by Enid O'Dowd
Deputy O’Hanlon referred to the need to ensure value for money and long-term benefits under the ultimate cancer care strategy as set out by the Department of Health and Children and the Health Service Executive. While that is important, it would be a pity if value for money was the only objective. It is not simply a question of value for money, it is also a question of retaining a high standard of care for people who are ill and require a certain level of care. In that regard, St. Luke’s Hospital is ahead of the rest. It is not a scientific assessment, but if one looks at ratemyhospital.ie, it is rated by patients above virtually every other hospital in the country. Ultimately, patients are the barometer, as they are the ones who benefit from the high standard of care available in St. Luke’s Hospital.
I very much support the amendment. If it is not acceptable to the Minister, perhaps she might consider Deputy Reilly’s amendment on Report Stage. It is important that a clear commitment is made to retain St. Luke’s Hospital for the benefit of cancer patients in the future.
Minister for Health and Children (Deputy Mary Harney): It
is important to recap on why we are where we are on this issue. In 2003 the Government published its radiation oncology plan which strongly recommended that radiation services should be integrated with surgical and oncology services. That is why we are doing this. Subsequent to the plan, an international evaluation took place of all of the facilities in the country, including St. Luke’s Hospital. All hospitals were evaluated according to five criteria. I will be happy to let the Deputies opposite have a copy of the evaluation. St. Luke’s Hospital had a score of 46.7 as against 85 for St. James’s Hospital.
There is virtually unanimous support among the experts for the cancer control programme. I am aware of only one expert who does not support it. It is seen to be delivering for patients. Central to the strategy is the integration of treatment services in a multidisciplinary unit environment. That is why the service will be provided in Dublin at Beaumont and St. James’s hospitals. The facility in St. James’s Hospital will be available later this year and in Beaumont Hospital next year. We are spending more than €58 million.
St. Luke’s Hospital has a track record, reputation and an ethos because until relatively recently anyone who received radiation oncology services in this country received them in St. Luke’s Hospital because there were no other facilities available. Now such facilities are available in Galway and Cork. There are also private sector facilities available. Traditionally, all such services were provided in St. Luke’s Hospital. Therefore, there is a strong affinity between patients and their families with the hospital. We want to keep this. That is why the network is will be called the St. Luke’s network. On 8 July I will engage with the Friends of St. Luke’s Hospital who have a fantastic record in raising money for the hospital. They want to continue to raise money for cancer services.
It is clear that after 2014 there will not be radiation oncology services available on the site. The service will be integrated with the eight specialist centres. The services in Limerick and Waterford will be subsumed into the public system at that point or perhaps earlier. That is not only desirable from a treatment outcome point of view but also from the point of view of ensuring access to the range of experts we can put in place in both Limerick and Waterford. We will have two centres in Dublin and one in Galway and Waterford. The unit in Limerick will be a satellite unit of the centre in Galway, while the unit in Waterford will be a satellite unit of the centre in Cork.
It is clear that there are access issues for people living in County Donegal which is why we have been working with the authorities in Northern Ireland. We have agreed to provide capital to meet the cost of building the new facility at Altnagelvin. Three weeks ago I had further discussions with the Minister, Mr. McGimpsey, on the project which has received strong support among patients and patient advocacy groups in County Donegal.
As I have said on many occasions, the site will be kept for public health purposes. When the Deputies opposite talk about cancer and palliative care services, the latter service is not just provided for cancer patients, it also involves other patients. If we were to say it was for cancer patients only, it would rule out that option.
The board of the hospital has commissioned a prospectus and a report on the best use of the facility. That report is imminent. I repeat the commitment, once again, that the building will be used for public health purposes. It might be used to provide a combination of palliative care services, including for non-cancer patients who require palliative support, and perhaps long-term care services. Until we receive the report and engage with the various parties involved, I do not wish to be prescriptive in legislation. I assure members that there is no intention to use the site for anything other than health care services. I will be more than happy to come back to the committee when we receive the report to discuss the contents. The facility will not be used for anything other than public health services, whether it be palliative care or support services for cancer patients receiving treatment in one of the big centres, or long-term care services. I give a commitment to members that it will not be used for any other purpose.
I know there is concern. Fears were raised that the hospital would be used for all kinds of odd things. It is difficult to secure land close to the centre of Dublin for public health services. Given that we have a site at St. Luke’s Hospital, we need to keep it. As Deputy Reilly acknowledged, there will be a growing demand for additional services for patients and the facility will have to be used for that purpose.
Deputy Jan O’Sullivan (Lab): While I accept the good faith of the Minister in maintaining the site for health services, she will not be Minister forever----- Deputy Mary Harney: One never knows, the Deputy might be the Minister herself. There could be a choice to be made between any of the three Opposition Members present.
