bodies) Act 1961. Providing for the effective delivery of radiation oncology services as a fully integrated component of the cancer control programme is the main purpose of this Bill. Accordingly, the Bill provides for the dissolution of the board of St. Luke’s and the transfer of St. Luke’s staff and facilities to the HSE.

This means that all staff of the new network will be employees of the HSE and not of any individual hospital. This will facilitate the transfer of employees between locations, subject of course to the usual industrial relations mechanisms. It will allow for a single referral facility, a single management structure and shared support services across all three sites. Additional development funding and 54 posts have been provided to the cancer programme this year for the new centres. In addition to these, some staff and resources will transfer from St. Luke’s to the new centres in the second half of this year.

In 2014, when the national plan for radiation oncology will have been completed and further capacity will have been developed at St. James’s and Beaumont, all remaining staff and resources will transfer from St. Luke’s Hospital to St. James’s Hospital or Beaumont Hospital and radiotherapy will no longer be provided at St. Luke’s.

Deputy Jan O’Sullivan: Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  On a point of order, a copy of the Minister’s script is normally circulated to Members if the Minister is reading from one. Are copies of the script available?

Acting Chairman (Deputy Brian O’Shea): Information on Brian O'Shea  Zoom on Brian O'Shea  We have not received copies of it yet. I take it they are on way.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  They are. Apologies for that.

From 2014, therefore, all publicly-funded radiotherapy services in Ireland will be provided as part of an integrated multidisiplinary service involving surgical, medical and radiation oncology. This is in keeping with the recommendations of the Hollywood report.

That there has been great loyalty and support for the hospital over the years from patients and their families who have experienced the services of St. Luke’s and also from staff and from the wider community. St. Luke’s has combined technical excellence with outstanding patient care. The commitment, expertise, tradition and ethos of the hospital and its staff should not be lost when services move from the site itself in a number of years from now. This was acknowledged by Government in 2005 when it approved the plan.

With the establishment of the St. Luke’s network, we have a duty to ensure that the less tangible but immensely valuable aspects of St. Luke’s are as much part of the provision of the new services as its more tangible resources. Staff can play a key role here and therefore it is to be welcomed that St. Luke’s staff will be in place in all three centres in the network from its establishment.

As many people will be aware, there are organisations that are closely associated with St. Luke’s but that are at the same time separate entities. They are not encompassed within this legislation, nor should they be. My Department has liaised closely with the board of St. Luke’s on the future of these organisations — the St. Luke’s Institute of Cancer Research and the St. Luke’s Cancer Research Fund. The focus of both these entities is on cancer research and the continued development of expertise and knowledge and there is widespread agreement that this should continue into the future. I understand that the board of St. Luke’s is taking the necessary steps to ensure that these organisations continue to have legally sound structures following the enactment of this legislation and I very much welcome this.

I also want to mention the significant work that has been done by the Friends of St. Luke’s Hospital over many years. To date, I understand that the friends of the hospital have raised [617]more than €26 million in funds for various projects within the hospital. The friends of the hospital have been a major force in fundraising for radiation oncology services over the years and I understand that those involved wish to ensure that the great goodwill and support for St. Luke’s in the community can continue to benefit cancer patients into the future.

Another key policy area of the Bill relates to the reallocation of certain functions from the health sector to the Department of Social Protection. The Government decided some time ago that in order to increase the effectiveness of the health service generally, it was important that the service concentrated fully on addressing its core health objectives. Accordingly it was felt that there could be scope to transfer certain functions out of the health service and locate them more appropriately within other Departments.

The subsequent Core Functions of the Health Service Report 2006 found that there were a number of schemes which were seen to be more income supports than personal social services. A number of implementation groups were set up to carry out the transfer of functions. One of these, the interdepartmental group on non-supplementary welfare allowance payments, was given specific responsibility to examine the transfer of income supports to the Department of Social Protection. A total of 25,000 domiciliary care allowance cases transferred from the HSE to that Department in 2009. In this context the infectious diseases maintenance allowance, IDMA, was examined by the group. The IDMA was originally introduced in 1947 for a specified list of diseases, including TB.

In a situation where policy is moving towards mainstreaming supports for people with a disability, the sustainability of a separate income support payment for a prescribed set of diseases must be questioned. The group found that the key objectives of the scheme were now met by other allowances, in particular the disability allowance and supplementary welfare allowance. The incidence of the specified infectious diseases has been steadily declining and the number of people in receipt of the allowance in 2009 was fewer than 20. The group therefore decided to ask the HSE to examine the small number in receipt of the allowance with a view to establishing their eligibility and suitability for transfer to the appropriate equivalent Department of Social Protection.

The HSE completed its examination of the small number of recipients in 2009. It found that some were no longer eligible for the allowance and others were suitable for transfer to the appropriate Department of Social Protection. It should be noted that the weekly payment rates for this allowance, the supplementary welfare allowance and the disability allowance were the same and therefore those who transferred to a new payment were not disadvantaged.

The HSE has informed my Department that no one is currently in receipt of this maintenance allowance and there are no applications or appeals on hand. Therefore, it has been decided to remove the infectious disease maintenance allowance from statute by repealing section 44 of the Health Act 1947 and section 36(2) of the Health Act 1953.

I will refer to the principal features of the Bill. Part 1, comprising sections 1 to 4, inclusive, contains standard provisions dealing with the Short Title, commencement, definition and expenses. Section 3 removes the Health Service Executive’s duty to provide an infectious diseases maintenance allowance and also revokes the St. Luke’s Hospital Board (Establishment) Order 1999. Parts of the legislation will come into operation by ministerial order and different provisions will be brought into operation at different times.

I will deal with the specific provisions of the Bill that relate to St. Luke’s, that is, Part 2 of the Bill, sections 5 to 13, inclusive. Section 5 provides for the board of St. Luke’s Hospital to be dissolved.

Section 6 provides for the transfer of land and other property of St. Luke’s to the HSE. The Bill also includes a provision that the site may not be disposed of in any way without the [618]permission of the Minister. Many people will be familiar with the location of St. Luke’s and the attractive grounds of the hospital. How this site may be used in the future will be on many people’s minds. I understand that the Friends of St. Luke’s and the board have been considering the future use of the hospital after 2014 and I understand that proposals will be submitted to me in the near future in this regard. I look forward to receiving these proposals. I have previously stated that I believe St. Luke’s has a future within the public health service and I will consult with the friends of St. Luke’s, the HSE and other interested parties on how the site could best be used for the benefit of patients.

Sections 7, 8 and 9 are standard provisions dealing with the transfer of rights and liabilities of St. Luke’s board to the HSE, the preservation of contracts and pending legal proceedings.

Section 10 relates to the transfer of St. Luke’s staff to the HSE. The transfer of staff is being done to support the future provision of radiation oncology services within a network model. For staff, some of whom will transfer to other sites in the network at the end of this year, and some of whom will remain at St. Luke’s for a number of years to come, this provision provides certainty as regards their future conditions of employment. All current employees of St. Luke’s at the date of transfer will become employees of the HSE on conditions and pay that are no less beneficial than those that they currently have. Superannuation benefits and reckonable service will also transfer with the employees. Furthermore, the Bill provides that the pension liabilities of St. Luke’s will now become the pension liabilities of the HSE. This Bill therefore provides certainty about the future for pensioners of St. Luke’s also. These provisions are similar to those under which the national screening service staff transferred to the HSE in April of this year.

Sections 11, 12 and 13 are standard provisions dealing with the transfer of records and the preparation of a final report and final accounts of St. Luke’s Board for submission to the Minister and the Oireachtas.

Part 3 of the Bill, sections 14 to 17, deal with various miscellaneous technical and textual amendments. Section 14 updates the definition of “nursing home” in the Health (Nursing Homes) Act 1990 to reflect the new legal framework for the regulation of nursing homes, namely the Health Act 2007. Section 15 is a technical amendment to the Health Act 2007 to enable a decision by a chief inspector of social services to take immediate effect in cases where the registered provider or applicant informs the chief inspector that he or she accepts the decision. Section 16 makes textual amendments to the Medical Practitioners Act to correct typographical errors. Section 17 updates the definition of “proprietor” in the Nursing Homes Support Scheme Act to reflect the new legal framework for the regulation of nursing homes. It also amends the definitions of “allowable deduction” and “minimum retained income threshold” to ensure that they take account of situations where both members of a couple enter long-term residential care.

The contribution of St. Luke’s Hospital board and its staff to the provision of cancer services has been immense. I take this opportunity to acknowledge this contribution and to thank the board members, the management and staff for their commitment and dedication. It is also very important to say that the board has provided great support and co-operation for the process of integration into the cancer programme.

I look forward to the ethos and sense of professionalism, which is so much a part of St. Luke’s, contributing to the continued successful implementation of the cancer control programme and in particular the new St. Luke’s radiation oncology network.

I commend the Bill to the House.

[619]Acting Chairman (Deputy Brian O’Shea): Information on Brian O'Shea  Zoom on Brian O'Shea  Deputy James Reilly has 30 minutes.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  With the Acting Chairman’s permission, I wish to share my time with Deputy Neville. I shall speak for 20 minutes and he for ten. Perhaps the Acting Chairman will let me know when I have a minute left.

Acting Chairman (Deputy Brian O’Shea): Information on Brian O'Shea  Zoom on Brian O'Shea  Agreed.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  I welcome the opportunity to speak on this important Bill, which provides for the dissolution of St. Luke’s Hospital board and the transfer of its employees, assets and liabilities to the Health Service Executive. It is important to note that this Bill also provides for the amendment of the Health Acts 1947 and 1953 to discontinue the infectious diseases maintenance allowance, about which the Minister has informed us, and provides for technical amendments to the Health Nursing Home Act 1990, the Health Act 2009 and the Nursing Home Support Scheme Act 2009.

