Cancer in a Cold Climate

by Enid O'Dowd

  Deputy Reilly reminded the house that the Minister had verbally agreed to the Fine Gael amendment he proposed to introduce at this stage which she had now contradicted by her own amendment.

  Mary Harney then spoke. She seemed a little angry which perhaps showed some of the publicity and our lobbying had got to her. In particular the Irish Daily Mail had been running patient stories and editorials supporting the retention of St Luke’s. And the Sunday Tribune had commented on the low marks given to St Luke’s in the competition process.

  She quoted the marks gained by St Luke’s and James’s but she quoted the total marks rather than individual section marks where the results were certainly open to question. As mentioned earlier under the category suitability of site Luke’s got 46.75 (out of 100) while St James’ got 85.5. She mentioned that three of the experts were nominees of three medical bodies outside Ireland but she did not mention then that the other three experts were all Irish public servants. Later in her speech she mentioned there were two Irish doctors on the panel but did not state they were employed by her. She never mentioned the HSE (non medical) manager on the panel. She said she has to listen to experts and would be criticised for not doing so. This comment is interesting in the context of the fact that an expert report supportive of retaining St Luke’s in addition to James’s was not officially presented to her by the St Luke’s Board and the Friends of St Luke’s who jointly commissioned it. This matter is covered in Section V.

  She then said causing a gasp of anger in our group

  ‘I know that patients have had a happy experience in St Luke’s and many of them are sad and, in some cases, emotional about what is happening.’

  That word emotional upset us. Was that her justification for the total lack of consultation with patients? They are experts too – surely at least as expert as the HSE manager on the panel of experts.

  She then attacked, unfairly in our opinion, opposition deputies for saying they supported the governments cancer control strategy when in reality they were opposing it by asking that St Luke’s be retained.

  We became angrier as opposition deputies responded to these remarks and she didn’t back down.

  Then the vote. Even Bertie Ahern appeared when the bells tolled. No book launch today.

  The amendments were lost by four votes; the overall bill passed by four votes.

  Later we noted from the Dail records that 136 deputies voted. There are 163 TDs currently given that there are three bye elections to be held. That means that allowing for the Ceann Comhairle Seamus Kirk who does not vote unless there is a tied vote, 26 deputies did not vote. When TDs are away on official business or sick it is normal for a ‘pair’ to be agreed by the party ‘whips’ so that there is no party advantage arising from necessary absence by a member. Thus it appears that 13 deputies were not there and were ‘paired.’ Six of the missing government TDs were ministers and it is understandable that their schedules would not permit attendance for all votes. However one has to ask what the other missing TDs were doing that was important enough for the opposition whips to agree a pair.

  The Dail only sits for about half the year so surely it isn’t much to ask that back bench TDs turn up?

  But we’ll never know the truth. A contact in the Dail told me, ‘the whips organise pairing and their records are highly confidential.’

  The fight moved to the Seanad.

  Health (Miscellaneous Provisions) Bill: Report and Final Stages.

  Dáil Eireann

  30 June 2010

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

  In page 4, between lines 6 and 7, to insert the following:

  “6.—From the commencement of this Act any review of services, including those of any land and buildings, at Saint Luke’s Hospital, must be laid before the Dáil and the Oireachtas Joint Committee on Health and Children by the Minister for approval.”.

  I do not wish to delay the House unduly on this amendment. We discussed this issue at a meeting of the Select Committee on Health and Children. I proposed that I would table an amendment on this matter for Report Stage. I want to read into the record what I said on this matter at the Select Committee on Health and Children. I said:

  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 also make another point which is not relevant to this matter. I will cite, for the benefit of the Minister of State as the Minister for Health and Children is not here, what the Minister said in reply. She said: “I am happy to agree to Deputy Reilly’s suggestion.” Therefore, I am somewhat surprised to see amendment No. 2, which does not reflect what I sought, unless amendment No. 2 is to be subsumed into the amendment I tabled. The difference between the Minister’s amendment and the proposal I highlighted clearly on Committee Stage, to which the Minister agreed, is that any proposal for any changed uses of lands at St. Luke’s would be laid before the Dáil and the Oireachtas Select Committee on Health and Children.

  The Minister’s amendment states “the Executive shall use the land vested in it by this section for the purposes of the delivery of health and personal social services within the meaning of the Health Act 2004”, but it does not stipulate, as I did in my amendment, of which I gave notice and to which the Minister agreed, that any proposal for any changed uses of the lands would be laid before the Oireachtas by the Minister. The purpose of doing that is to allow the Oireachtas act on full information and to allow the people to see precisely what plans are being put in place before such plans are acted upon. That is what democracy is supposed to be about. It will not in any way tie the Minister’s hands per se. If the then Government were to have a majority on such a proposal, then it would have a majority, but at least the people of Ireland who have used this wonderful service would know of the proposal.