Deputy Jan O’Sullivan (Lab): There is a view that, despite the verbal commitments given by the Minister, that we need to pin this down and ensure the site will be maintained for public health services. The wording of the amendment has been chosen deliberately. The reference is “for medical purposes related to the treatment of cancer”. This would not preclude other forms of treatment such as palliative care being provided for other patients.
To return to a point I made about satellite centres, I come from Limerick. Originally it was not meant to be included in the provision of centres of excellence, nor was Waterford, but because people in the two regions felt so strongly about the issue, campaigned and raised money in order to ensure radiation oncology and other services would be available in these areas we succeeded in having them included in the provision of satellite centres connected with the centres in Galway and Cork. Sometimes the impression is given that if one tries to vary the cancer programme in some way, one is somehow or other against it. I strongly refute that argument. All parties have strongly supported the concept of ensuring we have so-called centres of excellence and that we provide the best possible services to ensure the best possible outcomes for cancer patients, but that does not mean everything must be done in specific centres. That is proved by the fact that we will have satellite centres in Limerick and Waterford connected with the centres in Cork and Galway and a satellite centre in County Donegal connected with the centre in Derry. There is no principled reason it should be seen as a betrayal of the cancer programme that we should seek to keep St. Luke’s Hospital as part of the St. James’s Hospital or Beaumont Hospital network in Dublin. There are many examples to show how this approach works very well in other parts of the world, where there is a highly respected centre of excellence with a highly regarded team but also a satellite centre connected clinically with the larger centre.
I am convinced by those who say the atmosphere in St. Luke’s Hospital contributes to the recovery of patients because it is calm and family-friendly. It is not a busy, acute hospital campus. The Minister must review the matter to ensure the qualities people have been able to enjoy in St. Luke’s Hospital
in the treatment of their loved ones are maintained within the service. The wisdom of clinicians is sometimes seen as the be-all and end-all. However, there are questions on how the marking scores were arrived at, particularly when St. Luke’s Hospital scored so low considering how so many claim it is a wonderful place for those recovering from an illness. Some €15 million was spent on four new linear accelerators recently.
The decision on St. Luke’s Hospital was made at the same time it was decided there would be no centres in Waterford, Limerick and County Donegal. Variations have since been made to the plan. St. Luke’s Hospital should be considered in the same context.
There is a genuine concern that after 2014 the site will be sold. It is an extremely valuable site located in an up-market part of Dublin. While its value may be somewhat reduced because of the current economic climate, there is a fair chance it will be valuable again by 2014. While I do not doubt the Minister’s word, a verbal commitment on the future of the site is not enough. Something stronger is needed.
The original plan to which the Minister referred has been varied since 2003. The quality of cancer care provided in St. Luke’s Hospital during the years cannot be easily measured or quantified. Many claim the atmosphere it provided had a strong bearing on people’s recovery from illness. These factors need to be considered.
Deputy James Reilly (FG): While I do not doubt the Minister’s commitment, clarity is needed. As time passes, Governments change. I will table an amendment on Report Stage to have any review of services or new plans for St. Luke’s Hospital brought before the committee by the Minister. This would allow members to have their say and act on the basis of full information. I agree with the Minister on the fantastic work done for the institution by the Friends of St. Luke’s Hospital.
Deputy Mary Harney: I am happy to agree to Deputy Reilly’s suggestion.
The plan on cancer care has not been varied. It was adopted by the Government in 2005 and provided for a facility in Limerick and Waterford. They are different from St. Luke’s Hospital in that they are both cancer centres. The plan does not include provision for a stand-alone radiation facility.
A facility will not be located in County Donegal but at Altnagelvin Area Hospital in Northern Ireland. Currently, there is only a radiation oncology facility in Northern Ireland at Belfast City Hospital. For capacity reasons, the Northern Ireland authorities will provide a facility at Altnagelvin Area Hospital which will open in 2015. As this facility will suit patients in County Donegal, we are anxious to avail of the service, about which the Northern Ireland authorities are happy. We will contribute to the capital cost of the investment and also procure services paid for on the number per patients treated each year. This has received much support from the clinical community in County Donegal and patients’ advocacy groups.
The scoring was not done by me but by the Royal College of Radiologists in London, the US National Institute of Health and the European Society for Therapeutic Radiology and Oncology, world experts in this field. While I do not know how they came to their conclusions, the advice is it is better to integrate radiation oncology services with surgical services rather than having stand-alone facilities.
What has happened in Limerick and Waterford in the meantime is that private facilities have opened. The question for the State is should it procure services for public patients. No one wants to see facilities available just for one group of patients. The facility run by the Mater Hospital in Limerick will be subsumed into the public system in Limerick and there will be a facility built at Waterford Regional Hospital.
I will be happy to reflect on the concerns raised about the use of the St. Luke’s Hospital site for public health facilities before Report Stage. There should not be disagreement between us, as we are all at one on this matter. It is not my intention that the site should be used for any purpose other than the provision of public health services.
