Cancer in a Cold Climate

by Enid O'Dowd

  We must acknowledge the reality. We have to take account of expert opinion and advice. Between 2005 and 2007 more than 27,000 new cases of cancer were diagnosed every year. Our population has grown quite rapidly and, unfortunately, in tandem with that the number of cases of cancer patients presenting has increased dramatically. During the 1990s and the early years of this decade Ireland fell way behind in terms of dealing with the new developments and advancement in cancer treatment. We now rank as one of the worst countries in terms of having a national plan to deal with cancer care. That is the reason I welcome the national plan for radiation oncology. It is necessary and important that we do everything in our power to implement it. I recognise the Minister’s commitment to that and her ambition to implement it and, in so far as it is possible, we all have a duty to respect that and to work with it. It is an ambitious plan, which I sincerely hope - I genuinely mean that - will deliver better and improved cancer treatment facilities and care for patients throughout the country. It is imperative that I acknowledge that the strategy has been devised by some of the top medical experts, some of the most eminent cancer specialists not only in Ireland but from further afield. I would not pretend to second guess these medical experts when it comes to identifying medical need. I also would not be so bold as to second guess them in terms of outlining the types of streamlined services that are required to tackle the shortfall in radiation oncology services here. It is important that we, as politicians, examine needs and the best possible strategy to tackle cancer on a national basis and in an integrated fashion. That is the onus on us and we cannot afford to be populist in that regard.

  I also understand that radiation oncology must be integrated with other cancer treatments. Essentially, radiation must be integrated with surgical and medical oncology. In essence, that is not happening in St. Luke’s. I understand this is the most pressing reason for the decision to relocate radiation services from St. Luke’s and to bring them under auspices of St. James’s Hospital.

  In that context, it is important to remind the Minister of commitments made by her predecessor, the Minister, Deputy Martin, in 2003. He said:

  “… that the ethos and strengths of St. Luke’s must remain as key drivers nationally. How best to ensure this happens will be a key objective of mine. In the meantime, I am fully committed to ensuring that the excellent standards of care at St. Luke’s continue to be supported.”

  The Minister, Deputy Harney, in 2005 committed that “arrangements to ensure the continuity of St. Luke’s expertise and ethos in the service” would be maintained. I am confused as to how exactly that ethos will be maintained within the precincts of St. James’s Hospital. I have no confidence that the ethos and the quality and the level of care, to which people have become accustomed and have come to expect, in St. Luke’s will be maintained or that the dignity afforded to cancer patients there will be carried through and replicated under the auspices of St. James’s Hospital. I do not have any confidence that will happen. I would like some assurances on that. That is the reason I am disappointed the Minister, Deputy Harney, is not present. I want to hear from her and I hope in her reply to this debate on Second Stage she will address this issue because we have no clarity on it. I have been raising the issue of St. Luke’s in this Chamber since I was elected to it and prior to that I raised it through engagement with patients and campaigners from and in support of St. Luke’s.

  Over and over we requested assurances and guarantees from the Department, the Minister and the HSE regarding how the level of care can be maintained and how people can have confidence in the HSE to deliver that level of care and they have not been provided. The aspiration was set out by the former Minister, Deputy Martin, followed by the current Minister. They both proclaimed they were committed to delivering and maintaining this ethos but they have outlined nowhere how it is expected that can or will be achieved.

  St. Luke’s Hospital is set in just over 18 acres of beautiful landscaped gardens in Rathgar. It was always the objective of the patrons of the hospital that it would be a place of refuge, peace and tranquility where people from different parts of the country and south Dublin who were battling for their lives could access the best medical care, compassionate care and be afforded the greatest dignity while undergoing hugely stressful radiation, chemotherapy and other treatments. That is the unique element of the hospital, which marks it out from all the other public hospitals in the State. It is something for which people have a deep affinity and that is why there is such outrage of the prospect of the hospital’s closure. It is also why many people, including me, are concerned about the proposed closure.

  There are strong medical arguments in favour of moving the hospital’s services lock, stock and barrel to St. James’s Hospital but it is conceivable that the special conditions available to patients in St. Luke’s Hospital, including the peace, tranquility and solace, will be lost forever. These conditions have a healing power in their own right and that is not hocuspocus. Strength of will and of mind is an essential element in healing. It is not simply about medical treatments; it is also about the psychological and we cannot afford to lose that element of the healing process as well.

  While the oncology service may well have to be relocated to St. James’s Hospital, there is a strong case for retaining St. Luke’s Hospital for recovery, rehabilitation and respite care.

  The time has come, particularly in light of this legislation, for the Minister to outline her vision for the site in Rathgar and for the input of the hospital in the long-term provision of health services for the city of Dublin. I plead with her not only to maintain this unique hospital for the delivery of cancer care or some other form of care but to integrate and maintain it as an essential part of the health services in the city and the country

  No vote was taken.

  The Bill moved to the Select Committee on Health and Children on 24 June 2010.

  CAMPAIGNERS DECLINE MINISTER’S COFFEE OFFER

  Next came the committee stage on 24 June which (in theory) allows bills time to be properly discussed and amended. The Select Committee on Health and Children has 13 members; 7 Fianna Fail, 4 Fine Gael and 2 Labour.