  We have all been at one in praising the service provided by St. Luke’s, in particular, its ethos, the manner in which it looks after patients and their families in such a holistic fashion, and the great work done by the organisation, Friends of St. Luke’s. They all want to be assured that the people, as represented by their elected representatives through the Houses of the Oireachtas, will be able to have a say on what happens to St. Luke’s Hospital. That is reasonable. I was very pleased that the Minister agreed to that proposal. She said: “I am happy to agree to Deputy Reilly’s suggestion.” I hope there will not be any rowing back from that position.

  I appeal to the Minister of State, in representing his senior Minister, to accept this amendment. What I have said is true and it can be checked in the “blacks”. There is no question of my trying to in any way to twist what the Minister said.

  What I cited is a direct quote from her from the record of the Committee Stage debate.

  I propose that this amendment be accepted. I believe it will meet the concerns of many people who have used St. Luke’s, are very proud of their association with it and who wish to see the wonderful ethos in it continue throughout our oncology services.

  I do not wish to end on a negative note but the reality is that the HSE does not have such an ethos and we are deeply concerned that the ethos in St. Luke’s could be lost and equally that those lands and buildings could be lost. We do not want to see that happen.

  Deputy Ruairí Quinn (Lab): Amendment No. 3 in my name and that of my colleague, Deputy Jan O’Sullivan, states:

  In page 4, 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”.

 
; To translate that into vernacular English, we want to hold on to St. Luke’s as a centre of cancer excellence; we do not want it to be sold. If the Minister wants to sell it, she or her successor will have to bring such a proposal back to this House and make a persuasive case for it. It is pretty simple.

  The Minister of State is not the senior Minister responsible and therefore he is not accountable for undertakings given by the Minister verbally in the Chamber. Any verbal undertaken given by any Minister in any Administration is not worth the paper it is not written on. For the Government to suggest, with the arrogance that only a tired Administration can command faced with an election in 2012, that it will not implement a decision in 2014 makes Robert Mugabe look like a reluctant tyrant. Let us be realistic. This Administration will not form the next Government, according to all the opinion polls. To suggest instinctively, that Deputy Harney as Minister would give a verbal undertaking that the Government would not be disposed to do as we seek indicates the reason for the Government parties’ rankings in the polls and why the Minister’s party has disappeared.

  I attended the opening of Lios na nÓg, a Gaelscoil in Cullenswood House last Monday. I persuaded the Minister of State’s colleague, Deputy Treacy, when he was junior Minister with responsibility for the Office of Public Works, in 1987, after much argument and debate, not to proceed with the firesale of Cullenswood House. As the Minister of State may recall it was the birthplace of Scoil Eanna, the birthplace of the Gaelscoil movement and the birthplace of the school that Padraic Pearse established in Oakley Road for the teaching of young people through the medium of Irish in the early part of the 20th century. The then Minister of State, Deputy Treacy, listened to the arguments I put to him, namely, that this was a dilapidated building in poor condition. The Office of Public Works then faced similar economic constraints and firesale conditions, although the conditions were not as bad as those now faced by the Minister of State’s Department and the Government. I advised the then Minister of State that the building was a building site and that little or no money would be secured from its firesale and that it would become an apartment block of anonymity and privacy. He was persuaded by my argument. Through a long process of preservation, consultation and gestation, having regard to the original purpose for which the building was preserved or held on to by the Cullenswood House committee, the building was transposed into the provision of a new Lios na nÓg school beside Scoil Bhríde, which was one of the original Gaelscoileanna in this country. President McAleese had the honour of opening that school less than ten days ago. If the then Minister of State, Deputy Treacy, had not had that courage, which I hope the Minister of State possesses, we would not have had that celebration less than ten days ago. This building would probably become an anonymous, badly built, speculatively constructed, apartment block, something of which Ranelagh does not need more.

  We have been told nothing will happen for another four years, until 2014. The property market will probably have recovered in part by then but our economic circumstances will remain difficult. The temptation to sell off this property in Dublin 6, as my constituency colleague, Deputy Lucinda Creighton, will concur, will be strong. If it were to be sold off and the proceeds transferred to the Health Service Executive which would then provide an equivalent facility of the same quality in another location, I would be somewhat open minded though still not persuaded. However, the idea of handing over that haven of calm, as one speaker described it on Second Stage, to the chaos of the HSE is beyond belief.

  The Minister of State’s party will not be in government in four years’ time. He must not allow this facility to become the bureaucratic entitlement of the Department of Health and Children or the HSE, which is accountable to nobody. In the case of the Department, we can at least see our public servants in the Chamber today. Under the old system, some of us were members of health boards, possibly including the Minister of State, Deputy Moloney. However, the HSE is like the KGB, with public representatives never seeing or meeting with its officials. They do not answer our questions and are entirely unaccountable.

