Cancer in a Cold Climate

by Enid O'Dowd

  As I said, we weren’t there in person due to the rush into the Seanad and it would have been nice to hear live that deserved tribute to Joe. It’s a small world; Joe was at De La Salle secondary school in Ballyshannon, in the same class as Mr White’s brother. Pauric White was in the year above. Joe recalls all the times he waited around with the White brothers for the bus home. Given Senator White’s public tribute to Joe, which presumably her husband Pauric White endorses, it’s hard to understand why he did not give Joe a copy of the Weafer Report as soon as available to use in our lobbying campaign.

  What is the Weafer Report? — you’ll find out soon.

  The debate -

  Note there has been some limited editing of speeches where it does not relate to the St Luke’s section of the Bill. Not all speeches are included.

  Minister of State at the Department of Health and Children (Deputy Aine Brady): I am pleased to have the opportunity to introduce the Bill, which has several purposes, to the House. Its main purpose is to give further effect to the Government’s cancer control strategy and, in particular, the development of radiation oncology services under the national plan for radiation oncology. The plan will result in the expansion of public radiation oncology services, integrated with surgical and medical oncology. It includes the integration of St. Luke’s Hospital, Rathgar, into the HSE’s national cancer control programme. Accordingly, this Bill dissolves the board of St. Luke’s hospital and transfers the hospital and its staff to the HSE. The Health (Miscellaneous Provisions) Act 2009 provided for the integration of the national cancer screening service into the national cancer control programme. Cancer screening is an intrinsic component of cancer control and integrating it into the cancer programme ensured that services and resources were coordinated in the fight against cancer. Similarly, the provision of radiation oncology services is an intrinsic component of cancer treatment. This Bill makes provision for the integration of St Luke’s into the HSE’s cancer programme along the same lines as last year’s legislation for the cancer screening service. The legislation also provides for the discontinuance of the infectious diseases maintenance allowance, which was introduced in 1947. Nobody is currently in receipt of this allowance and financial and other supports are provided to such persons under a number of other schemes. The HSE’s national cancer control programme, NCCP, was established and approved by Government in 2007 to give effect to the national cancer control strategy 2006. The strategy set out the future framework for delivery of cancer treatment in Ireland. It also endorsed the national plan for radiation oncology which had been approved by Government in 2005. Implementation of the programme involves the transfer of diagnostic, surgical and radiation oncology services to designated centres each with a critical mass of expertise, sufficient throughput of cases and a high concentration of multidisciplinary specialist skills. This approach is supported by international evidence, which demonstrates that the concentration of cancer services in large volumes in specialist centres produces superior outcomes.The reorganisation of breast cancer diagnosis and surgery into the eight cancer centres has been the most high profile aspect of the work of the cancer programme to date. This has been a significant and challenging task and its completion late last year marked a major milestone for the cancer programme. Considerable progress has also been made on other cancer services. One important development is the establishment of rapid access diagnostic clinics for lung and prostate cancer patients in each of the eight centres. These clinics will speed up access to diagnosis and multidisciplinary decision-making for patients whose symptoms are indicative of these cancers. So far, we have six lung clinics and five prostate clinics and the remainder are due to be established this year. Good progress is also being made on the reorganisation of surgical services for pancreatic and rectal cancer patients. There will be one national centre for pancreatic cancer surgery, at St. Vincent’s Hospital in Dublin, while rectal cancer surgery will be carried out in each of the eight centres. The community oncology programme is a more low profile aspect of the cancer programme’s work but an extremely important one. The major focus of this programme is on creating capacity and knowledge among health professionals in the community to promote best practice in cancer control. These initiatives are all part of the overall implementation of the cancer control strategy. Demand for cancer services, including radiation oncology, will continue to increase in the coming years as the population ages. The report of the expert group, Report on the Development of Radiation Oncology Services in Ireland, in 2003, the Hollywood report, recommended the development of a clinical network of large centres. The national plan for radiation oncology services was approved by the Government in 2005 and, as I said, endorsed in the 2006 cancer control strategy. Its aim is to provide new or additional radiation oncology facilities in four cancer centres: St. James’s Hospital, Beaumont Hospital, Cork University Hospital and University Hospital Galway. There will also be satellite facilities at two other cancer centres, the Mid Western Regional Hospital, Limerick and Waterford Regional Hospital.The implementation of the national plan for radiation oncology services is under the governance of the cancer control programme. Construction of new facilities at St. James’s and Beaumont hospitals will be completed at the end of this year. When these new facilities come on stream, they will increase radiotherapy capacity significantly. We will have 12 linear accelerators in the public system in the eastern region, compared with eight currently in operation at St. Luke’s Hospital. The two new facilities at Beaumont and St. James’s hospitals will come together with the facilities at St. Luke’s