For more than 55 years, St. Luke’s Hospital, in the Dublin suburb of Rathgar, has been caring for cancer patients from all over Ireland. Since its formal opening in May 1954, hundreds of thousands of patients and their families have been through its doors and experienced the excellent care that the hospital and its staff have provided at its unique site at Oakland.

I echo the Minister’s praise for the board of St. Luke’s Hospital and for the Friends of St. Luke’s who have contributed so much and raised so many funds over the years. I would be very concerned that the wonderful ethos that exists in that hospital should continue into and infect our general oncology services. I must put it to the Minister that the HSE has not had that ethos at its centre. I shall refer to that later in terms of people’s experiences. The progression of today’s Bill reminds us of the many changes that have taken place in the provision of cancer care services since the publication of the Cancer Care Strategy in 2006.

This Bill reminds us of individuals such as Rebecca O’Malley and Susie Long who brought the failings of our cancer services to the nation’s attention. The late, very brave Susie Long paid far too high a price for the dysfunctional system of our cancer services. The passing of this Bill also reminds us of the situation in Portlaoise where 97 women needed to be recalled after their ultrasounds were reviewed and were left waiting for contact until a sufficient “cohort” of files was reached. What on earth was meant by that? One still wonders but what I found repugnant about it, and what the people of this country found repugnant, was that a health service could form the view that it would deal with people when it felt it was appropriate, in terms of a magic number arbitrarily decided by somebody, as to when it would be worth its while to deal with women, some of whom transpired to have cancer.

When we think of that ethos we think of the north east where the people, having had 6,000 X-rays and ultrasounds performed on 4,500 of the population, needed to have those re-examined because of a question mark over the competence of the individual who initially read them. Despite knowing in September 2007 there was a problem, this HSE system took no action until May 2008. Several people died. We do not know whether their demise was unavoidable in any event but to make a cold callous decision of that nature is something abhorrent to me, as a doctor and as an Irish citizen. Therefore, I hope our new cancer centres will absorb and embrace the excellent ethos of St. Luke’s Hospital which always looked at patients from an holistic perspective, not looking only to their radiological and oncological needs but also looking to their social needs and had the ability to provide them with an experience that would mimic the home as much as possible. That ethos is what makes St. Luke’s so famous and such a success. Rarely have I heard patients complaining about St. Luke’s. Unfortunately, the same cannot be said about the rest of our services.

[620]The Minister alluded to colonoscopy and bowel cancer screening. These are to be welcomed. At the beginning of 2009, the Minister instructed the HSE to ensure that patients needing an urgent colonoscopy should not have to wait more than four weeks following referral from their general practitioner. More than a year later, high numbers of patients continue to wait excessive lengths of time for colonoscopies. The Irish Cancer Society recently reported there are 951 people waiting more than three months for a colonoscopy. That data were provided to the Irish Cancer Society by the National Treatment Purchase Fund. As the Minister well knows, the consequences of long waiting times for these tests can be fatal, as they were for the late and very brave Susie Long. We must sort this out or there will be more unnecessary deaths.

Last January, the Minister announced the roll-out of a colorectal cancer screening programme for people aged between 60 and 69. However, this programme will not commence until 2012, in selected hospitals. As the Minister knows, colorectal cancer is the second most commonly diagnosed cancer among men and women in Ireland, with approximately 2,200 new cases diagnosed every year and of which approximately 1,000 people die. Given the seriousness of the illness Fine Gael looks for an earlier roll-out of the programme and the immediate expansion of this programme to younger age groups. To wait until 2012 does not seem reasonable when this disease is such a major killer of Irish people, men and women alike.

I believe a real opportunity has been missed in regard to colonoscopy. Colonoscopy is a procedure that can be carried out safely in an outpatient setting. We all understand the need to provide more care in the primary care community setting rather than in hospitals, where appropriate. Therefore, the fact that only hospitals are applying for the additional colonoscopy capacity rather than primary care centres being encouraged to do so is a huge missed opportunity. There is no reason that these procedures could not be carried out in major primary care centres.

I do not intend to embark on a long dissertation on the lack of progress in the roll-out of the primary care strategy which was announced in 2001 and has delivered so little to date. When we are planning new services we should look to where they can be provided most cost effectively and conveniently for patients. I believe this is the case with colonoscopy.

I will provide a context for where we stand. Demographically, we are heading for a great increase in the number of people aged over 85 years of age. By 2021 the numbers will more than double from the present figures, as will the age group between 74 and 84 and 65 to 74. If memory serves me correctly, today’s figure is 510,000 people aged over 65 years. By 2021 this will have risen to more than 900,000. Unfortunately, there will be more cancers because, as people live longer they are more likely to develop the disease. We need early intervention because the country will go broke if we do not change the way we are delivering health care. As much as possible, this should be delivered through primary care which is cost effective and convenient for patients.

This morning I had the pleasure of launching a book by Joe Ahern and John Whelton, “Applying “Lean” to Healthcare”, based on the Toyota manufacturers’ new approach to creating efficiencies in their factories. It has been applied to health care in Ireland and abroad, and I have two examples. The metabolic lab in Temple Street hospital has, through reorganisation of people’s work and where equipment was placed, reduced a 30-day turnaround to five days. That was without any new tests or modalities. As we are talking about cancer services, the oncology unit in St. James’s Hospital used the lean approach and significantly improved patient satisfaction ratings, service to patients and efficiency. We will need more of that in future, along with close scrutiny of how we deliver care and the various players — front line and others — operate together in their work.

[621]I am a fan of treating the patient at the lowest level of complexity that is timely and safe. To put this simply, we do not want to see nurses taking blood samples when phlebotomists should be doing it, GPs taking blood pressure readings when nurses could do it or consultants reading ECGs when GPs can do it. It is about appropriate services from appropriate clinicians. As the Minister knows, 800 pharmacists have been trained by the Royal College of Surgeons to deliver safe adult vaccines. Vaccination programmes in America and many other places are run on such a basis so there is a whole new role for other members of primary care teams.

There was an excellent programme in St. Mary’s orthopaedic hospital in Cork, which is mooted to be closed with the physiotherapy unit to be shoehorned into a very small space in the South Infirmary. Its study, which replicated one in England, showed that the number of referrals to consultant surgeons could be reduced by 40% if patients were given appropriate physiotherapy and exercises. There are many ways to improve the way we deliver care and we must consider the matter. According to the VHI, the health bill will be €37 billion by 2021. Although I do not necessarily accept the figure, it sparks a necessary public debate nonetheless.

The main provision of this Bill is the dissolution of the board of St. Luke’s Hospital. It is a statutory body funded by the HSE and is currently the largest provider of radiation oncology services in Ireland. The Minister has told us two new radiotherapy centres at St. James’s Hospital and Beaumont will open at the end of 2010 under phase one of the national plan for radiation oncology. It is important to note that the full network of radiation oncology services as promised under the national network for radiation oncology was supposed to be rolled out by 2011 but, like so much else, this will not happen and the deadline has been extended to 2015.

In July 2005, the Government announced a decision to move the services at St. Luke’s to the site of St. James’s Hospital as part of the national radiotherapy network. Radiotherapy services will continue to be delivered at St. Luke’s until at least 2014, when additional capacity is scheduled to come on stream under phase two of the national plan for radiation oncology. On this occasion, I congratulate the Minister on not doing away with the existing service before the new service comes on stream, as has happened in so many places like the mid-west and others.

We need this capacity as our general capacity in the health service is creaking at the seams. I raised earlier the fact that 52 beds have been closed in Beaumont, which is one of the proposed centres. We were told today that 60 beds are to be closed in the Mater, a surgical ward closed in Cavan, beds were closed in Portlaoise and Roscommon and there has been a major bed closure in Portiuncula. The bottom line is that patients cannot access the service; it does not just come down to numbers and figures.

I was informed today by a colleague of a female patient in her 40s who attended a Dublin hospital in December last year. She was kept in the accident and emergency department for two days, having been advised that she needed to be admitted to the hospital because of a serious heart arrhythmia, which is an irregular heartbeat. That predisposes her to ventricular fibrillation and cardiac arrest.

After 48 hours in the accident and emergency department, she was informed there was no bed and she could not be admitted. She was sent home on medication and advised she would get an early appointment. That early appointment is for 13 August this year. The lady is experiencing symptoms and has been back and forth to her GP and the accident and emergency department. This is no way to treat people. The woman continues to be at risk and may need a surgical procedure, which is why she was to be admitted. This illustrates a broken health service that is not working or delivering.

The excellence in the service provided at St. Luke’s is about staff attitude to the patient and people in general, seeing the patient as a person rather than a number at the bottom of a page. [622] I hope that ethos will be taken up by broader HSE services but this will not be possible if the capacity does not exist.

I mentioned the north-east region earlier. Hospitals such as the Mater and Beaumont, along with Cavan, have been affected and the facility in Monaghan is gone. Services are being shoehorned through Drogheda to the Dublin hospitals which cannot cope. They do not have enough beds but we cannot reduce emergency admissions by 33,000 when we do not have the facilities in the community to prevent those emergencies from developing. We will probably see more emergencies developing as people wait longer for elective surgery without getting it. A problem which may be treatable in an elective planned fashion could become an emergency, and everybody in the House knows that when there is emergency surgery, the chances of an optimum outcome are reduced when compared to planned surgery.

I would appreciate if the Minister could arrange for a briefing on progress of the wider radiation oncology plan. It is important that we know what progress has been made, when it will be completed, how much it will cost and what the funding will be, etc. I recently read that 79 posts in the cancer control service earmarked for the development of planned radiation oncology services can only be filled if a similar number of posts of equivalent salary value are suppressed elsewhere. Will the Minister assure us the suppressed posts will not be from the front line? We would appreciate clarity on this important matter.