  If this legislation is passed in its current form, St. Luke’s Hospital is gone. If the Minister of State does not accept the Labour Party amendment, this vital facility is doomed. Can he name another hospital anywhere in the country that could evoke the same degree of emotion, sympathy and support which the Friends of St. Luke’s Hospital have been able to mobilise? It is not simply a question of a feel good factor, as many mothers of children born in certain maternity facilities feel good about the process of having given birth there. We are talking about something much more substantial. We are talking about people who went through a journey which they may or may not have survived. They and their families attribute their survival, or the calm acceptance of the alternative outcome, as being greatly assisted by the calm environment of St. Luke’s Hospital. Yet the Minister is going to substitute it for St. James’s Hospital. We are going to transpose St. Luke’s Hospital and everything that surrounds it into the facility off St. Stephen’s Street. Who is in charge here?

  Once state-of-the-start medical practice has measured and identified what is wrong with an individual patient - Deputy Reilly is more familiar than I with what is involved in that - the course of therapy is outside the narrow confines of measured medical interventions. There are other factors that cannot be measured but which contribute to the recovery or palliative care of patients. Just because we cannot measure them does not mean they do not exist. That immeasurable quality exists in St. Luke’s Hospital, yet the Minister of State is going to let the HSE flog off the facility even though his party will not even be in government when it happens. The Minister of State will regret, when he is in opposition in four years’ time, that he did not have the courage to say he did not agree with the permanent officials of the Department of Health and Children or the monster that is the HSE. A future Minister will have to come into this Chamber in 2014, stand where the Minister of State is standing today and persuade the House that it is a good idea. It is certainly not a good idea in 2010. Why is the Minister of State ceding to people in the HSE - people who never have to face election or accountability of any kind - the power to destruct a facility that has won the hearts and affections of hundreds of people throughout the State? For whom and for what is that being done? It is mind blowing.

  We have not made a success of the reorganisation of our health services; everybody in the House would agree with that. There is much work to be done. I am advised by people who know far more than I about the mechanics and science of medicine that national centres of excellence and the centralisation of cancer services is the best way forward. I do not dispute that, but the reality is that we do not know everything. What we do know, however, is that St. Luke’s Hospital works. Why impose a death certificate on this cancer treatment facility, which is what the Bill will do if our amendment is not accepted? It is a death certificate with a time stop of four years.

  I have collected four boxes of petitions, which will be delivered to the Minister’s office, from people throughout the country. Deputy Creighton will concur that this is not simply a constituency issue. St. Luke’s Hospital is a national institution which happens to be located in the constituency of Dublin South-East, and the vast majority of the people who have petitioned me and Deputy Creighton do not live in the constituency. This is not parish pump politics; it is a question of national solidarity with an institution that works and whose existence has evoked an extraordinary loyalty. Yet the Minister of State wants to destroy it. I urge him to accept our amendment. If necessary, the Minister, Deputy Harney, can introduce the change in the Seanad. I ask the Minister of State to do a “Noel Treacy” on this and save St. Luke’s Hospital.

  Deputy Jan O’Sullivan (Lab): Our objective is to save the best aspects of our health services. St. Luke’s Hospital has indisputably played an enormous part in many people’s recovery from cancer - people from throughout the country - over many years. I say this in the context of being
fully supportive of the cancer strategy. Whenever we raise issues at the edge of the cancer strategy, the Minister disingenuously claims we are not supportive of the strategy itself. That strategy is about centres of excellence; it is not about doing away with the elements of excellence that already exist in the system. We are not arguing that St. Luke’s Hospital should be a stand-alone centre of excellence. Rather, we are arguing that it should be linked into one of the designated centres for the Dublin area while retaining its unique character and continuing the work it has been doing for generations.

  It is difficult to measure the positive benefits for people recovering from or undergoing treatment for an illness like cancer of the type of atmosphere offered by St. Luke’s Hospital. A substantial body of research suggests that one’s state of mind, one’s environment and the way is which one is treated all contribute significantly in terms of recovery and response to treatment. Those elements are uniquely available at St. Luke’s Hospital in a way they are not in the large acute hospitals that have been designated as cancer centres.

  We are not suggesting that diagnosis or surgery should be available in St. Luke’s Hospital, we are suggesting that there is a role for it to be attached to one of the other centres.

  As health spokesperson for the Labour Party, I would hate to have been involved in throwing out all of the good elements of our health service to fit it into a straitjacket-style strategy; that is why I am arguing this point even though I support the core of the Minister’s strategy with regard to providing excellence in cancer treatment, where we do not do everything all over the place, which was the reality in the past and which needed to be addressed. This is different, it is about preserving something unique and special that could not be reconstructed.

  There is protection until 2014 in the legislation and on Committee Stage when I tabled this amendment, the Minister appeared sympathetic to our arguments and said she would come back with a positive amendment. Initially, when I read the amendment she tabled, I thought she was responding to what we had raised. When we look at the detail of the amendment, however, it is subject to subsection (5) - that the executive must use it for the purposes of the delivery of health and personal social services. That subsection states that the executive may not without the consent of the Minister sell, exchange, let or otherwise dispose of any land vested in it by this section. If that is turned around the other way, with the Minister’s consent, the executive can sell St. Luke’s Hospital. That is why the amendment is meaningless, it simply restates the contents of that subsection, it does not deliver what it promises at first reading. It does not give any reassurance beyond 2014 that St. Luke’s will be retained for health services.