by Enid O'Dowd
Sunday Business Post 30 September 2007
Dr Ian Fraser
‘You can’t stimulate someone to fight against cancer if they are locked into a small cubicle rather than in a nice open, breezy room….the grounds of St Luke’s are integral to the care of cancer patients and it is highly unlikely that the service provided there (in Luke’s) could be replicated elsewhere.’
Irish Times 20 March 2007
‘St Luke’s Hospital is an absolutely beautiful place, and if I were a cancer patient in Dublin and offered a choice, I’d go there because environment does matter.’
Irish Times 11 July 2008
John A Weafer MA, Research Consultant, Weafer and Associates Research and Consultancy Ltd
‘The review of literature in chapter 2 reported an increasing amount of credible evidence to support the tangible impact of ‘non medical’ factors on patients well being and satisfaction. Some of these factors are ingrained into the very fabric of St Luke’s Hospital, including garden landscapes, a peaceful and safe hospital environment, psychological and spiritual support services, staff that are not unduly stressed and the provision of a range of complementary medicine, such as art. The views of patients and staff, together with the evidence explored in the literature review, suggest that there is a tangible link between aspects of the environment within which patients experience treatment and care, and the outcome of that care.’
From ‘More than a Leafy Suburb’
Ciaran Corry, former St Luke’s patient
‘The ethos, the positive aura, the calmness, the immeasurable benefits of this haven of spirituality and dignity will be lost forever once they change one little thing in what is the people’s hospital. Priceless, unaccountable assets will go, scattered to the four winds, and why? All because it is the opinion of six so-called ‘experts’ and the experience of Mr Keane in his work in Canada.’
‘Oh, and also because of a dubious marking system in which St Luke’s got laughable low marks that suited the ‘outcome’ for the experts and convinced the government that they had discovered a secret magic wand that will cure all our health services ills.’
‘I would prefer to die in St Luke’s a week earlier than die in a huge noisy, busy medical centre that had extended my unhappy existence artificially through the most modern of equipment, while, outside, my nearest and dearest frantically tried to get parking before I breathed my last. That is not the outcome I want. Am I being selfish?’
‘If St Luke’s closes, we might as well give up on our values as a society. It is more than just a hospital close to many people’s hearts.’
‘It is an oasis of sensibility in a crazy world; it is Irish society working at its best; it is a national asset; a proud symbol of .the caring Ireland that we are now striving to return to in the aftermath of our economic madness.’
Fiona Doyle, family member of a St Luke’s patient:
‘Because of the wonderful care and excellent treatment that my Mum received at St Luke’s Hospital, we had an extra year with our lovely mother, a year we wouldn’t have had if such a facility wasn’t available in Ireland. ‘
‘In my mind it is all very simple, “if it’s not broken, why try to fix it”?!!’
‘The people of Ireland need to stand up for their rights and to stop voting for politician’s who want to close down the few good hospitals that we have, in a country that is literally riddled with cancer.’
Marion O’Dwyer, family member of a St Luke’s patient:
‘We were dismissed as being ‘emotional’. I cannot express how emotional I am about the profound ignorance I saw displayed by our so-called democratic government in relation to the closure of St Luke’s.’
‘The defence the Minister has put up for making this extraordinary decision to close one of the few hospitals in this country that patients LOVE, is that she listened to experts and it was their expert advice that led to the decision to relocate the cancer services provided by St Luke’s to the hospitals allocated for the Cancer Control Strategy. Aren’t patients and their families the real experts? She neglected to say that these experts were given parameters which automatically made it impossible for them to choose St Luke’s. The full story is only being uncovered gradually, but we are now aware that she didn’t listen to all the ‘experts’, only those who agreed with the decision to close St Luke’s.’
‘In fact, for some patients it is more pertinent to their healing to be somewhere like St Luke’s. Why close it? It makes no sense. Unless you’re a developer I suppose.’
‘A spiritual friend of mine commented that the healing energy must be very strong in St Luke’s as it would have built up over the years. Indeed ‘spiritual’ is a word often used in association with the place. I had occasion to visit St Luke’s as a campaigner, two and a half years after my father died. The magic of St Luke’s worked on me again and instead of being overwhelmed by grief, I was soothed and comforted all over again. I will fight to keep that magic for future cancer sufferers and their families.’
Six experts advised the Minister in 2005. The results? St Luke’s was to close. The six equally eminent experts quoted above differ.
HOW THE CAMPAIGN STARTED
Two of the experts quoted in the previous chapter are Campaign committee members, one from Donegal and the other from north Dublin. Our current committee is broadly based geographically with me, the only person living in the Dublin South East constituency in which St Luke’s is located.
The Campaign to Save St Luke’s began in 2006.
On the day the Minister’s press release issued in late July 2005, Joe Guilfoyle did not know that he had cancer. And he was on holiday like so many other people. So neither he nor they realised that this national treasure was under threat. In October of that year Joe was diagnosed with prostate cancer and so began his St Luke’s journey. He tells his story on p. 230.