Another issue of particular interest to me and others, and which has been raised in the House recently, is the regulation and control of the use of sunbeds, which we know can cause skin cancer. We are back to trying to prevent rather than cure the disease. We know sunbeds are a real risk, particularly if there is exposure during childhood. Unless we act, more young people will be at risk of developing cancer through prolonged use of sunbeds. We know much education is needed to inform people of the dangers, as people want girls in particular to look well on days such as when they celebrate first holy communion. Children are being exposed unnecessarily and recklessly so we must legislate on the matter. We have a duty of care to our children.

Will the Minister indicate when the legislation on sunbed use will be introduced? She launched the strategy for cancer control in 2006 and this legislation was part of it. In the past number of years we have seen a rapid increase in the number of tanning centres and as people are not aware of the dangers we must take positive action.

I will finish by commending the fantastic work done in St. Luke’s Hospital. I also commend the Friends of St. Luke’s Hospital, who have raised so much funding and been at the sharp end of leading the way in radiation oncology. I would have no problem with supporting the Bill, but I warn that we must protect the ethos that made St. Luke’s Hospital so successful.

Deputy Dan Neville: Information on Dan Neville  Zoom on Dan Neville  I welcome the opportunity to speak on the important Health (Miscellaneous Provisions) Bill 2010, which provides for the dissolution of the St. Luke’s Hospital board and the transfer of its employees, assets and liabilities to the Health Service Executive.

As Deputy Reilly stated, for more than 50 years St. Luke’s Hospital in the Dublin suburb of Rathgar has been caring for cancer patients from all over Ireland and thousands of patients have experienced the excellent care it delivers. Staff and patients at St. Luke’s Hospital have campaigned for a number of years on the grounds that this move would not be in the best interests of the patients it treats. Apart from the intention to move off-site in 2014, we know little more about the hospital’s projected future. Given that this matter is of particular interest to patients and staff, perhaps the Minister could inform the House about what decision has been made regarding the future use of the site and its facilities.

[623]I wish to raise the issue of cancer services. It was disappointing to read in today’s The Irish Times an apology from the Minister of State at the Department of Health and Children, Deputy Áine Brady. Information she read out in the Dáil three weeks ago suggested that Clare County Council had required planning permission for the location of a mobile digital screening unit in Ennis. This gave the impression that Clare County Council had been responsible for the delay in the provision of breast screening, which was incorrect and unfair to the council’s staff and members. Planning permission was not required at any time by the council. Indeed, it has provided a site for the mobile unit, but the service has not arrived. In the 2001 national health strategy, Quality and Fairness, the Government promised that programmes for breast and cervical cancer screening would be extended nationally. Almost ten years later, this has still not happened.

At the end of March, Fine Gael Deputy Joe Carey asked the Minister for Health and Children the position regarding the roll-out of BreastCheck to County Clare. Conveniently and as regularly occurs, the Minister was unable to respond due to industrial action. Perhaps she will take the opportunity when replying to clarify the status of BreastCheck in County Clare. Given the facts that there is a site, planning permission is not required and the Government promised to roll out BreastCheck, why has this not been done?

Regarding the radiation oncology plan, in early April we learned of a dispute between the HSE and management at the UPMC Whitfield Clinic in Waterford. According to the managing director of UPMC, the HSE failed to renew the contract on radiotherapy services, which expired at the end of December 2009. UPMC tried to put a new agreement in place that would have offered improved services at reduced rates but it failed to get any meaningful response from the HSE. It was not until this issue hit the headlines that the HSE seemed willing to engage on a new service level agreement. I understand that discussions have been held. Perhaps the Minster could confirm whether this process has concluded and agreement been reached. If not, how will the issue be progressed and how long will it be before completion?

I was relieved when the Minister reversed her decision on the cervical cancer vaccine. This is a matter on which Fine Gael and Deputy Reilly in particular campaigned for a number of months. Fine Gael welcomes the long-awaited commencement of the cervical cancer vaccination plan, but more detail is required. My colleagues in Fine Gael and I would like more detail from the Minister about the HSE’s plan, breaking down which students will be vaccinated in May and which in September and providing more information on the decision to vaccinate some girls in schools and some in special clinics. It is important that we get the implementation right. Poor uptake, as has been the case in other jurisdictions, will fail to protect the maximum number of girls and represent poor value for the taxpayer.

Like Deputy Reilly, I urge the Minister to prepare and implement legislation on the regulation of sunbeds. This was a recommendation within the national cancer control programme of 2006. Years have passed but little has been done. Action in this regard would have a clear benefit in helping to reduce the cause of cancer. The measure would have long-term benefits for the health service, in that it would reduce costs.

I compliment and highlight the contribution of the board and staff of St. Luke’s Hospital to the provision of cancer services. As the Minister stated, their contribution has been significant. I thank current and former board members, management and staff for their commitment and dedication. As the Minister also stated, the board has provided considerable support for and co-operation with the process of integration into the cancer programme. However, concern has been expressed in certain areas of the country regarding services for cancer patients after they leave the hospital. Sligo was highlighted to me as being one such area. Patients coming from Galway believe they have inadequate after-care services. After-care services are not consist[624]ently bad throughout the State but in some areas they are less than adequate for the continuing care and rehabilitation of people following cancer treatment.

Deputy Jan O’Sullivan: Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  If Deputy Quinn attends this debate, I would like to share my time with him.

An Leas-Cheann Comhairle: Information on Brendan Howlin  Zoom on Brendan Howlin  Is that agreed? Agreed.

Deputy Jan O’Sullivan: Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  It is with a sense of sadness that we discuss the change of the role St. Luke’s Hospital in Dublin, which has been caring for cancer patients from all over Ireland for more than 50 years. I understand it was founded by the then Cancer Association of Ireland in 1954. No family in Ireland has not had some experience of the care provided by St. Luke’s Hospital. My family experienced it, since my father attended the hospital. His care was excellent. When people discuss the hospital, they are referring to its atmosphere and air of tranquility more than anything else. There is a sense that someone is cared for as a human being as opposed to as a number going through the system. Families were involved in everything. I was reading through some of the documentation that we got from the library in preparation for this Bill and I came across quotes from people who were involved in the Friends of St. Luke’s Hospital and various other protests. They talk about that ethos as being part of what St. Luke’s Hospital represents in the minds of the Irish population. My mother used to get a letter twice a year from a lady whose husband was in St. Luke’s at the same time as my father. They maintained that friendship and contact for many years afterwards. That is a snapshot of the way in which St. Luke’s cared for people and for the families of people who were in there because they had cancer. That is the ethos that all of us in this House and the people of Ireland want to see preserved. We are right to be sceptical that this might not happen in the future plans for the hospital.

We understand that times move on and that we have to use resources well. In spite of what the Minister might say sometimes, we all supported the cancer strategy. We had one doubt about it, which was the fact that there was no centre north of a line between Galway and Dublin. By and large, the Government got the kind of support from the Opposition on the cancer strategy that I feel would not have happened if it came from the other side of the House. It must be acknowledged that we all want better outcomes for patients, which is why we largely supported the ethos of the national cancer strategy. This move today is a part of that, and St. Luke’s will be part of a wider network of care for patients who have cancer in that part of the Dublin region.

We will now have four main centres, plus two ancillary centres in Waterford and Limerick. We all hope that will produce better outcomes for cancer patients, because the statistics are quite stark. The National Cancer Registry statistics show that between 2005 and 2007, an annual average of 27,023 new cancers was registered. Apart from non-melanoma skin cancer, the most common cancers were prostate cancer at 2,462 cases, breast cancer at 2,335 cases, colorectal cancer at 2,156 cases and lung cancer at 1,118 cases. The risk of developing cancer was roughly 6.6 per 1,000 persons per year over the two year period in question. Our wish is that those statistics be addressed primarily through screening, early detection and prevention.

I welcome the fact that we pretty much have BreastCheck all over the country now, and we will have colorectal screening within a couple of years. Like Deputy Neville, I was aware of the situation in Clare. I do not understand why that issue arose in respect of planning. I was screened from a mobile van in the grounds of a premises owned by the HSE in Limerick. The procedure was perfectly fine for me and for my neighbours, so it is unfortunate that there was a glitch in the roll out, because Clare is the last county to be incorporated in the plans. I was [625]in the House when the Minister of State, Deputy Brady, made her statement a couple of days ago, and it is to be regretted. Overall, there is no doubt that we are making progress.

I support the calls by Deputy Reilly and Deputy Neville for the Minister to tell us that we are on schedule for the roll out of colorectal screening in accordance with the plans that have been outlined to us. There were 952 people waiting for more than three months for a colonoscopy in the most recent statistics. That is directly at variance with the specific plans of the Minister in respect of access. When she signed the most recent consultants’ contract, one of her aims was to ensure that there would be no difference in waiting times between public and private patients for colonoscopies. That is welcome and we remember the tragic story of Susie Long that was put into the public domain. At the beginning, she did not use her own name, but eventually she did. If she had been diagnosed earlier, she would have had a better prognosis for the outcome of her case.

While the Minister has said that there will be no difference between public and private patients in respect of waiting times, the reality is completely different. Private patients can go to private hospitals and clinics to have colonoscopies carried out and can then access the service sooner than public patients. That is the reality of the world in which live. Private patients make appointments every day and are seen within a short period of time.

We need a system of health care in this country where everybody is treated on the basis of need. We need it especially in respect of early diagnosis of killer diseases like cancer. There should be no difference between public and private patients in the diagnosis. If somebody needs a diagnosis, then he or she should get it. If there are symptoms of colorectal cancer, then the person should get in as quickly as possible to have a colonoscopy if that what the person’s GP considers to be the best option. It is not within the capacity of GPs to decide that one person is urgent and another person is not urgent. If the GP sees symptoms, he or she will want that person to have the diagnosis.

I want to express my concern about the future of St. Luke’s Hospital and Deputy Quinn will continue in that vein because of his own experience of people who live near the hospital. We do not know anything about the future use of the site and we have not been given any undertaking on that use. We need to provide certainty that the site will be retained for health purposes. It is being transferred to the ownership of the HSE, as are the staff and the resources, but we need to know that the site will be retained for health purposes. There are many health needs in this city and across the country, and I would like the Minister to give us that kind of undertaking today.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  It will be retained for those purposes. I am awaiting their proposals.