  None of us had ever attended a Dail committee meeting before.

  We had naively believed that Dail committees like this examine bills and changes are made in a co-operative spirit to strengthen the bill for the benefit of all. Not so, at least on this occasion.

  We had lobbied committee members so they were all aware of the issues. We noted with some concern lack of attendance by some Fianna Fail members. We also noted the Minister present with two aides. We knew that Labour were proposing an amendment restricting the use of the land and building to cancer services.

  Dr James Reilly the Fine Gael spokesman on Health said he was supporting the Labour amendment, but if it failed, he would propose an amendment at the third stage of the bill. Dr Reilly’s amendment would mean that once the HSE had taken over the hospital, any review of services or new plans for St Luke’s must be brought before the Select Committee by the Minister as this would allow members to have their say and act on the basis of full information.

  Minister Harney said, ‘I am happy to agree with Deputy Reilly’s suggestion.’

  (You can see this in the full transcript of the committee proceedings in this chapter. Her remark is significant when you read the next chapter which describes the third and final stage debate on 30 June).

  She said she could not accept the Labour amendment as she did not want a ‘prescriptive’ amendment which would tie her hands. She added that she was shortly to meet the Friends of St Luke’s (a charity limited by guarantee based in the hospital which has raised millions for it) to discuss a report commissioned to suggest possible future uses of the site.

  No Fianna Fail member, other than Dr Rory O’Hanlon, bothered to speak and say why, despite the lobbying letters, they could not support the amendment.

  When the vote was called, the missing committee members appea
red, voted on party lines and the amendment was lost. We lost by two votes as Minister Harney voted though not a member of the Committee. This is allowable under the rules but we thought how undemocratic that was. If we had persuaded any Fianna Fail committee member to support the amendment, we would still have lost as the Fianna Fail chairman would have a casting vote.

  The rest of the Bill was then passed by the committee, and moved to its third stage in the Dail.

  Campaigners Nancy Browne and Mary Reynolds spoke to Minister Harney as she left after the vote.

  Nancy said to me afterwards, ‘I pleaded with her; I said this is a black day for cancer patients. She offered to take us for coffee but we declined. We just felt she wasn’t listening.’

  Health (Miscellaneous Provisions) Bill 2010:

  Committee Stage 24 June 2010

  MEMBERS PRESENT:

  Deputy Bobby Aylward

  Deputy Thomas Byrne+

  Deputy Margaret Conlon

  Deputy Paul Connaughton

  Deputy Lucinda Creighton*

  Deputy Beverly Flynn,

  Deputy Mattie McGrath*

  Deputy Denis Naughten*

  Deputy Dan Neville Deputy Charlie O’Connor

  Deputy Rory O’Hanlon

  Deputy Jan O’Sullivan

  Deputy James Reilly

  Deputy Jack Wall*

  *In the absence of Deputies Bernard Allen, Niall Blaney, Dan Neville and Kathleen Lynch, respectively.

  +In the absence of Deputy Charlie O’Connor for part of meeting.

  DEPUTY SEAN Ó FEARGHAÍL IN THE CHAIR.

  Chairman: A briefing note on the amendments has been circulated to members for their information.

  Sections 1 to 5, inclusive, agreed to.

  SECTION 6

  Deputy James Reilly (FG): I move amendment No. 1:

  In page 4, subsection (5), lines 29 to 31, to delete all words from and including “may” in line 29 down to and including “section” in line 31 and substitute the following:

  “may not dispose of any land (including buildings) vested in it by this section and must continue to use the land (including buildings) vested in it by this section for medical purposes related to the treatment of cancer in public patients in a manner and form determined by the Executive with the consent of the Minister”.

  Deputy O’Sullivan has arrived. I have moved the amendment for her. She might like to address it.

  Deputy Jan O’Sullivan (Lab): The amendment seeks to ensure St. Luke’s Hospital will be retained for public use, particularly in the provision of cancer treatment services. We all spoke in the Dáil Chamber on Second Stage on the services provided in the hospital and the ethos of the hospital and mentioned that it was a haven of calm in the Rathgar area of Dublin. The amendment seeks to ensure it will be retained for the purposes for which it has been used. The Minister has indicated that it will form part of the oncology services network in Dublin and that it will provide radiological services. I have tabled the amendment to ensure that will be the case. People throughout the country have highlighted the importance of the hospital in how it assists patients in their recovery, not simply in the medical treatment they receive but also in the atmosphere to be found there which is unique and something we do not want to lose in the health service.

  We have been given a commitment that St. Luke’s Hospital will form part of the network up to 2014, but what are the Minister’s intentions for the hospital post-2014? Under the cancer programme, we have a system of centres affiliated to larger so-called centres of excellence. For example, Limerick Regional Hospital and Waterford Regional Hospital are directly connected with centres of excellence. There is also a proposal that a satellite centre in County Donegal will be linked with a larger centre. St. Luke’s Hospital could play a similar role as part of a larger Dublin network controlled by experts. The purpose of the amendment is to ensure the service the hospital has provided for patients in Dublin and throughout the country and its unique atmosphere, to which many have attested, will be maintained. I urge the Minister to consider the amendment favourably.