Hospital to form the St. Luke’s radiation oncology network. The new facilities will be under the governance of the cancer programme, not the individual hospitals. To facilitate the establishment of the St. Luke’s network, the former director of the national cancer control programme, Professor Tom Keane, advised that there be a single governance model and that, therefore, St. Luke’s Hospital should also come under the governance of the cancer programme. St. Luke’s Hospital was established by statutory instrument in 1999 as a voluntary hospital under the Health (Corporate Bodies) Act 1961. It already receives all its operational funding from the HSE.Providing for the effective delivery of radiation oncology services as a fully integrated component of the cancer control programme is the main purpose of the Bill. Accordingly, it provides for the dissolution of the board of St. Luke’s Hospital and the transfer of its staff and facilities to the HSE. This means that all staff of the new network will be employees of the HSE, not any individual hospital. This will facilitate the transfer of employees between locations, subject, of course, to the usual industrial relations arrangements. It will allow for a single referral facility, a single management structure and shared support services across all three sites. Additional development funding and 54 posts have been provided for the cancer control programme this year for the new centres. In addition, some staff and resources will transfer from St. Luke’s Hospital to the new centres in the second half of this year.In 2014, when the national plan for radiation oncology services is completed and further capacity has been developed at St. James’s and Beaumont hospitals, all remaining staff and resources will transfer from St. Luke’s Hospital to St. James’s or Beaumont Hospital and radiotherapy services will no longer be provided at St. Luke’s Hospital. From 2014, therefore, all publicly funded radiotherapy services in Ireland will be provided as part of an integrated multidisciplinary service involving surgical, medical and radiation oncology services. This is in keeping with the recommendations made in the Hollywood report.As many will be aware, there are organisations which are very closely associated with St. Luke’s Hospital but which are at the same time separate entities. They are not encompassed within the legislation, nor should they be. The Department of Health and Children has liaised closely with the board of St. Luke’s Hospial on the future of these organisations — the St. Luke’s Institute of Cancer Research and the St. Luke’s Cancer Research Fund. The focus of both entities is on cancer researc
h and the continued development of expertise and knowledge and there is widespread agreement that this should continue into the future. The Minister understands the board of St. Luke’s Hospital is taking the necessary steps to ensure these organisations continue to have legally sound structures following the enactment of this legislation. She very much welcomes this.The Minister is also very aware of the significant work done by the Friends of St. Luke’s Hospital for many years. To date, it raised more than €26 million in funds for various projects within the hospital. It has been a major force in fund-raising for radiation oncology services during the years and the Minister understands those involved wish to ensure the great goodwill and support for St. Luke’s Hospital in the community can continue to benefit cancer patients into the future. This is also to be welcomed.The specific provisions of the Bill that relate to St. Luke’s Hospital are in Part 2, comprising sections 5 to 13, inclusive. Section 5 provides for the board of St. Luke’s Hospital to be dissolved. Section 6 provides for the transfer of the land and other property of St. Luke’s Hospital to the HSE. The Bill also includes a provision that the site may not be disposed of in any way without the permission of the Minister. Many will be familiar with the location of St. Luke’s Hospital and its very attractive grounds. How this site may be used in future will be on many people’s minds. The Minister understands that the Friends of St. Luke’s Hospital and the board have been considering the future use of the hospital after 2014 and that they intend to submit their proposals to her in the very near future. The Minister stated during the Dail debates on the Bill that she is committed to St. Luke’s remaining within the public health service and that she will consult the Friends of St. Luke’s Hospital, the Health Service Executive and other interested parties on how the site could best be used for the benefit of patients in the future. To provide further assurance, the Government introduced an amendment to the Bill on Report Stage in the Dail which ensures that St. Luke’s will continue to be used by the HSE for the delivery of health and personal social services.Sections 7 to 9, inclusive, are standard provisions dealing with the transfer of rights and liabilities of the St. Luke’s board to the HSE, the preservation of contracts and pending legal proceedings. Section 10 deals with the transfer of St. Luke’s staff to the HSE. Staff are being transferred to support the future provision of radiation oncology services within the network model. For staff, some of whom will transfer to other sites in the network at the end of this year and some of whom will remain at St. Luke’s for a number of years to come, this provision provides certainty on their future conditions of employment. All current employees of St. Luke’s at the date of transfer will become employees of the HSE on conditions and pay that are no less beneficial than those they have currently. All superannuation benefits and reckonable service transfer with the employees. Furthermore, the Bill provides that the pension liabilities of St. Luke’s will now become the pension liabilities of the HSE. The Bill provides certainty, therefore, about the future for pensioners of St. Luke’s also. These provisions are similar to those under which the national cancer screening service staff transferred to the HSE in April this year.