Deputy Jan O’Sullivan: Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  I thank the Minister. She said in her own contribution that she has engaged with the Friends of St. Luke’s and is waiting to hear from them. Maybe she can give us a clearer picture when she replies.

I have doubts and concerns because I am familiar with reconfiguration. It is happening in my own region. In spite of all the assurances given to us that there would be full resources available at the Mid-West Regional Hospital before services closed in Ennis and Nenagh, services have already closed in Ennis and Nenagh and further services will close in July but the critical care unit that was promised, the kind of resources needed by the accident and emergency department and the extra beds are not in Limerick yet. In fact, beds are being closed as they are being closed in other parts of the country. We were given all these undertakings that reconfiguration is good for everybody and that hospitals in the network could do more for patients. The hospitals in Ennis and Nenagh would get day beds and day wards and much more work would be carried out there, but that has not happened either. Therefore, I am extremely [626]sceptical about promises in respect of the future use of health resources. It is an issue for other regions as well and people in those regions are beginning to experience what we have already experienced in the mid-west.

It is a huge issue in the north east and I am sure Deputy Ó Caoláin will address it when he contributes to the debate. We cannot trust the Government or the HSE to deliver what they undertake. That is the real problem, particularly so now because there is a shortage of resources. There are indiscriminate cuts across the board which do not take any account of their effects. The moratorium is crucifying many of the health services because key people are not being replaced.

  2 o’clock

Today, we heard that 60 beds are to be closed in the Mater Hospital. In Beaumont Hospital, 52 have already been closed with other bed closures throughout the country. More and more patients are not getting into hospitals because the beds are not there. People are clogged up in accident and emergency departments and on longer outpatient waiting lists. People in pain and distress are waiting to get access to the health services and that is a direct result of the closure of beds. The Minister cannot sit there and treat that as an abstract concept. These are real people with real suffering. I spoke with a man who recently sat on a hard chair for 15 hours in an accident and emergency department in Dublin with his sick wife. The real people of Ireland depend on the health service and most of them are public patients who do not have the opportunity to go into the more cushy surroundings of private hospitals. The Minister for Health and Children cannot stand over that and she needs to engage more in what is happening in the health services.

The Minister has promised legislation on the control of sunbeds and I understand they are to be banned for those under the age of 18 years. That legislation is urgently required because those who use sunbeds are usually young women who do not seem to have any understanding whatsoever of the fact that the rays in sunbeds are damaging. There is real danger that these young women will develop skin cancer as they get older and that is an urgent matter. I hope the Minister will respond to us on this.

With regard to other matters, if nobody is claiming the infectious diseases maintenance allowance then none of us has a problem with the fact that it will no longer exist. Will the Minister clarify the issue of the transfer of functions? Will the Minister update us on the plan to transfer some of the work of community welfare officers from the HSE to the Department of Social Protection? There is some concern among community welfare officers about what exactly is happening.

With regard to the measures on nursing homes in the Bill, I know they are minor amendments and I do not have any particular difficulty with them but other issues arise with regard to nursing home legislation, particularly the time that financial assessment takes. I believe there was a proviso in the Bill that it would be reviewed after a period of time. If the Minister is to review it, she should consult as widely as possible beforehand, including with the owners of nursing homes and with the workers in the HSE doing the assessments. There are difficulties with delays in people being discharged from hospitals because of the time it takes to do some of the financial assessments. While the Minister told me at one stage that it was all right to move people out even if the full assessment had not been carried out, I am told that no nursing home will take a person if it is not sure that person will qualify under the fair deal because nursing homes are afraid of losing money. As hospitals are trying to move out of acute beds people who are finished with their care, they cannot do so because the nursing homes will not take them. There are practical difficulties arising with the legislation and if there is a review the Minister needs to be aware of them.

[627]I pay tribute to everyone involved in St. Luke’s since 1954. I strongly reiterate the importance of retaining the premises for the use in health services and, more important, the ethos. It has been described as a haven in Rathgar and that is a very good description of what St. Luke’s has meant to many families in Ireland over the years. We need to ensure that type of thinking remains in the care of cancer patients. Unfortunately, in the life of a busy general hospital or tertiary hospital it is difficult to maintain that so it is important that the units are appropriately designed, laid out and structured and that there are garden and outdoor areas and the sense of calm and peace that patients need. I do not know how that can be achieved but it is the strong view of people who have experienced what happens in St. Luke’s that it should be retained for the families concerned.

Deputy Ruairí Quinn: Information on Ruairí Quinn  Zoom on Ruairí Quinn  I thank my colleague, Deputy Jan O’Sullivan, for allowing me to intervene in this debate. I have seldom spoken on health matters because, quite frankly, I know very little about the medical side of health and I would hate to have to deal with the complexity of the problems in our system. Therefore, I do not propose to try in any way to second guess those who have put much more effort and consideration into these matters.

I wish to offer some observations, from a personal point of view and from a constituency point of view. I will start with the HSE itself. I do not think any of us - certainly I did not - opposed the concept of the HSE at the time. However, I do not think any of those who vigorously proposed its establishment, including the former Minister for Health and Children, Deputy Micheál Martin, and the present Minister, would ever have believed it would become the unmanageable monster it now is. In the course of that transition from inefficient and various health boards to what became an integrated single unit, the credibility of our ability in efficiency terms to deliver an efficient health service, or the perception of that — and frequently perception is more important than reality — is that it is a dysfunctional body.

The Minister proposes to implement the Hollywood report and, as she stated to me in reply to a question in March 2007:

At the time, that reply sent shockwaves and fear across the cancer community I encountered who visited St. Luke’s on a regular basis and among many of the residents who live there. I never encountered a resident in the Rathgar area who was worried or upset by the excessive car parking that took place on occasion or gave out about it. I never encountered a resident who felt his or her privacy or the tranquility of a residential area was marred or disrupted by people walking manifestly sick and dying relatives because of the haven of calm, to use the phrase referred to by Deputy Jan O’Sullivan, that was Rathgar and that still is St. Luke’s.

Let me declare a personal interest. I am a graduate of cancer treatment and I can still remember, five years on, that extraordinary sense of total inner panic and fear that came right through me when my doctor said to me that one of the six sample tests which took place out in Tallaght was cancerous. The word “cancer” for my generation has the same resonance as “TB” for my parents’ generation. The health outcomes, as the Minister knows much better [628]than I do as she has the statistics to hand, are wonderfully positive. It is not the TB of our generation; it is a curable disease. We know a great deal about what cures it but a framework and context in which those around one can be reassured is critically important.

I had my full total body assessment after I went to the consultant when he told me that the first task was to find out if there was any cancer anywhere else in my system. I went through a long process. Going to St. Luke’s was like going to a religious retreat. It was not like going to accident and emergency in St. James’s. It was not like trying to find a parking place in the vicinity of St. James’s and then negotiating something akin to a bazaar in Istanbul to get to the right place.

The best architecture in the world will not transform St. James’s into a place which will provide the sort of calm which already exists in St. Luke’s. In her speech and in the overall report that has been produced, I understand the Minister is bringing the facilities that were offered by St. Luke’s to the National Oncology Centre. I am sure the medical treatment will be of the best possible quality. I consulted with some colleagues in my constituency who are medical professionals and they said from a medical point of view the recommendations are the best, but we do not know everything about medicine. Our present standing in the world does not mean we are the most knowledgeable or that future cohorts of population and expertise will not discover anything new or different.

We do not know what psychosomatic elements contribute to recovery from prostate cancer for some people and a failure to recover for others. In sports psychology the whole area of mind over matter is discernible and has been observed but given the limitations of science and knowledge it cannot be quantified. When I was a young athlete my coach gave me a book which described an incident in a garage in England. A man who was an athlete and had a young child had a Morris Minor up on a block. Something happened, the block shifted and the child was trapped under the car. The man let a roar out of him, bent down and lifted up the Morris Minor to save the child. When it was all over somebody asked him if he knew what he had just done. He said, “No, is my kid all right?”. The person said, “You have just lifted this car. Try and do it again”. Of course he could not.

There are aspects of the human condition, physiology and emotional drive that we know about but cannot yet measure. I am putting to the Minister that what we know but cannot measure is the healing calm that is St. Luke’s. I respectfully suggest, with the comfort of ignorance because I am not a medical scientist, that there are components of the campus in St. Luke’s that provide that healing calm. After the diagnosis in my case, which took place in St. Luke’s, I had regular treatment. I cycled up to St. Vincent’s on the Merrion Road at 8 a.m., got my 15 minutes of treatment and came in here on the bus or by bicycle. It was in July five years ago. I was the lucky one because I was not very sick as they got it very early.

Other people were receiving chemotherapy and serious radiotherapy and had to be driven from different parts of the country. I met people who flew down from Donegal. There is a string of bed and breakfasts on the Merrion Road which cater for outpatients of St. Vincent’s for that kind of thing. Where are they going to find that close to St. James’s? The Minister’s medical report examined the X-rays and the medical inputs. It is a one-dimensional world. They do not travel with a relative who has to come and stay in a bed and breakfast on the Merrion Road. I ask the people down the road to reconsider and not to throw out the healing haven which is there.

I share the concerns of Deputy O’Sullivan regarding undertakings given in all good faith by the Minister, her colleague sitting beside her or the HSE. Things change and those guarantees cannot necessarily be honoured. They were not given dishonestly or in bad faith, but things [629]change. We know that ourselves in our personal and professional lives. In the answer the Minister gave to me as regards the future use of the site and facilities at St. Luke’s she said her objective is to ensure the resources are utilised in the best interests of the health service. What does the health service need? More cash. What is the most valuable site in Dublin 6? St. Luke’s. It was a no-brainer in terms of making a decision to sell the site.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  Not any more.

