by Enid O'Dowd
I fully subscribe to the Labour Party amendment. It was defeated at the Select Committee on Health and Children. This is a compromise which I again remind the Minister she agreed to at the meeting. I can only lay my case before the House and let others be the judge.
Deputy Ruairí Quinn (Lab): I have listened with interest to what the Minister of State said. I regard any person elected in this republic and to this assembly as an equal citizen with the same mandate. There are no first or second division Deputies, irrespective of what party they belong to or if they belong to none. If what I might have said or the way in which I said it suggested that I did not so believe, that is not the case.
I do believe, however, that just as the KGB was the secret service in the Soviet Union, the HSE in the way in which it relates to directly elected Members is the secret service of our health system because we do not get answers. I was with Professor Drumm in the Alexander Hotel when the best of things were promised and I had great hopes for that kind of response. The reason I stopped writing to the HSE or attending those meetings is that they ceased to be effective.
As my colleague, Deputy Jan O’Sullivan has stated, we support the national cancer strategy. We support the experts. My Second Stage speech on this Bill did not challenge that. I merely pointed out with a degree of humility and on behalf of this generation of human beings that we do not know everything. The things we can measure are not all we can experience and the calm haven of St. Luke’s to which Deputy Ó Caoláin referred has benefited many people. We are not seeking to change the national cancer strategy or its timetable. All we want is to add a belt and half a brace to the legislation, which will only become active in 2014 - who knows what will prevail by then - so that the decision making process will be delayed to allow the continued delivery of a residue of cancer treatment in the calm haven of St. Luke’s.
Minister for Health and Children (Deputy Mary Harney): I wanted to be here earlier but I was taking the prescription charges legislation in the Seanad. When that debate concluded I came to the DÓil, although I do not mean to imply I have no confidence in the capacity of the Minister of State, Deputy Moloney, to address the issues arising. I wish to make some remarks for the record because I have grown weary of Opposition Deputies constantly saying they support the cancer control programme only to criticise specific parts of it. Four years ago, 32 hospitals performed breast cancer surgery in Ireland. In one instance, a surgeon carried out a single procedure in a year. This was totally unsafe and it produced bad outcomes for patients and the health care system. We have changed these practices after asking a group of 23 people, of whom 19 were clinicians, from this country and abroad to investigate the best international practices which this country should follow in organising its cancer services. This group made recommendations which were endorsed by the Government. A group under Professor Hollywood was established specifically to examine radiation oncology. The report of the group recommended that radiation oncology should not stand alone from other cancer services. An evaluation was conducted of all the facilities, including St. Luke’s. The evaluation committee, which comprised nominees from the National Institutes of Health in the United States, the European Society for Therapeutic Radiation and Oncology and a radiation oncology institute in the UK, gave the following scores: St. Luke’s, 3,965; St. James’s, 8,897; St. Vincent’s, 8,497; and Tallaght, 7,484.
All hell would break loose in this House if I moved a facility that received a score of 8,000 to one with a score of 3,900. I would be rightly told, as I was during Private Members’ business last night, that I did not put patients first. A motion has been put before the House which asks us to establish a new authority that would put patients first, yet every clinician who works solely in the public system favours this approach, as do the Irish Cancer Society, Europa Donna and every other patient advocacy organisation I have encountered.
I fully acknowledge that St. Luke’s has a terrific reputation and I want to preserve its ethos. Until relatively recently radiation oncology could be administered only in St. Luke’s. Members of all our families have been given a fantastic service at the hospital. Health care moves on, however, and developments in cancer care are revolutionary as well as evolutionary. We either go with the pace of change in order to achieve better outcomes for patients based on evidence or we stay fixed in time and deliver less. Neither I, as Minister for Health and Children, nor the Government is prepared to take the latter option.
I made the remarks to which Deputy Reilly referred in the context of a Bill which at the time lacked provision to maintain public health services at St. Luke’s. I have now come forward with an amendment because my word was not trusted. Since this decision was made, I have stated it was never intended to use St. Luke’s for any purpose other than public health because, God knows, we have relatively few facilities close to the centre of Dublin and its growing population. Instead of giving my commitment to discuss the issue in committee, I am writing it into the legislation. How much stronger could I be?
Do not pretend I am reneging on my word because I do not renege on the policies I make. We were required to put the cystic fibrosis unit at St. Vincent’s to public tender but the company which came first was not in a position to make the tender bankable. I am confident that a successful tender will be found shortly. I do not choose who constructs these projects but I stand over the policies I make. I accept the cervical cancer vaccine was delayed for financial reasons but all the girls who were affected in that year are being covered. The programme was delayed but it was not reneged on and the Deputy needs to use his language carefully.
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. However, all the clinical expertise we could assemble, both from within this country and from abroad and including an expert of Professor Keane’s global reputation in radiation oncology, supports what we are doing. I do not wish to ring fence the future use of the facility for cancer treatment because it could also serve palliative patients. Not all palliative patients are cancer patients. Perhaps it could incorporate a long-term care facility. Prospectus is producing a report for the Friends of St. Luke’s Hospital and we will engage honestly with regard to the future use of the hospital. I had thought a guarantee that it will be used for public health services would be good enough for the Deputies opposite and I am sorry that is not the case.
