Cancer in a Cold Climate

by Enid O'Dowd

  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 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 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 nobrainer in terms of making a decision to sell the site.

  Deputy Mary Harney: Not any more.

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

  Deputy Mary Harney: I saw that.

  Deputy Ruairí Quinn (Lab): 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 immediately 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.

  Chris Andrews (FF): 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 they 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 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 Minist
er 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 Chaoimhin 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 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 very 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; 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.

  Wednesday 9 June 2010

  Second Stage Health (Miscellaneous Provisions) Bill 2010 resumed

  Lucinda Creighton (FG): I am pleased to have an opportunity to speak on this important Bill but I am disappointed that the Minister is not present for the debate. It would be fitting that the Minister would see fit to appear in the House to take this legislation given its important and far-reaching ramifications for the health service in the future. It is important it is noted that the Minister did not see fit to come to the House.

  The purpose of this Bill is the dissolution of the board of St. Luke’s hospital and the transfer of staff in the hospital and the hospital’s assets and liabilities to the HSE. I take the opportunity to express some degree of concern at that development. It is well-recorded that politicians and the public have almost lost all confidence in the Health Service Executive. It is difficult to have confidence in that body.

  The original concept of the HSE was a good one. The aspirations of the Minister and the Government in establishing it were well-intentioned but the objective of eliminating bureaucracy and the parochial element associated with the old-style, traditional health boards was not achieved. What replaced the traditional health boards is essentially an everexpanding and pretty frightening monster, namely, the HSE.

  What we have been left with is a complete absence of the streamlining of services. We have an inaccessible, a confusing and an often frightening system which people shudder at the thought of interacting or interfacing with. We have some very old and well-known problems with over-staffing, excessive administration and with an absence, or at least a very severe shortage, of front line services. These problems are acute and are growing by the day. There is no clarity about the division of workload within the HSE. There is a hugely demoralised workforce within the health service.

  From my experience of the HSE, the delivery of health services is getting worse. I say that with a heavy heart because it is essential to provide a quality service in which people can have confidence. However, that has not been my experience. To call it a fiasco is a serious understatement but the fiasco about which we heard in recent days in regard to the ultrasound which went wrong in Our Lady of Lourdes Hospital in Drogheda is simply symptomatic of deep and ingrained problems in the health service. I know that from my experience of dealing with constituents and from the experience of my family members. My uncle contracted MRSA in a hospital in Louth and died as a result. My father contracted MRSA in another public hospital in a different part of the country and was severely debilitated as a result. I am not unique in that there are few people and few families who have not been touched by the ongoing problems throughout our health care system, if one could call it that.

  It is time the Minister stood up and was counted in terms of tackling the bureaucracy and the systemic problems in the HSE. I would be the first to acknowledge that the Minister set out with good intentions, with an agenda to reform the health service and that she did so in good faith. She is a politician for whom I have a huge degree of respect and she is a competent and capable politician. It was her intention to try to effect and drive change within the health service but she soon realised that would not be possible for a variety of reasons.

  They include the intransigent work practices within the health service and, more crucially from the Minister’s point of view, the resistance from back bench Government Deputies who will protect the status quo at all costs and resist any sight or sign of change or meaningful reform within the health service. It is not the case that the Minister lacks the drive or intent to effect change and achieve reforms, but rather that she is constrained by the main Government party, which has been in power for too long and does not want, or have any enthusiasm for reform or change. That is a sad situation, the legacy of which, unfortunately, we will have to li
ve with for many years to come as it will take years to solve the endemic problems within the HSE.

  In contrast to the HSE, St. Luke’s Hospital, otherwise known as “The Haven in Rathgar”, is a beacon, a shining light, in the administrative labyrinth that is the health services here. Since 1954, when it was formally established, St. Luke’s has provided the best quality of care for its patients and the best possible services to cancer patients from all over the country. Every family has been touched in some way by St. Luke’s Hospital. Virtually every family has had some family member or friend attend St. Luke’s at some point. Yet, St. Luke’s is to cease operation in 2014. It is all very well to point to expert reports, expert opinion and the most cutting edge of medical advice, but it is difficult to explain to even the most intelligent human beings why the Government wants to dismantle one of the few public hospitals that functions and does its job with aplomb and replace it with a subsumed and submerged cancer service that will be provided via St. James’s Hospital. The latter does not rank as one of the top hospitals in terms of hygiene, services available or its ethos and environment.

  St. Luke’s has been consistently rated as one of the top, one, two or three hospitals in the country on ratemyhospital.ie. Its rating is not scientific but it matters because it is the view of patients. They take the trouble to go on-line, complete surveys and judge the service they have received. It is the patients and their family members who have selected St. Luke’s and held it up as a beacon in the HSE health service quagmire.