Deputy Ruairí Quinn: Information on Ruairí Quinn  Zoom on Ruairí Quinn  I had the temerity to say, “Do not let the Progressive Democrats sell St. Luke’s”.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  I saw that.

Deputy Ruairí Quinn: Information on Ruairí Quinn  Zoom on Ruairí Quinn  The former leader took great offence to it but the Minister’s answer left that charge open. The best interests of the HSE could have been to realise its capital value and put it into the many areas where capital shortages are hindering her work.

St. Luke’s works for an aspect of the healing care which is associated with the TB of our generation. We do not know everything; no generation ever will but we think that because we are the current cohort we do know everything. It is a welcome facility.

It is not often that a facility like St. Luke’s is available in a suburban area. It has the capacity to absorb and maintain the calm that many people, who travel long distances, require. Frequently the people who are panicking most and are the most fearful are not those who have the disease but the immediate family around them. We have all experienced that. That itself can be a cause for additional strain and stress. St. Luke’s has addressed that.

The Minister should put herself into the picture of travelling five days a week to get to St. James’s to get regular radiotherapy treatment and navigate the Luas and car park. She should come to the Mad Cow roundabout, an area she knows well, and get on the Luas. She would be stressed out.

This Bill will be passed. The decision has been made. I am sure the medical advice is the best available; I am not disputing that. However, there are components which cannot be quantified but which can be experienced in St. Luke’s. In view of this I urge the Minister not to throw the baby out with the bath water.

Deputy Charlie O’Connor: Information on Charlie O'Connor  Zoom on Charlie O'Connor  I welcome the opportunity to make a brief contribution to this important debate. The Health (Miscellaneous Provisions) Bill 2010 provides for the dissolution of St. Luke’s Hospital board and the transfer of its employees, assets and liabilities to the HSE. The dissolution, I am told, arises from the national plan for radiation oncology, under which there are to be four radiation oncology centres, two in Dublin, one in Cork and one in Galway, and two satellite centres in Waterford and Limerick. I am also advised that the Bill provides for the amendment of the Health (Nursing Homes) Act 1990, the Health Act 2007, the Medical Practitioners Act 2007 and the Nursing Home Support Scheme Act 2009. It also repeals section 44 of the Health Act 1947 and section 36(2) of the Health Act 1953.

I have listened carefully to the last two speakers and I compliment them on their contributions. I heard Deputy O’Sullivan comment on calm and peace in regard to hospitals. In fairness, Deputy Quinn made the same point regarding St. Luke’s. I am glad that we are now in the calm and peace of Thursday afternoon in the Dáil. One of the Leas-Cheann Comhairle’s colleagues said recently that if the Dáil reaches Thursday it is a good week. We had an interesting morning and I am glad we are now much more peaceful and calm.

[630]I have a lot of sympathy with the point made by Deputy Quinn regarding the role of St. Luke’s and other hospitals. I am from a bygone Dublin age. I was born around these parts. I lived on the corner of St. Stephen’s Street and George’s Street. There were many hospitals——

An Leas-Cheann Comhairle: Information on Brendan Howlin  Zoom on Brendan Howlin  Not Tallaght, Deputy?

Deputy Charlie O’Connor: Information on Charlie O'Connor  Zoom on Charlie O'Connor  No, funnily enough I was not born and bred in Tallaght. I was born and bred in the inner city.

I might not be a Deputy today if I had not moved to Tallaght with an employer who was a trustee of the Fine Gael Party but nevertheless saw some potential in me.

Deputy Caoimhghín Ó Caoláin: Information on Caoimhghín Ó Caoláin  Zoom on Caoimhghín Ó Caoláin  This is all the fault of the Leas-Cheann Comhairle.

Deputy Charlie O’Connor: Information on Charlie O'Connor  Zoom on Charlie O'Connor  My family were able to go from the inner city to St. Kevin’s, which is now St. James’s, the National Children’s Hospital, the Adelaide, Sir Patrick Dun’s and Mercer’s Hospital, where I had my tonsils removed. I feel strongly about the cluster of small hospitals, including St. Luke’s.

Thank God, I have never been a patient of St. Luke’s but I have visited it on many occasions and I agree with Deputy Quinn in regard to its sense of peace and calm and the professional manner in which patients are treated there. A good friend of mine was a former nurse at the hospital for some of its 56 years and she always told me about the way people were looked after. I acknowledge the positive contribution it has made to the Dublin region and the entire country over many years. I assure the Leas-Cheann Comhairle that I am a proud Dubliner.

I intend to speak about my local hospital in the context of this Bill but Deputies need not worry that I will refer to Tallaght for its own sake.

An Leas-Cheann Comhairle: Information on Brendan Howlin  Zoom on Brendan Howlin  I have every confidence in the Deputy.

Deputy Charlie O’Connor: Information on Charlie O'Connor  Zoom on Charlie O'Connor  At the end of May, the Minister for Health and Children announced the appointment of Dr. Susan O’Reilly as new director of the National Cancer Control Programme, NCCP. I understand Dr. O’Reilly will take up her position in September. As a member of the Joint Committee on Health and Children, I look forward to meeting her to discuss her plans.

I had the opportunity to meet Professor Tom Keane on a number of occasions while he was in charge of the NCCP. I was always impressed by his professionalism and dedication and I pay tribute to him. On 29 January, his last day in office, he kindly sent me a long letter regarding cancer control in my own region.

I have had a long association with Tallaght hospital. On one occasion, I would not have been reappointed to the hospital planning board if the Leas-Cheann Comhairle, as the then Minister for Health, had not intervened. I am proud that I have been a long-term member of the board and I acknowledge the Leas-Cheann Comhairle’s help in that regard.

It is important that hospitals such as Tallaght gain a local perspective through the appointment of local people to their boards. I have raised with the current Minister my concerns about the composition of the board of Tallaght hospital and the proposals for a new board. I do not wish to imply the people on the board are not doing a good job but it should include a local dimension.

The Bill before us, which I will support, allows the HSE to take control of St. Luke’s hospital. However, the HSE will not take up its position on the board of Tallaght hospital. I was a [631]member of the new board when the hospital opened in 1998 and remained on it until I stood down from Dublin County Council in 2003, when I was replaced by my colleague, Jim Daly. When the HSE was established it decided for its own reasons, perhaps political ones, not to take up its position. Given its interest in hospitals, I wonder why it took that decision.

I raised concerns about the processes of the NCCP as they relate to Tallaght hospital. There was considerable upset and distress in Tallaght, which is the third largest population centre in the country, as well as the wider catchment area, which extends to counties Kildare and Wicklow during the initial stages of the transfer of breast cancer services from Tallaght to St. Vincent’s and St. James’s. My priority was to stress to Professor Keane and his colleagues the necessity of ensuring patients from Tallaght would be looked after in the best possible way.

Deputy McGinley’s presence in the Chamber reminds me that, while people from County Donegal have to travel sometimes torturous journeys to get good services, the situation is different in Dublin. However, as Deputy Quinn noted, people who are unwell can be presented with challenges when crossing the city or worrying about getting the Luas. As a local Deputy for Tallaght, I will continue to make the case to the HSE and the NCCP that patients who have been treated in Tallaght — I commend the services provided in my local hospital — are facilitated in going to other centres.

Professor Keane’s letter states:

I want that standard to be maintained and I will continue working to ensure that is the case. When I have the opportunity to meet Dr. O’Reilly, I will advise her of the need to look after those patients who were satisfied with Tallaght hospital. We must ensure that everything is done in order that they are looked after and further stories do not emerge about appointments being stalled or other problems.

I compliment the newly appointed chief executive of Tallaght Hospital, Professor Kevin Conlon. Many Deputies know Professor Conlon and hold him in high regard. He has a difficult job and must cope with many difficult issues, including cancer services at the hospital. I wish him well.

Some months ago, Tallaght Hospital was the focus of much negative publicity concerning X-rays and doctors’ referral letters. It was an upsetting time. Several weeks ago, I and my constituency colleagues, Deputies Pat Rabbitte and Brian Hayes, and the Minister of State, Deputy Conor Lenihan, met Dr. Maurice Hayes, who is well known to members. Dr. Hayes, who was appointed to carry out a detailed investigation into events at the hospital, offered many assurances at our meeting. We asked him to make himself available to patients and families in Tallaght and he did so. I understand he will hold further meetings. Dr. Hayes also indicated [632]that he hoped to have his report completed by July and I wish him well in this regard. The bottom line for me is that public confidence in Tallaght Hospital is restored. The transfer of cancer services from the hospital, an issue addressed in the Bill, has also affected public morale.

I understand the process of transferring St. Luke’s Hospital to the Health Service Executive is being completed under the governance of the board of the hospital, which is the largest provider of radiation oncology services in the country. Radiation oncology is the use of ionising radiation to treat disease and is most commonly delivered using linear accelerator equipment.

I pay tribute to the staff of St. Luke’s Hospital who have served the public well since the hospital was established in 1954. I am not reluctant to admit I remember the year the hospital was founded. I may have considered Rathgar a different area from my own but I was always happy to pass through it.

St. Luke’s Hospital has provided a great service for more than half a century. Yesterday, I spoke to Deputy Chris Andrews, the local Fianna Fáil Party Deputy for the area, on the changes under way at the hospital. Not everyone will be pleased about these changes, no more than I was when many inner city hospitals closed in the past. Many years from now people will wonder why certain hospitals were closed and certain decisions taken. Two similar cases which I recall from my youth were the closure of Mercer’s Hospital and the pulling up of the tram lines in Aungier Street and Georges Street. Fifty years after those events, one must ask who made these decisions and why were they taken. I hope, in the years ahead, the decision to transfer services from St. Luke’s Hospital will be considered a good one and in the interests of the community. The jury will be out on that issue for some years.