The decisions taken by the Government were based on the best clinical expertise we could assemble from within this country and abroad. The three nominees from the aforementioned institutes, along with two doctors from Ireland, evaluated all the submissions and scored them accordingly. We may not like the scores but we must be prepared to accept them. For that reason, I am not in a position to reverse my decision or to maintain what is broadly known as a stand-alone radiation oncology facility at St. Luke’s beyond 2014. As I want to maintain the hospital’s ethos and name, the new unit at Beaumont or St. James’s will be called the St. Luke facility. However, this issue is about more than just a name because we are focused on achieving the best outcomes and care for our cancer patients.
Deputy Jan O’Sullivan (Lab): Once again the Minister is distorting what Opposition Deputies have said. I previously stated that we did not believe 32 hospitals should carry out surgery and we completely supported her decision in that regard. She should not shake her head because I want the same respect as the Minister of State, Deputy Moloney, demanded. We are entitled to this respect as public representatives.
We are not insisting on maintaining St. Luke’s as a standalone radiation oncology unit. I am sick and tired of having my words distorted when I speak about cancer in this House. As Labour Party spokesperson on health, I support the national cancer strategy but we are trying to maintain St. Luke’s as a facility for the treatment of ailments related to cancer in public patients in a manner and form to be determined by the HSE with the consent of the Minister. That language is open enough to a
llow other forms of palliative care if that is what she desires, although I doubt she will still be Minister when this provision comes into effect.
I do not want my words distorted. I support the concept of excellence and the type of strategy enunciated by the Minister. However, having moved surgery, certain diagnostics and other services from Sligo to Galway, the Minister agreed, following talks she and Professor Keane had with people in Sligo, that patients could have subsequent care provided in Sligo General Hospital in a safe manner. Why is a similar position not allowed in the case of St. Luke’s Hospital? Why can the hospital not be linked into one of the Dublin centres of excellence? What is the difference between St. Luke’s Hospital and Sligo General Hospital?
Deputy Mary Harney: Radiation is not provided in Sligo General Hospital.
Deputy Jan O’Sullivan (Lab): I am talking about cancer not radiation. This is precisely what I meant when I stated the Minister is interpreted our words in a way that suits her argument.
Deputy Mary Harney: The Deputy suggested last week that St. Luke’s Hospital should become a satellite centre.
An Leas-Cheann Comhairle: Please allow the Deputy to make her contribution without interruptions. I ask Deputy O’Sullivan to conclude.
Deputy Jan O’Sullivan (Lab): The Minister should refer to what is in the amendment, rather than what she imagines is in it.
Deputy Caoimhghín Ó Caoláin (SF): The Minister arrived late, although I do not believe that is the reason she has chosen to present a particular view of Opposition Deputies’ arguments. For my part, my voice is perhaps unique among all the voices in the House in saying that I am not happy with the Minister’s cancer plan, as I will describe it. As I stated before the Minister took her seat, it discriminates against the community I represent and people of all regions north of a line from Dublin to Galway. The Minister will be familiar with the axis from Dublin to Galway but there is another part of the country north of it where people are no less deserving of cancer services at locations in the north west and north east. The current and intended arrangements fall far short of what is required.
There is also potential for real and imaginative cross-Border co-operation. I do not believe the current signalled exodus of people from Donegal to Belfast comes in any way close.
I disagree with the Minister’s proposal on St. Luke’s Hospital. The Bill, as drafted, will remove the hospital and the adoption of amendment No. 2, in the Minister’s name, will not alter a scenario which will present whereby St. Luke’s Hospital will be employed in a non-related, non-cancer area in the HSE or, worse, sold off, perhaps even to fund the working budgetary needs of the HSE in future.
The Minister has failed to take on board the critical concerns of Members. I commend amendment No. 3. The reason I refer specifically to this amendment is it leaves the door open for the decision to be taken on the future of St. Luke’s Hospital in a clear and positive manner in relation to cancer care provision and in the public health service network. This is the future that those of us on this side of the House and many more people the length and breadth of the State and beyond want to see. The issue is not simply a local constituency matter because St. Luke’s Hospital has all too sadly been very much part of the family experiences of too many families up and down the length of the State over many years.
(Some contributions have been edited here. The full debate is available on the Houses of the Oireachtas website).
Deputy James Reilly (FG): The Minister can wag her head all she wants. Furthermore, she very conveniently neglected to mention her failed and utterly discredited co-location hospital policy. Regarding cystic fibrosis, it is the Minister’s duty not just to apportion funds, but also to ensure that those funds are used for the purposes for which they have been allocated and that tendering processes etc. are done in a way that result in the desired outcome that people expect. However, that is not happening. Because it is designed to be paid at the end, in the current economic climate I warrant that the Minister will have grave difficulty getting tenders to go through successfully. In the meantime Irish citizens, many of them living in my constituency are being disadvantaged to the point where they die ten years younger than their counterparts in the North of Ireland do. That is real. It is real for Orla Tinsley who spoke from her hospital bed on radio this week. We are not talking about theoretical situations here; we are talking about reality.