Deputy Jan O’Sullivan (Lab): That is welcome. My point about services in Limerick and Waterford is that originally there was no intention to provide radiation oncology facilities there.
Deputy Mary Harney: The Government’s decision was made in 2005 and the plan included facilities in Waterford and Limerick.
Deputy Jan O’Sullivan (Lab): Yes, but only because people in Limerick and Waterford fought to have these facilities provided.
Deputy Mary Harney: In 2003 the advice was that we should build the backbone of the main service before dealing with satellite facilities. Later this year the St. James’s Hospital facility will come on stream, followed next year by the facility at Beaumont Hospital. The clinicians working at these facilities will be the same.
Deputy Jan O’Sullivan (Lab): If there had not been campaigns in Waterford and Limerick, I have no doubt these services which were originally set up as private facilities would not be part of the system.
I welcome the Minister’s commitment to consider the concerns expressed about the hospital site before Report Stage. However, I want to press the amendment because we need to put down a marker that a statutory commitment should be made that the site will be retained for public health use.
Deputy Mary Harney: It is important to note that even if something is incorporated into law, it can still be changed.
Deputy Jan O’Sullivan: That is true.
Amendment put.
The Committee divided: Tá 6; Níl 8.
150,000 SIGNATURES IGNORED
The following week, the third and final stage of the Bill in the Dail was taken on 30 June.
We decided to hand in the 150,000 signature petition which had been collected from supporters all over Ireland. Committee member Olive Stanley Wetzel and supporters had collected over 5,000 signatures from the Taioseach’s constituency alone, but all counties were represented in the total.
Joe Guilfoyle, on his many trips from his home in Waterford to Dublin for treatment, used to collect signatures on the train. He asked Pauric White, Chairman of the Board of St Luke’s to accept the signatures but he felt it was inappropriate as Chairman to do this. Former Luke’s patient Deputy Ruairi Quinn agreed to accept them and get them safely to Minister Harney. We were mounting a picket on the Dail until it was time to go in for the debate and Ruairi came out with a trolley for our boxes of signatures. It was chaotic outside the Dail; fighting for pavement space with those opposing the civil partnership bill and others supporting stag hunting.
Joining us on the picket line was the writer Ulick O’Connor – one of St Luke’s strongest supporters. Ulick grew up in Rathgar opposite the cul de sac leading into the hospital and still lives there today. He has contributed his thoughts on St Luke’s earlier in this book.
We knew that Labour and Fine Gael had put down amendments, the Labour one that had been defeated at select committee stage and the amendment promised by Dr Reilly in the select committee debate with which Minister Harney said she ‘had no problem’.
We were not enthusiastic about the Fine Gael amendment because if the current government were in power when the HSE brought a proposal to the select committee to sell the land or to use it other than for public cancer patients, then the change would most likely go through on party lines, just as the Labour amendment had been defeated on party lines.
Minister Harney was not in the chamber for the start of the debate but came in later. Junior Health Minister John Moloney was there from the start.
Dr Reilly opened the debate with the amendment he had promised at committee stage and read into the record the Minister acceptance of it. But immediately there was a problem as he queried amendment No 2 tabled by Minister Harney which did not reflect what she had agreed to earlier.
Again Deputy Quinn made an inspiring speech, emphasising that St Luke’s is a national institution and that it was not a constituency issue, a matter of parish pump politics and that the majority of people who had contacted him and the other deputies from the Dublin South East constituency did not live in the constituency.
His constituency col
league, Lucinda Creighton, objected to the legislation being ‘rammed’ through referring to an earlier week when no issues of any substance were timetabled and when the Bill would have had more time in which to be properly discussed. She said, ‘it is depressing to see constructive amendments as put down at the committee stage the previous week voted down by government deputies who had not even attended to listen to the debate.’ She presumed this would happen again – and she was right.
The chamber was lacking in government deputies. They might claim they were listening to the debate in their offices but we felt that given the lobbying a few at least should have had the decency to come into the Chamber and explain why they were intending to vote to close St Luke’s. No Green Party deputies attended. When the division bells tolled, Green Party leader John Gormley led in his party colleagues to vote down the opposition amendments.
When Junior Health Minister Moloney spoke on the debate to date, he immediately suceeded in alienating our group by attacking Ruairi Quinn for supporting St Luke’s as it was in his constituency. This was the opposite of what Quinn had said; he had stressed that most of the representations came from outside the constituency as Luke’s is a national institution respected by citizens all over Ireland.
As the debate progressed, we had felt there was some hope of the government accepting the amendments because of the standard of the contributions from Labour, Fine Gael and Sinn Fein. How naïve can you be! After criticising Deputy Quinn unfairly, Minister Moloney stated that the Minister would not be accepting either the Labour or the Fine Gael amendments. Her own amendment, he claimed, provided for the use of the site for health and social services in line with the Health Act.