  Sections 11 to 13, inclusive, are standard provisions dealing with the transfer of records and the preparation of a final report and final accounts of the St. Luke’s board for submission to the Minister and the Oireachtas. The contribution of St. Luke’s Hospital board and its staff to the provision of cancer services has been immense. The Minister acknowledges this contribution and thanks the board members, the management and staff for their commitment and dedication. It is also important to say that the board has provided great support and co-operation for the process of integration into the cancer programme. The Minister looks forward to the ethos and sense of professionalism, which is so much a part of St. Luke’s, contributing to the continued successful implementation of the cancer control programme and in particular the new St. Luke’s radiation oncology network. I commend the Bill to the House.

  Senator Geraldine Feeney (FF): She spoke from the heart with such knowledge. I can see she has a genuine compassion and concern for what is happening here today. That probably comes from all sides of the House, where everybody, whether one has had members of one’s family or one’s friends affected by cancer, knows somebody who has been through St. Luke’s. Thankfully, I have never had anybody close to me there, but I have certainly had some good friends who have gone through, received very good treatment and come out the other end, and equally so, ones who did not come out the other end.What is lovely about St. Luke’s, everybody says, is the beautiful serenity, peacefulness and solace. The Minister of State mentioned it when she spoke about the grounds. It is a special place. Really, it is a little oasis tucked away in a busy part of Dublin called Rathgar.Unfortunately, we are here today to see the winding up of St. Luke’s Hospital. I say “unfortunately” with a little smile on my face because we are fortunate also in that our cancer control programme has reached such a level and we are now seeing the establishment of eight new specialist centres. I will always called them “specialist centres”, rather than the term “centres of excellence” that is commonly used, because, as I have heard Deputy Aine Brady state previously, every centre that provides health care services is a centre of a excellence but these are specialist centres where there are multidisciplinary teams. I congratulate the former director of the entire cancer programme, Professor Tom Keane, and I wish his successor well in her new role.No doubt before the national cancer programme was rolled out Ireland had one of the worst records in Europe. Sadly, we all know the sorry tales of the women who have been affected so badly by misdiagnosis of breast cancer, cervical cancer, ovarian cancer — all sorts of cancer. Not alone have women been misdiagnosed, but men have been misdiagnosed.However, today is not a day to dwell on the national cancer control programme. It is a day for us to pay tribute to St. Luke’s and the wonderful work it has done over 55 years. It was set up in 1954. I note Senator Mary White has just come in. Her husband, Padraic, has been chair of the board for ten years. They always seemed to attract very good, hard-working, progressive caring-type minds to St. Luke’s and they carry out their duty in a diligent and — again, I use the word — serene way. Things are done and nobody knows about them, but those who avail of the service certainly know about it. I come back again to speak about the wonderful caring staff. I am glad they will be redeployed and that they can carry on the significant work they have been doing over the years for cancer sufferers.I was delighted to hear Deputy Aine Brady state that the building and the grounds will be almost ring-fenced and nothing will be done without the Minister’s say. Naturally, one cannot leave it as a shrine but it seems to be a very special place. The board of St. Luke’s to which I have briefly alluded certainly seems to be caring and hard-working. All boards are hard working, but it is difficult to get that special mix of people who really feel for what they are doing and how they do it. They certainly seem to have it on the board, and the staff are no different to their board.I refer to the reason given for the closure of St. Luke’s Hospital. Professor Tom Keane, rightly, has found that the hospital cannot be a stand-alone unit and that its facilities must be transferred to the specialist centre in St. James’s Hospital. The wonderful radiotherapy unit will cease to operate in 2014, when the other two units will come into play at St. James’s and Beaumont hospitals. I echo the sentiments expressed by Senator Fitzgerald that there is a concern that the date of 2014 will be extended to 2015. I do not see a real problem with this because St. Luke’s Hospial will continue to provide a first-class service. I agree the specialist units and multidisciplinary teams are the way to go. Ireland had to come into the real world. As the Minister said yesterday in the House on a completely different matter, we have men and women in the medical world at the height of their careers who are leading the country and its 4.5 million people towards the best global level of health care and that we will be able to hold our heads up. However, there have been hiccups, which we will not deny. W
ith the centres in place, it is to be hoped Ireland will move on and that patients who present with cancers will be treated appropriately. It is to be hoped also that fewer will present because there will be better screening programmes.I will speak about a parochial matter. I reiterate that I have always supported the moving of smaller units to specialist units and have not changed my position. I supported the transfer of breast cancer services from my own hospital in Sligo. However, I was surprised to find that one of my colleagues had discovered under freedom of information legislation that the service in Galway might not have been ready for the transfer. I have been informed by the cancer support group, Cancer Ireland, that the transition has been made and things are working out well.I wish those involved in St. Luke’s Hospital well in the transition. I congratulate the hospital for the wonderful service it has given the nation in the past 55 years. I thank, in particular, its wonderful, dedicated staff, its wonderful board and the incredible Friends of St. Luke’s Hospital which, with the staff and the board, has helped patients to come out the other end. This is wonderful to see, but it is equally important to acknowledge the wonderful comfort and solace St. Luke’s Hospital provides for those who will not be fortunate to come out the other end. I know from talking to a person who had a family member in the hospital that it was the most wonderful place for the person concerned to end their days and find solace. I wish the Bill well and look forward to the debate on the remaining Stages. It is lovely to see everyone singing from the same hymn sheet on legislation. I congratulate the Department for dealing with the matter so sensitively and the Minister of State for presenting the Bill.