One week while staying in Oaklands Lodge at St Luke’s in 2006, Joe heard worrying rumours about the hospital’s future but nobody was able to confirm or deny them. He went home that weekend and discovered from the internet that Minister Harney had indeed signed St Luke’s death warrant. Returning to the hospital the following Monday, he called a meeting of patients and explained that the hospital was under threat.
Thus started the national campaign to save St Luke’s. The patients elected Joe as chairman. He felt then, and still does, that there was an agenda behind the decision one that had nothing to do with best outcomes for patients. He believes the prime Dublin 6 site on which the hospital stands is under threat from for developers whether for private medical facilities or for expensive housing.
A public meeting in Ranelagh Multidenominational School in the Dublin South East constituency in which St Luke’s is based was held in October 2007. Platform speakers that night included Mary Lou McDonald, who grew up in Rathgar, then an MEP for Dublin, and Rory Hearne who had stood in the 2007 general election for the People before Profit Alliance and had made St Luke’s an important issue in his campaign. This meeting was my introduction to the hospital.
I was so impressed by patients describing their experiences there. The biggest applause of the night came when an elderly man said, ‘it’s the other St Luke’s they should be closing.’ The Mahon Tribunal was then in session then and St Luke’s, the constituency office of Bertie Ahern in Drumcondra was much in the news. From that public meeting a Dublin group was formed which operated independently of the existing national campaign, though I liaised with Joe and his committee.
Two marches were held. At the first in December 2007, Minister John Gormley’s special adviser Ryan Meade addressed the crowd saying that the Minister supported the campaign to save St Luke’s. The minister is also a TD for the Dublin South East constituency.
The national campaign obtained 150,000 signatures on a petition. It was never presented to the Minister. Campaigners thought the decision was on the long finger due to the opposition, and the fact that the valuable site in Rathgar was now le
ss vulnerable due to developers’ cash flow problems.
And money had also been spent upgrading facilities and developing services. This is arguably not something you do if closure is a certainty. Two months before Minister Harney announced her decision to close St Luke’s she opened a 15-bed extension to Oaklands Lodge, making it a 49 bed facility. Oaklands Lodge is a wonderful facility in the hospital grounds where country patients and their families can stay free of charge during their chemotherapy and radiation treatment.
Four new linear accelerators were acquired at a cost of €15 million meaning that many new patients could be treated at St Luke’s. Careful attention was paid to landscaping the grounds and to the development of rehabilitation services. Car parking space was expanded. The out patients’ department was made available to a GP co-operative (Lukedoc) to provide a local weekend and after hours service.
But St Luke’s was not safe.
In the next chapter, health analyst Marie O’Connor reveals the real truth behind the rush to close St Luke’s.
And in subsequent chapters we see how the Bill was rushed through the Dail and Seanad without any real consideration being given to the amendments put down by Labour and Fine Gael, and the president’s signature was fast tracked by using a little known section of the constitution..
BIG BUSINESS: BEHIND THE PLAN TO CLOSE ST LUKE’S
MARIE O’CONNOR
Cancer sufferers will soon be treated like commodities, sold off, in effect, to the lowest bidder. Closing St Luke’s Hospital is central to the future trading of cancer patients.
Government policy aims to privatise our health system. This is a goal shared by others, including civil servants in the Department of Health, managers in the Health Service Executive (HSE) and academics in the Economic and Social Research Institute. We are now rushing, pell-mell, to recast our health system––in an American mould. This is the hidden agenda that lies behind most announcements that are made in health.
Corporations rule
Twenty years ago the idea that the State would outsource cancer services to commercial companies would have been unthinkable. Much has changed since, both on the international front and in Ireland. During the 1990s, pressure built up globally to open public services to international trade and this led, in 1995, to the signing of GATS, the General Agreement on Trade in Services. GATS left Ireland wide open to market forces. By then, health services were long being provided here on a commercial basis, and suppliers were already in competition with one another.
Six years after GATS, the Government introduced tax breaks for building or refurbishing non-profit nursing homes and hospitals. The following year, in 2002, Charlie McCreevy generously extended these concessions to for profit companies. Cash-starved US corporations were not slow to respond.
From 1990 to 1997, foreign direct investment in health care in the United States rose tenfold. The only private health system in the world was now beginning to look a bit crowded. American health care companies looked to other countries to boost their flagging revenues. Ireland, with its tax schemes tailored to corporate needs, offered rich pickings. We also happened to be the (English-speaking) gateway to mainland Europe, with its massive market of 450 million.
One of the consequences of GATS is that cancer patients in Ireland are now being treated by a variety of ‘providers’, including overseas companies. These investor-owned corporations mark a sea change, where the owners are no longer the managers, and patient care may take second place to turning a profit. Even where there are no shareholders to satisfy and companies are technically not for profit, directors tend to pay themselves enormous salaries, with hefty ‘surpluses’ divided out every year among top managers and lucrative contracts given to friends of friends and families of families.