I note that Professor Tom Keane strongly advised that St. Luke’s Hospital be subsumed into the Health Service Executive as soon as possible to facilitate the establishment of an integrated network. I suspect Professor Keane, who left the position of director of cancer services in January, maintains an interest in this issue.

The establishment of an integrated network will enable the creation of a single management and clinical governance structure and all staff will become employees of the HSE. Staff and resources may be shared across the network and there will be a single team of physicists, engineers and other support services for the three centres at St. Luke’s Hospital, Beaumont Hospital and St. James’s Hospital. Some staff and resources at St. Luke’s Hospital will transfer to other sites in the network in the second half of this year.

The provisions in the Bill relating to St. Luke’s Hospital are similar to those contained in the Health (Miscellaneous Provisions) Act 2009 which transferred other health agencies, including the National Cancer Screening Service board, to the Health Service Executive. All staff at St. Luke’s Hospital will transfer to the HSE under their current terms and conditions. The pension liabilities of the hospital board will also transfer to the HSE.

The Department is working closely with the board and management of St. Luke’s Hospital and the national cancer control programme to ensure the ethos of the hospital is retained in the new structure. The involvement of its staff in all centres from the establishment of the network is particularly welcome in that regard.

Radiography services will continue to be delivered at St. Luke’s Hospital until at least 2014 when additional capacity is scheduled to come on stream under phase two of the national plan for radiation oncology. At that point, the remaining staff and resources will transfer from the hospital.

The Bill contains a number of other miscellaneous amendments, including with regard to the infectious diseases maintenance allowance. I was astonished to learn that no one is currently in receipt of this allowance, which was introduced in 1947.

[633]I welcome the opportunity to contribute to this debate. I wish the process of transferring responsibility for St. Luke’s Hospital well. It is important that those of us who have the honour and privilege to serve in Dáil Éireann take every opportunity to support the health services. While I have views and concerns about the manner in which the HSE is operating, those issues should be debated on another day. I look forward to hearing the Minister’s response at the conclusion of the debate. I ask the Minister of State, Deputy Finneran, to pass on my good wishes to the Minister. I support the Bill.

Deputy Dinny McGinley: Information on Dinny McGinley  Zoom on Dinny McGinley  I also welcome the opportunity to say a few words on the Bill, the purpose of which is to provide for the dissolution of St. Luke’s Hospital board and the transfer of its employees, assets and liabilities to the Health Service Executive. Normally, any measure or legislation that improves cancer treatment services is welcome. Nevertheless, I have mixed views on the Bill because it foresees the closure of St. Luke’s Hospital, which has provided excellent cancer treatment for numerous patients over the years.

Deputy O’Connor referred to Donegal. I visited St. Luke’s Hospital long before I became a Member of the House. More than 40 years ago, as a young teacher in Dublin, I used to visit neighbours who were patients at the hospital. People from my parish and county are receiving the excellent treatment we have come to expect from the excellent facilities in the hospital. I have seen that hospital develop through the years. When we went there way back in the 1960s it was just like a country mansion. There has been much development with new wards and facilities upgraded to turn it into a model hospital. Attached to the hospital is the excellent hostel provided by the Friends of St. Luke’s Hospital. Patients who do not need constant care and attention, and are not confined to bed and are only there for the radium treatment have the facilities of the lodge there. It is just like a four or five-star hotel. Patients have their own private rooms and kitchen facilities. Facilities allowing members of the family to stay are also provided. St. Luke’s Hospital has provided excellent treatment and facilities for patients through the years. I often notice the number of people from my county who make a choice to come to St. Luke’s Hospital instead of going to alternative venues.

The national cancer strategy was launched a number of years ago by the then Minister for Health, Deputy Noonan. The latest instalment of the strategy is the eight centres of excellence, with three in Dublin. What is significant about that strategy is that north of a line from Dublin to Galway there is no centre of excellence, which means people from the Ulster counties of Cavan, Monaghan and Donegal and other places to the north must go to Dublin or Galway. We felt left out at that time and a major campaign was mounted by the Letterkenny General Hospital, which provides cancer services. It has an excellent oncology unit and has a surgeon who treats breast cancer. It has a great reputation and has a top-class oncologist. The only progress to be made is that Letterkenny General Hospital needs to be recognised as a satellite unit to the major centre of excellence in Galway. That has not been fully developed or got off the ground yet.

The great controversy and disappointment in the north west is that the very good and worthy cancer treatment facilities in Sligo General Hospital are being phased out. People in the north west must go to Galway or St. Luke’s Hospital in Dublin. There is a cross-Border dimension and people from the north west have the option of going to Belfast. That has not been fully developed and in time we expect to have radiation treatment available in a location nearer to Donegal than Belfast, Dublin or Galway. I understand talks are taking place between the Northern health authorities and our own to have something nearer home, perhaps in Letterkenny or Derry. We all look forward to that being achieved.

[634]St. Luke’s Hospital has a great history and as far as Donegal is concerned it is the hospital of choice. While we welcome the improvement in cancer treatment, nevertheless there is an element of sadness that such a facility that we have come to know and respect so well will be phased out in the next few years. I understand that by 2014 St. Luke’s Hospital will not be operating as a cancer treatment hospital. I do not know what will replace it. If it is as good as St. Luke’s Hospital, we will be happy enough.

Everyone is interested in the health service and everyone has his or her problems as far as the health service is concerned. I should avail of this opportunity to dwell on a number of problems in my constituency. There are developments in Letterkenny General Hospital. We are getting our new accident and emergency unit, which is at an advanced stage. I also understand that a number of wards are being provided to increase the inpatient facilities in the hospital and meet the demands for such facilities by the rising population in the county.

Last Sunday week, public representatives including Members of the Oireachtas attended a protest in Lifford. The people in Lifford and its catchment area are very concerned over the future of Lifford Community Hospital, which has been established for more than 200 years. I believe the first hospital opened in Lifford in 1775. It developed to provide health facilities for the people in its catchment area for 235 years. I visited Lifford Community Hospital on a few occasions recently and its facilities are very good. Today it provides residential care for people who need residential care at a community hospital. It also has a health centre. It is planned to build a primary health care centre in Lifford on a greenfield site, which is welcome.

However, we are concerned about what will happen to the residential part of the hospital. There are a number of options, the first of which is to make investment in it. It is an old building but could be upgraded. It is suitable for present day requirements for patients who need that sort of care and attention. The second option would be to provide a new facility along with the primary health care centre that is being built on a greenfield site. However, whatever happens, Lifford needs to be looked after. It is a large catchment area with no other equivalent facility nearby. It covers east Donegal and the Finn valley. I hope it will continue to provide the service it is providing. I make no apologies for mentioning Lifford Community Hospital in the context of cancer services. I know many people in the last stages of that serious illness find the care and attention they need and to which they are entitled is provided by Lifford Community Hospital. I had occasion to visit constituents whose time was limited and who were getting excellent care in that hospital.

The Health Service Executive has stated that a review is taking place. When I hear the word “review” in the context of such facilities, the bells begin to ring because a review often means phasing out. I hope that will not happen at Lifford Community Hospital.

There are two other hospitals in the south of my constituency in Ballyshannon and Bundoran, the Rock Hospital and the Sheil Hospital. There were question marks and a review there also. I believe the crisis has passed there and these facilities, at least the excellent Sheil Hospital which has a long history, will be allowed to continue to provide a service for the people of its catchment area.

Not alone do the patients from Donegal come to St. Luke’s Hospital, but that hospital has always provided a consultant to go to Donegal twice a month to carry out a clinic, which saved people from Donegal having to go the long distance to Dublin for a consultation. One person in particular, Dr. Healy, used to come from St. Luke’s Hospital. I believe he has retired. He was [635]very well known throughout Donegal and was an excellent consultant. I understand someone is still continuing the tradition.

I suppose it is progress that we will have two centres of excellence in Dublin. The activities in St. Luke’s Hospital will be transferred to Beaumont Hospital and St. James’s Hospital. It is very sad to see St. Luke’s Hospital going given all the ancillary facilities it has, including the lodge. It is in a beautiful location and is like St. Stephen’s Green. It has lovely grounds and one would not know one was in the heart of the city. St. Luke’s has been like a lung in the city of Dublin. I do not know what the future holds, but St. Luke’s has served its purpose very well down through the years and we appreciate what it has achieved in that time. Hopefully, its replacement will be just as good. When the final plans are made, the needs of the north west must be looked after, whether that is in Letterkenny, Sligo or Derry, because it is a long journey to Dublin from Arranmore or Tory Island to Dublin. That journey takes a lot out of cancer patients travelling for treatment.

I will now allow my colleague, Deputy Seymour Crawford, the rest of my time.

Deputy Seymour Crawford: Information on Seymour Crawford  Zoom on Seymour Crawford  I thank Deputy McGinley for sharing his time with me and allowing me to speak on this important issue. He said he had been visiting St. Luke’s for 40 years. I cannot say I have been doing it as long, but I have been visiting it for a long time. Many relations and close friends have spent some time in St. Luke’s. I recall something a neighbour of mine who was in St. Luke’s 20 years ago said to me. He was there at a time when the place was not at its best. He was the owner of a machinery hire company and at this time of year he would have to deal with machines that broke down. He said to me that if he was cutting silage for somebody and his machine broke down, he would have to get it fixed or hire in a new machine and would not be able, like hospitals, to delay the work or send people home for another week to wait for their cancer treatment. He pleaded with me, if I was ever in power, to ensure the system was improved.

I am glad to say that since that time, St. Luke’s has improved dramatically. In the short time Fine Gael was in Government, the then Minister for Health, Deputy Michael Noonan, made a major commitment to St. Luke’s and it has improved dramatically since then. Over the years, despite various glips or hitches from time to time, St. Luke’s has provided a tremendous service to people from all parts of Ireland, particularly from my part of the country. In recent years, the lodge at St. Luke’s, which was provided by the Friends of St. Luke’s, provided a homely atmosphere where people could relax. Relaxation is important for people with cancer as tension does not help their situation. The lodge has provided a great service. For the past number of years, the matron of St. Luke’s has been a lady from my village of Newbliss, County Monaghan. She has been an example to all her staff on how to deal with patients in what is often a delicate situation. I wish to pay tribute to all those who down through the years have given service in St. Luke’s. Circumstances for cancer patients are often quite tragic, but thankfully many people now recover from an illness which seemed to be a death sentence some years ago.