  Senator Niall O Brolchain (Green): I welcome the Minister of State. Her speech was comprehensive and to the point. I acknowledge the quality of speeches today. It is an honour to speak in such a debate. There have been some responsible and heartfelt points made by Members. I note I am following a number of lady speakers. Every Member who spoke heretofore has been a lady. This demonstrates the caring nature of women and the need for women in politics. This debate is about an older facility, into which great love, care and attention has gone. This caring facility has thrived because of the major community effort people put into it. The reality is that the old infirmary building is no longer up to the task of providing top-level facilities needed in the modern era in rolling forward the national cancer programme, which everyone in the House is behind.Health care should not be considered from the point of buildings alone. Health care is about people, not about buildings. When we talk about St. Luke’s, I hope we are not talking about the closure of St. Luke’s. Not only is there a building, there is an ethos and years of history. People have put great effort into what St. Luke’s is today and it is essential that every effort is made to ensure those who put in the effort are accommodated and facilitated in terms of their knowledge and the work they have done so that they become part of the new service in so far as possible.We have a major problem here, with cancer increasing by 41% between 1994 and 2015. We spoke about sunbeds recently. When we have such debates, it is important not to talk only about cancer care but also about cancer prevention. Good and all as St. Luke’s, St. James’s Hospital and the new national cancer programme are, we do not want our people getting cancer. We want to minimise the risk of cancer. It is possible to propose measures that minimise these risks.The population is projected to increase to 4.3 million by 2015 even though there is a certain amount of emigration. We must upgrade our facilities and ensure the HSE is as efficient as we can make it. Any Government will contend with this problem, whether the HSE or another structure is governing health care. It is important to have an efficient and caring system. My fear regarding this issue is that this Bill pertains to a system that was based to a great extent on caring and that worked with facilities that were neither the most modern nor the most up-to-date. Although the intention is to move to a highly technical process using very good facilities, we may be losing something in terms of caring. Caring should never be lost from the health services because it is the way in which so many people get better. I refer to how people who may not feel cared for but who understand they are getting the best medicines would have an ability to recover much faster. I believe Senator Fitzgerald used the word “holistic” and while many people do not understand the word, holistic health is highly important. As for people being in the right frame of mind, many studies have backed up the importance of mental and emotional linkages to good physical health. Radiation therapy itself is an important treatment that is used in cancer management by 50% to 60% of patients and is successful. It is used in the clinical management of a limited number of non-malignant medical conditions and two major types of radiation therapy exist, namely, external beam and brachytherapy. I acknowledge that between 1960 and the 1990s, many centres were undeveloped. However, the work of Professor Keane has been mentioned and there has been a huge initiative on the part of the Government, the body politic and the HSE to improve cancer care services.