  Deputy James Reilly (FG): Pending the outcome of our deliberations on the amendment, I give notice, on behalf of the Fine Gael Party, that a further amendment will be tabled on this matter on Report Stage. I echo the words of Deputy O’Sullivan and reiterate comments I made in the Dáil Chamber. The ethos of St. Luke’s Hospital is remarkable and the outstanding service it has provided is held in the highest esteem in the health service, notwithstanding the many problems experienced in the health system in recent years. The spirit of the amendment is to ensure the ethos of the hospital will not be lost and that there will be some level of certainty about its future after 2014. I respectfully suggest there be no change in the use of the hospital without the matter being first discussed at this committee. If a review of services takes place in 2014, the relevant Minister should place it before the committee for its consideration.

  I reiterate the points made vis-à-vis the role of St. Luke’s Hospital as a safe haven. In so doing I am mindful of a recurring theme in the Health Service Executive, namely, its practice of removing services today with a promise of nirvana tomorrow. Unfortunately, tomorrow never comes. Following the passing of this legislation, responsibility for the management of St. Luke’s Hospital will transfer to the Health Service Executive. All of us are concerned to ensure appropriate and necessary services will be retained at the hospital. Notwithstanding the development of new services, notably radiological oncology services, at St. James’s Hospital and Beaumont Hospital, the Minister has indicated to the committee previously that the number of cancer cases is expected to double in the next 20 years. It is, therefore, highly likely that we will require the retention of the services provided in St. Luke’s Hospital.

  St. Luke’s Hospital provides a unique environment which will remain important in the treatment of cancer. Cancer care is very much about the whole patient. It is not solely about white cell counts and the radiation dosage but also about providing patients with sociological and psychological support in facilities such as St. Luke’s Hospital.

  On Monday I visited Lifford, Ballyshannon and Stranorlar in County Donegal where people were concerned about cancer services and were looking forward to the provision of a radiation oncology service locally. Until such time, many in counties Cavan, Monaghan and Kildare, among others, will continue to depend on the facilities provided in St. Luke’s Hospital.

  Members may not be aware that radiation only takes a few moments to complete. Patients commencing a course of treatment are usually relatively strong but become debilitated and weak by the fourth or fifth week of treatment, at which point travel is no longer an option. For years St. Luke’s Hospital has offered patients who need to minimise travel an opportunity to stay locally. I fully support the amendment and, depending on the outcome, will table a further amendment on Report Stage.

  Deputy Rory O’Hanlon (FF): While I do not have a problem with the spirit of the amendment, I have a difficulty with its practical application from the point of view of the Minister and Health Service Executive. Deputy Reilly referred to care for the whole patient. I have always held the view that as many services as possible should be provided under one roof. The treatment of cancer in a single hospital is not as good for patients as being treated in a general hospital in which patients have access to a range of other services that they frequently and regrettably need.

  I am not in favour of tying the hands of the Minister or the HSE by an amendment of this nature. I would like St. Luke’s Hospital to continue to provide services if this option is practical, appropriate and delivers value for money. Detailed work needs to be done and a judgment must be made as to whether it would be in the best interests of the health service to maintain the hospital. I certainly do not have a difficulty with acute cancer services transferring elsewhere.

  Deputy Lucinda Creighton (FG): As I am not a member of the committee, I am grateful to the Chairman for his indulgenc
e in permitting me to speak in favour of the amendment. In my Second Stage contribution to the Bill I accepted that a significant body of expert opinion supported the view that it was necessary to make surgical treatment available in conjunction with oncology treatment. I do not have sufficient expertise to dispute this view.

  I have worked with the Friends of St. Luke’s Hospital, visited the hospital on many occasions and become familiar with a broad range of people from my constituency of Dublin South-East and other parts of the country who have used its services. Deputy Reilly referred to people from counties Donegal, Cavan and Monaghan. Many generations of families from around the country have benefited from the extraordinary care provided by St. Luke’s Hospital. The amendment reflects the desire and determination of people the length and breadth of the country who have been touched by cancer and benefited from the wonderful care available to preserve the hospital for cancer treatment and care services. This may entail making palliative care or after care services available on the site.

  As I argued on Second Stage, the Department and specifically the Minister must provide a clear expression of intent with regard to the future of St. Luke’s Hospital. I am aware that the decision on the hospital is a legacy of the Minister’s predecessor in the Department, the current Minister for Foreign Affairs, Deputy Martin. Both Ministers stated on numerous occasions in the Dáil Chamber that they are committed to retaining the ethos of the hospital and the high standards of care provided. While I appreciate and welcome this commitment, we have never received a clear statement on what it will mean in practice and what are the Minister’s intentions for the hospital. Having debated the Bill for some weeks, I ask her to avail of this opportunity to set out a vision for the hospital and how it can best play a part in continuing to deliver high quality care services for cancer patients. I would welcome a commitment from her to retain the building which was, I understand, designated a protected structure recently for the benefit of cancer patients long into the future.