Mention has also been made of St. Anne’s Hospital. I remember my late mother bringing her mother to St. Anne’s. My granny knew everything that was wrong with every patient around her in the hospital, but she never suspected for a second what she was being treated for herself, and she lived to 98 years of age. She got cancer at 50, but she lived to tell the tale, even at that time.

I wish the cancer service well. The Fine Gael Party spokesperson has agreed we must take this route, but personally I am extremely disappointed that St. Luke’s is being closed. I have been concerned with the winding down, if not the closure, of Monaghan General Hospital, so [636]I know what this closure means. The Minister has given many promises as to what she intends for the service. I hope those promises will become more of a reality than the promises made to us in Monaghan when the new developments were proposed. We were told that no services would be removed until a better service had been provided and were told a centre of excellence would be provided before any closures would take place. We are now in a situation where the Monaghan hospital has been literally wound down and has only 26 beds for rehabilitation and respite, but no extra beds have been provided in either Cavan hospital or the Lourdes hospital in Drogheda. Both of these hospitals are chock a block, with people on trolleys or being sent home early. They also have other difficulties. However, the staff in both hospitals are doing everything they can and if one can gain access to the service, it is a good service.

The situation in Monaghan provides a warning that it is important that St. Luke’s is not closed until Beaumont and St. James are ready and capable of dealing with cancer patients. Whatever about other illnesses, when people with cancer are held back from getting treatment, they have less chance of surviving their cancer. When my late mother was in the nursing home in 1999, she was visited in October by her niece. She said then that if her niece did not receive treatment soon, the treatment would be too late. My mother was completely blind then, but she knew by feeling her niece’s hand and by listening to her breathe that she had a serious illness. Her niece was diagnosed the following January in a hospital in Northern Ireland and was told by the doctor that if her illness had been caught two months earlier, she could have been saved. Therefore, it is from personal knowledge and grief as a result of knowing what can happen to a patient if there is a delay in treatment that I make my comments.

I hope and pray that unlike on other occasions the Minister will deliver on her promises on time so that when St. Luke’s is eventually wound down, people will be guaranteed as good a service, if not better, in Beaumont or St. James’s. I cannot pay adequate tribute to St. Luke’s for what it did for so many families and patients. I remember being there when a cousin’s daughter, 17 years of age, was being nursed through her final weeks. The care and attention given to that family by staff at every level was excellent and could not be surpassed. I hope that same capability will be available when the change is made from St. Luke’s to the other units.

I could go on at length on the issue of the health service. We have a ridiculous situation currently where a surgical ward is being wound down in Cavan hospital. The senior staff there are extremely worried about the whole future of surgical services there.

An Ceann Comhairle: Information on Seamus Kirk  Zoom on Seamus Kirk  The Deputy is going off on a tangent.

Deputy Seymour Crawford: Information on Seymour Crawford  Zoom on Seymour Crawford  While the HSE media personnel continues to pump out guarantees, we know what those guarantees have meant in the past. The Pathways rehabilitation centre in Cavan provided tremendous support for those who had strokes and other problems and helped restore many people to full health. We were told it would only be closed until extra staff were appointed to it, but it was never reopened. People now have a totally different and unsatisfactory service.

I plead with the Minister to ensure proper services for patients. These must be provided not for our sake, but for that of patients, who should come first.

Proper structures must be put in place in order to ensure that patients, regardless of whether they come from Malin Head, County Donegal, or wherever, will be able to avail of services and will not be obliged to wait months in order to obtain the treatment they urgently require. If this happens, Fine Gael will have no difficulty supporting the Bill.

[637]Deputy Chris Andrews: Information on Chris Andrews  Zoom on Chris Andrews  I welcome the opportunity to contribute to the debate on this Bill. If Deputy Crawford has inherited his mother’s genes — she lived to 98 — then he has a long career in politics ahead of him.

The Bill provides for amendments to various Acts, namely, the Health Acts of 1947 and 1953, the Medical Practitioners Act 2007 and the Nursing Homes Support Scheme Act 2009. As Deputy Crawford indicated, however, the main purpose of the Bill is to provide for the dissolution of the board of St. Luke’s Hospital, the transfer of the employees at the hospital to other facilities and the transfer of its assets and liabilities to the HSE.

  3 o’clock

St. Luke’s Hospital is located in Rathgar in my constituency of Dublin South-East. For over 50 years it has provided state-of-the-art care for cancer patients from all over Ireland. I do not believe I have ever heard anyone cast aspersions on or express concerns about the care provided at St. Luke’s. The fondness former patients have for the hospital and the high esteem in which they hold it is evidence of the high standards which obtain there. I take this opportunity to pay tribute to the staff who, over many years, have provided an invaluable service to the people of Dublin and elsewhere.

In 1981, the Friends of St. Luke’s Hospital was established to fund-raise and enhance the care and services available at the hospital. To date, over €26 million has been raised by people who have in some way been touched by what happens at the hospital. There is not a family in Ireland which has not in some way been affected by the curse of cancer. The raising of €26 million is an incredible achievement and those responsible should be commended for it. The Friends of St. Luke’s Hospital has done a huge amount of positive work.

St. Luke’s Hospital is currently the largest provider of radiation, oncology and radiotherapy services in Ireland. It has 179 beds and almost 500 staff. As already stated, the Bill provides for the dissolution of the board of St. Luke’s Hospital and the transfer of its assets and liabilities to the HSE. The decision to proceed in this way was taken on foot of recommendations for the establishment of an integrated national oncology and wider cancer treatment service which were presented to the Department. The former director of the national cancer control programme, NCCP, Professor Tom Keane advised and strongly recommended that this should happen.

I am of the view that this is the best route to take in the context of cancer treatment. In view of the nature of cancer, establishing centres of excellence is the way to go. People will state that what is being done is not sufficient. A journey of 1,000 miles begins with a single step. I am of the view that this is an important step on the journey towards ensuring that there will be a top-class cancer service in this country.

The multidisciplinary approach to cancer treatment that is currently being pursued is central to the Government’s strategy for the creation of a world-class cancer treatment service and is in line with best international practice. The board of St. Luke’s Hospital is fully committed to supporting the Government’s decision because it recognises that the approach being taken will ensure the optimal outcome for patients and will in time lead to better survival rates for those who contract cancer.

Two new radiotherapy centres will open at St. James’s and Beaumont hospitals at the end of 2010 under phase 1 of the national plan for radiation oncology. As Deputy Crawford stated, it is important that we ensure that when the services at St. Luke’s Hospital are being wound down, alternative services that will match the standards set at the latter in the past will be available. The radiotherapy centre at St. Luke’s will combine with these new centres to form the St. Luke’s radiation oncology network. All staff will be employees of the HSE. Staff and [638]resources may be shared across the network and there will be a single team of physicists, engineers and other support staff for the three centres at St. Luke’s, St. James’s and Beaumont.

Some staff and resources from St. Luke’s will be transferred to other sites in the network in the second half of this year. The Department of Health and Children is working closely with the board of management of St. Luke’s and the NCCP to ensure that the ethos of St. Luke’s will be retained in the new structure. One of the major assets of St. Luke’s is the ethos to which I refer. Others include the services provided, the compassion of staff and the magnificent and tranquil setting in which the hospital is located. Radiotherapy services will continue to be delivered at St. Luke’s until at least 2014, when additional capacity is scheduled to come on stream under phase 2 of the national plan for radiation oncology. We must ensure that we obtain a commitment that following the completion of this integration, the Department of Health and Children will see to it that the future of St. Luke’s will be aptly planned for.

As already stated, St. Luke’s provides a calm and tranquil setting in which people can undergo serious health treatment and recuperate. The value of this cannot be overstated for those who are undergoing difficult treatment and living through an extremely stressful period. There is a special quality about St. Luke’s and I urge the Minister for Health and Children to ensure that the site will be retained in order that the type of care to which I refer can continue to be provided there for those who require it.

As I have stated on many occasions and as the Minister will be aware, there is a chronic shortage of step-down facilities in the constituency of Dublin South-East. St. Luke’s is unique in the context of the provision of respite and palliative care and the site on which it is located should be earmarked for the provision of continuing care in the area. A number of services are currently being provided in the area, including the out-of-hours GP service, which has been extremely effective. We must develop it and ensure that we take advantage of the fact that we possess a prime location on the southside of Dublin.

Last year, the Minister opened new step-down facilities at the Royal Hospital in Donnybrook and at Brú Chaoimhín in Cork Street. These developments are welcome but they constitute only a small piece of the jigsaw. We must ensure that more beds to cater for people who are coming out of hospital are brought on stream.

Deputies who live in Dublin will be aware that families in the city are often expected to send their elderly relatives to homes in counties Wicklow, Kildare or Meath. This is a major inconvenience for families, particularly those with young children, who are obliged to travel long distances to visit such relatives. People feel extremely guilty if they do not visit their elderly relatives and the need to travel long distances places a major strain on extended families.

There is a significant burden of travel, for example, for an inner-city family whose elderly relative is being cared for somewhere in Kildare or Wicklow. That is difficult financially and emotionally and it takes a lot out of families.

