Cancer in a Cold Climate

by Enid O'Dowd

  Come on Minister Haney, come into the real world and witness the suffering that these unfortunate people go through. It would be wrong to say that they don’t get great care in the likes of St James’s hospital, because my aunt who sadly passed away January 2009 received amazing care from John Kennedy and his team at St James’s, but when you look at the surroundings at St Luke’s, it’s the least people with this horrible illness should be allowed and the dignity to go with it.

  St James is a general hospital so a hospital dedicated to the illness is what’s needed and that is St Luke’s.

  I recently read Rory Quinn’s article about St Luke’s and the treatment he got there and it went straight to the heart. KEEP ST LUKES HOSPITAL OPEN.

  Ingrid

  “St Luke’s hospital is a wonderful facility for cancer patients. The staff is wonderful and the quiet setting gives a calm and private atmosphere to the hospital. My late husband received treatment and care there and there was wonderful support not just for him but also for all of us family.”

  Lavinia

  “St. Luke’s is a hospital that is well needed and it is more than a hospital. I have had two special people in my life who have had cancer around this time. One was my Dad whose cancer had gone too far and never made it to this hospital and is now in heaven and the other who was in St. Luke’s has since made a full recovery”

  III THE DEMOCRATIC PROCESS: GOING THROUGH THE DAIL AND SEANAD

  TD ‘OUTS’ HIMSELF AS LUKE’S PATIENT

  The next five chapters deal with the Bill’s passage though the Dail and Seanad. Many of the speeches are printed in full. But if you find them hard to read or a total turn off, just read the commentary below which tries to give the flavour of the debate.

  As the Minister caught us on the hop, we didn’t know the Bill had been introduced so we weren’t there for its First stage or for the Second stage debate which began on 3 June and continued on 9 June.

  We print below some of the speeches, including Minister Harney’s, opening the debate.

  Deputy Ruairi Quinn, a TD for the Dublin South East constituency in which St Luke’s is situated ‘outs’ himself as a former St Luke’s patient. Two other TDs from the constituency, Lucinda Creighton and Chris Andrews spoke. Deputy Creighton (FG), who spoke when the debate was resumed on 9 June, commented that the Minister wasn’t there and said, ‘it is important it is noted that the Minister did not see fit to come to the house.’

  Deputy Andrews (FF) mentions the unique environment at St Luke’s and stresses its relevance to healing for cancer patients yet goes on to promote, as a future use, step down facilities. He spoke of Dublin families being inconvenienced by having to travel to nursing homes in outlying counties to visit elderly relatives, and how much better it would be if the elderly relatives could live on the St Luke’s site. He admits that James’s does not have the same appeal, or tranquillity but he says, without giving any evidence, that as James’s develops into a centre of excellence it will improve recovery rates for cancer sufferers.

  Deputy Andrews obviously defines ‘closure’ differently to the average person – he says ‘I do not see it as closure but as the transfer of services.’

  The fourth TD for Dublin South East, Environment Minister John Gormley did not speak at the debate. We cannot say whether he was physically present in the chamber as we were not there. Obviously as a minister he has a busy schedule but it’s surprising that if other commitments prevented his appearance, he didn’t ask another Green deputy to speak on his behalf.

  Minister Gormley is on record as a St Luke’s supporter. Several papers reported his advisor Ryan Meade speaking on his behalf at the Dublin march in 2007. Prior to the 2007 general election, the then Deputy Gormley came out of the Dail, shook the hand of Joe Guilfoyle who was on a St Luke’s picket, promised his support, and said he would help in any way he could.

  In her speech Minister Harney refers to some Luke’s staff being transferred at the end of the year. This is worrying when St Luke’s doesn’t officially close until 2014. Concluding the Second stage debate, Junior Health Minister Barry Andrews states that the Minister believes St Luke’s has a future within the public health service and has indicated she will consult the Friends, the HSE and other interested parties on how the site can best be used in the future.

  Whether other interested parties includes patients and their families we don’t know! Patients and their families weren’t consulted in any way in the process to decide on the cancer centres of excellence. In the third stage debate featured later Minister Harney describes cancer patients as sometimes ‘emotional’ – which doesn’t indicate she intends to consult patients about the future use of St Luke’s.

  Referring to St Luke’s as a haven for cancer patients she says that ‘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.’

  So she agrees that what St Luke’s offers is vital then says, ‘ 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.’

  So, having said that, she proceeded to push through her Bill to close St Luke’s in record time!

  June 3 2010

  Second Stage Health (Miscellaneous Provisions) Bill 2010

  Minister Mary Harney: 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 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.

  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 cooperation 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.

  Deputy James Reilly (FG): 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 reexamined 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 look only to their radiological and oncological needs but also looked 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.

  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. This data was 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.

  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 servic
es 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.