Zombified banks have not dimmed the Government’s faith in ‘the market’. We now face a future where the medical services we fund as taxpayers will increasingly be provided by private operators. Blithely ignoring the damning evidence on private health care, the Government seems hellbent on outsourcing patient services. New roles for the private sector include providing beds for public patients (under co-location), carrying out medical procedures (under contract to the State) and implementing that pot of gold formula––design, build, finance and operate.
Within months of the 2002 Finance Act becoming law here, a major US hospital chain attempted to enter the Irish market. That company, HCA, was forced to pay $1.7 billion to the US Government to settle charges of insurance fraud. HCA also pleaded guilty to criminal charges. It was the biggest health care swindle in American history. Over 400 hospitals across America were named in the settlement with the US Justice Department. The Government also accused HCA of bribing doctors but these allegations were not resolved. The company subsequently broke up.
HCA’s successor, Triad, ran the Beacon Hospital in south county Dublin until 2007 by arrangement with an Irish company, the Beacon Medical Group. Triad had also formed a partnership with UPMC Cancer Centres, which were owned by another American corporation, the University of Pittsburgh Medical Centre (UPMC). The two companies ran a joint radiotherapy centre on the Sandyford hospital site, which was set to become a major European testing ground for General Electric equipment. UPMC took over the running of the Beacon Hospital in 2008 after Triad was bought out by Community Health Systems, another US hospital chain.
The Pennsylvania health care giant now owns a two-thirds stake in the Beacon Medical Group, and is lucky enough to have secured three of the four co-located hospital projects that the Government is now progressing. UPMC has a special interest in cancer care, and co-owns a second radiotherapy centre at the Whitfield Clinic, Waterford.
The Hanly Report
Growing the market for private providers requires public cuts and closures. Hot on the heels of the 2002 tax breaks came the Hanly Report. The group was chaired by David Hanly, a prominent business man––described in the media as ‘independent’––who used to run a private hospital in Baghdad. Published in 2003, the Hanly Report proposed, effectively, to close around 40 of our 53 acute public hospitals. (Hospitals offering emergency or unplanned care are known as ‘acute’.) ‘Patient safety’, Hanly argued, required large numbers of patients, but no good evidence existed for this view. Larger volumes of patients have not generally been shown to lead to better outcomes.
Hanly also recommended that all single stand-alone specialty hospitals–– such as St Luke’s––should close, in effect. Medical training bodies, such as the Royal College of Surgeons, supported the plan. There were ambitions, careers and incomes to be nurtured. Medical specialties had long been dividing into subspecialties, and these mini-empires required very large numbers of patients to sustain them, as very few, by definition, suffered from these subconditions.
The centralisation/privatisation programme widely known as ‘reform’ was now in full swing. Only the biggest publicly funded hospitals in the country were to be spared the axe.
Hanly led to a storm of protest, however, and was duly ‘disappeared’. Civil servants were even forbidden to use the name: henceforth, as a way of foxing the electorate, the report was to be referred to by its official title: ‘The Report of the National Taskforce on Medical Staffing’.
National bed-cutting targets were later introduced, implementing Hanly on the sly. A 2007 report commissioned by the HSE revealed the extent of the Government’s ambitious bed-cutting programme: public patient beds were to be slashed by 2014 from almost 13,000 to under 8,000. This represented a swingeing cut––around 40 per cent––in the national bed stock.
Public private partnerships
Meanwhile, privatisation was continuing apace. Public private partnerships (PPPs) are an important part of modernisation, the Department of Finance proclaimed in 2003. PPSs made an appearance in the health sector in 2005, when Mary Harney announced the building of six oncology units, mostly funded through PPPs. This particular PPP is central to the backstory of Luke’s: services there ar
e to be ‘transferred’ to one of these new oncology sites at St James’s Hospital. Built by BAM, the radiotherapy unit resembles an industrial-style bunker, squeezed into an already congested concrete site. Dublin’s Beaumont Hospital, Cork University Hospital and Waterford Regional were also selected as sites for the new oncology facilities, along with University Hospital Galway and Limerick Regional.
Then along came a new, highly controversial form of PPP: co-location. First announced by the Minister for Health in 2006, co-location is a particularly invidious form of privatisation, designed to intertwine for profit companies with acute public hospitals, and to maximise private profits at taxpayers’ expense. Co-located wings will save on salaries and insurance, being staffed by public hospital specialists, with compensation footed by taxpayers where the private hospital/medical consultant is held liable for patient injuries and/or deaths. Co-located coffers will also be boosted by public patients despatched from public A&E departments, while private patients in need of intensive care will be offloaded back onto the public hospital, thereby reducing company costs still further. A special sky walkway is planned in James’s Hospital to facilitate this two-way traffic.