It is vital that we take the opportunity to ensure St. Luke’s Hospital is developed in a way that is supportive of the need for community services by providing step-down facilities and long-term beds. The hospital is an ideal site for the provision of such services and it should be preserved, even ring-fenced, to ensure people in the area have access to step-down facilities such as those available at the Royal Hospital in Donnybrook and the Brú Chaoimhín in Cork Street. That will ensure families have shorter distances to travel to see their parents and grandparents and will be able to give them the care and attention they need and deserve. No family should have to make long traumatic journeys on various modes of public transport or be stuck [639]in traffic for hours in order to visit a loved one. I am disappointed no decision has yet been made regarding the future of the St. Luke’s site. It is a magnificent facility on the south side of Dublin which offers an opportunity to cater for the older people in our community who, at a difficult period in their lives, require care. Their plight should not be added to by having to be parted from their families due to weaknesses or gaps within the service.

Will the Minister of State give an assurance that this site, with its long tradition of providing health care, will remain in the hands of the Health Service Executive and will become a step-down facility that will continue to serve the community of Dublin South-East in the manner it has done for many years? I have visited many patients there and there is a tranquillity and serenity about the place that can only aid patients’ recovery. The Friends of St. Luke’s Hospital have done great work in the past in raising large amounts of money for the hospital. A decision to sell off the land for some type of development would be the worst of all options. Given the time and money invested in the site by the board, patients and relatives of patients, it would be a shame to let the opportunity slip past us to secure the future of this magnificent facility.

Almost every family has been touched by the traumatic experience of cancer. Concerns have been expressed in some quarters about the transferral of services to St. James’s Hospital, but St. Luke’s Hospital is not too far from St. James’s. The latter will not have the same appeal or offer the same tranquillity, but it will offer the services that are needed as it develops into a centre of excellence that will improve recovery rates for cancer sufferers. It is imperative that we ensure we have the best facilities available to those with cancer.

Deputy Crawford said earlier that St. Luke’s Hospital is to be closed; I do not see it as closure but as the transferral of services. We have an opportunity to develop community services and to ensure older people can be cared for in their communities. Any report that is available will show there is a shortage of step-down facilities for families in the south Dublin area. I spoke to a woman today whose mother is in a facility beyond Bray and who is finding the travel particularly difficult. She hopes to find somewhere closer to home for her mother where her mother’s husband will also be able to visit. That is another problem that often arises, where one older person may be unfit to remain at home but his or her partner can do so. That puts a huge strain on the person who is at home and may have to rely on extended family to visit his or her spouse. As I said, we should grasp the opportunity that is before us. I urge the Minister of State to give a commitment to maintaining St. Luke’s Hospital in Rathgar as a facility providing essential community services.

Deputy Caoimhghín Ó Caoláin: Information on Caoimhghín Ó Caoláin  Zoom on Caoimhghín Ó Caoláin  I have listened carefully to all the contributions thus far and I regret that I am the first to state I oppose this Bill. I do so for several rational reasons. It implements the closure of St. Luke’s Hospital to facilitate the putting in place of a so-called national plan for radiation oncology which provides for four radiation oncology centres, two in the city of Dublin, one in Cork and one in Galway, with what are termed satellite centres in Waterford and Limerick. This is not a national plan by any yardstick. It is not a national plan in the first instance because it is not an all-Ireland plan. It is not a national plan because none of the proposed centres is north of a line from Dublin to Galway.

I represent first-class Irish citizens from a constituency which, irrespective of what excuses or arguments are offered, is not being primarily provided for in this proposed arrangement. Huge swathes of the country will not be served and cancer patients in those regions will have to travel unacceptably long distances to access radiation oncology treatment. The health care rights and needs of the people of the Border counties and most of the western seaboard are being neglected yet again. Let us be in no doubt about the magnitude of transport and access [640]issues for those seeking radiation oncology services. Most Deputies who have already spoken in this debate have given personal testimony in regard to their and their families’ experience. I can say in my experience that it is a harrowing prospect to have to travel long distances for radiation treatment. It simply is not good enough that almost half the island in terms of this jurisdiction is to be left without a service.

We should not be surprised at this. Fianna Fáil health policy, as implemented by the so-called Independent Minister, wherever she might be, and the Health Service Executive, is denying the rights and failing to meet the needs of people every day in our health system. Today again we see the outcome of the savage health cutbacks being imposed. It has been announced that 60 beds at the Mater hospital are to be closed. This follows the closure of 62 beds at Beaumont Hospital. We learned yesterday that a whole range of services at Cavan and Monaghan General Hospitals in my constituency are to be closed for long periods during the summer. For a full 29 working days, between 28 June and 20 August, stretching over a two month period, these services will be closed. So much for the false promises of the Minister and Health Service Executive in regard to the range of care services that would be provided at Monaghan General Hospital following its being axed as an acute hospital almost 12 months ago in July 2009. These services can now be opened and closed at will as if the HSE were running a corner sweet shop rather than a vital health care facility.

The health care needs of the people I represent are a 365-day requirement, as is the case everywhere else in this country. They are not a water tap that can be turned on and off to suit management or budgetary requirements. People’s health care needs are a daily need for address by the State. The situation gets worse. Figures supplied by the INMO show that as of 28 May there were more than 1,000 beds around the State closed. The HSE is discharging long-term care patients and then closing beds despite the Minister and HSE having spent years telling us that the discharge of such patients would free up acute beds in our hospitals. These beds are now being closed, which is an absolute outrage. It baffles me that there is not greater anger being expressed in regard to all of these developments.

I wish to raise here with the Minister as a matter of urgency an issue directly relevant to section 14 of the Bill, namely, the plight of residents in Loughloe House, Athlone and their families. This particular matter has been raised in different ways here during the past number of weeks but there has not been any real or substantive address of the core issues involved. As the Minister knows, the recent HIQA report on Loughloe House did not recommend closure. It recommended important improvements, mainly in management, that can and should be made to keep this home open for current and future residents. I must report to the Minister, as she may not know this, that the response of the HSE has been nothing short of scandalous. Since the HSE announcement on Thursday, 6 May, of its disgraceful decision to close Loughloe House two of the residents have suffered strokes, one of whom is currently gravely ill in the Midland Regional Hospital, Mullingar. Another two residents had heart attacks, one of whom died in Loughloe House four days after the HSE announcement. One resident died having been moved from Loughloe House to St. Vincent’s in Athlone.

Residents have been warned not to talk to the press or public representatives. The question that must be asked is why would residents be so warned? Residents are threatened that they will be moved to Roscommon or Ballinasloe if they do not take the nursing home offered to them. I am reliably told that one resident was threatened with the street if she did not take a bed in another nursing home. On another occasion, staff were instructed to awaken a man from his sleep to tell him that he was leaving that day. Another resident was threatened with [641]the door for “inciting other residents to get them to stay put in Loughloe House”. The stress on residents, their families and staff is unbearable. Only last week I met with a significant number of those families campaigning and staff at Loughloe House who attended the Dáil.

Prior to the announcement, the last person in the home to die suddenly was a man who died from a heart attack a couple of years ago. Look at what has happened since. I implore the Minister to intervene now to protect the residents, to prevent the closure of Loughloe House and to prevent the eviction of residents from what is for them unquestionably their home. If the Minister doubts anything I stated on the record of this House this afternoon, I urge her to order an independent investigation by the Health Information and Quality Authority and-or another agency she deems appropriate into the HSE’s treatment of these vulnerable elderly people.

On the Bill before us, Sinn Féin has supported the retention and further development of St. Luke’s Hospital. We hear much from the Government about centres of excellence. St. Luke’s has clearly been a centre of excellence for cancer care for many years, yet the Government wants to close it. Like so many other Deputies I, too, had a personal experience of St. Luke’s when my brother-in-law was a patient there last year, Go ndéana Dia trócaire ar a anam dílis. He was a young man. I was impressed by St. Luke’s. This was undoubtedly a place apart, a hospital not like any other I had known. The Government has, therefore, in my view failed to heed the testimony of current and former patients and staff at St. Luke’s Hospital in regard to the need to review and reverse the decision to close this facility.

The experience of St. Luke’s is replicated in hospitals around the country which this Government wishes to downgrade or close. The Government is following a policy of over-centralisation of services and the privatisation of services. This policy is driven by commercial interests rather than the interests of patients. It is a policy that rewards the private health care sector with land on public hospital sites and tax breaks to develop private for profit hospitals. At the same time, the Government wishes to close long-standing, tried and trusted facilities such as St. Luke’s. Cancer patients have been denied life-saving treatment because successive Governments have failed to provide the radiation oncology facilities required. This dire need has been recognised for many years. The Government had ample time and a booming economy to plan and budget for the provision of radiotherapy centres. The State could and should have taken the lead and provided these centres directly as public facilities open to all on the basis of need alone. Instead, the Government committed itself to public-private partnerships to deliver them. When it was found that this would take too long a review was ordered. This is what has led to the delay in delivery to 2014 or 2015.

The Minister, Deputy Mary Harney, told us that the planned centres may have to be provided entirely by the private sector. Professor Drumm has on the other hand told us that the public sector can do it. Delay is piled upon delay and patients are dying. This Fianna Fáil-led Government is attempting to shirk its responsibilities for the chaotic state of cancer care services. Fianna Fáil-led Governments have for the past decade presided over a catalogue of failures and delays in cancer care. What is needed urgently is comprehensive public cancer care provided in the public health care system and available to all based on need, regardless of ability to pay and without discrimination based on geographic location. What is needed urgently is a comprehensive public cancer care provided in the public health care system and available to all based on need alone, regardless of ability to pay and without discrimination based on geographic location. St. Luke’s Hospital should have a central role in such a renewed and reformed system.

The Government has ensured that there will be no democratic accountability for these decisions. It has insulated the HSE from any responsibility to the local communities it is sup[642]posed to serve and the Minister, Deputy Harney, has insulated herself from proper accountability to the Dáil. For all these reasons, and for many more I could add but time will not allow, I restate once more that I will oppose the passage of this Bill and I declare now that I will reject it.

An Leas-Cheann Comhairle: Information on Brendan Howlin  Zoom on Brendan Howlin  The Deputy will have six minutes remaining when debate is resumed on the Bill.

Debate adjourned.


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