The Minister now wants to deny her own words. In direct response to what I said, the Minister now wants to revisit the context and change the context. What she said is very simple. She said: “I am happy to agree with Deputy Reilly’s suggestion.” I read the suggestion into the record of the House twice and Deputy Creighton has read it in once. The Minister can shake her head all she likes, but it is in black and white for the people to judge for themselves. What little credibility she had is rapidly diminishing.
The cancer strategy is not unlike the concept of the HSE. The devil is in the detail. There is nothing wrong with the concept of the HSE to provide health care for 4.2 million people. However, the manner in which the Minister went about it, amalgamating ten health boards and a shared services unit without anybody being asked to take redundancy, with everyone guaranteed to keep his or her job and stay in the same job has led to the total dysfunctionality we have. The chief executive officer, Professor Drumm, whom the Minister appointed, told our party before I even joined it that there were 3,500 people who did not even know what their jobs were. Nobody in this House believes any longer in the ability of the HSE to look after children in care or run our health service. It is completely discredited which is a terribly sad thing to have to say about the many excellent people who work in the HSE, in administration and medical-wise in nursing and many other areas.
Let us consider the Minister’s cancer strategy, with which I agreed in principle. I have no problem with the centralisation of services for specialised treatment. However, I object to her methodology and the very devious use of statistics to compare outcomes for breast cancer patients from the west coast vis-à-vis the east coast using figures for 2003-04 when there was no specialist in breast cancer, radiology specialising in mammography and pathology in Sligo. As five years survival means five years, the figures from 2003-04 relate to 1998-99 before these people were present. However, when the figures from 2007 relating back to 2002 are compared, they are every bit as good in the north west as they were on the east coast.
The Minister allows private facilities in Dublin to act as satellites with hospitals in America, but she has an issue with Sligo General Hospital doing it with the University College Hospital in Galway, and yet she reproduces that model in Letterkenny. It is the inconsistency and unfairness that bother people. I wanted to address those issues as the Minister raised them.
I wish to return to the core issue, which is that people have a deep concern about what will happen to St Luke’s Hospital. I support the Labour amendment, but I can understand the argument that it ties the Minister’s hands. My amendment allows us to revisit it in this House. In the Minister’s own words that was what she was happy to agree to. However, something has happened in the interim and she wants to reframe everything. For some reason unknown to me, she does not want to agree to what is an extremely reasonable compromise.
The Minister is a great woman at reframing the question. She stood up and waxed lyrical about the cancer strategy when what is being discussed here is an amendment to a specific Bill on the future use of the lands, facilities and buildings at St. Luke’s Hospital.
Deputy Ruairí Quinn (Lab): No more, no less.
Amendment put:
The Dáil divided: Tá, 66; Níl, 70.
Tellers:
Tá, Deputies Paul Kehoe and Emmet Stagg;
Níl, Deputies John Curran and John Cregan.
Amendment declared lost.
INTO THE SEANAD
After the Bill passed the third stage it went into the Seanad the next day. We didn’t realise this until it was too late to atten
d. The speed of the Bill’s passage to the Seanad compares with the lack of priority given to other more urgent legislation. Obviously Minister Harney felt it was urgent; but we didn’t understand the rush.
It is interesting to note that two of the three Green senators spoke given that none of the six Green TDs had contributed to the Dail debate.
Senator Niall O’Brolchain referred to a holistic attitude to health which might have indicated a willingness to retain St Luke’s as a satellite of James’s. But it didn’t as you will see in the next chapter when he merely appeared to vote down the opposition amendments. Green Senator Mark Dearey explained that his wife had worked in St Luke’s. He said ‘to characterise the move as an attack on the sick is convenient sloganeering, but it is not factually correct. That comes from my own resident expert (his wife).’ Senator Dearey was responding to a remark by Senator Pearse Doherty who spoke passionately in favour of retaining St Luke’s.
Like Senator Brolchain, Senator Dearey did not attend the third and final stage debate; he merely appeared to vote.
Fianna Fail Health spokesperson Geraldine Feeney praised the work of St Luke’s Chairman Pauric White, and commented he is married to her Fianna Fail colleague Senator Mary White. She also said, ‘it is lovely to see everyone singing from the same hymn sheet on legislation.’ But what did she mean? Everyone was not ‘singing from the same hymn sheet’; the amendment to save St Luke’s was lost in the Seanad by only four votes. Yes, every speaker praised St Luke’s, but then voted on party lines.
Senator Mary White acknowledged in her speech, ‘the passionate commitment of Mr. Joe Guilfoyle from County Waterford and the commitment of the patient support group led by him.’