Cancer in a Cold Climate

by Enid O'Dowd

  Exactly. Why such a rush?

  We were tired after our long day. The time of the debate had been changed and we had had to hang around. Our group was reduced to five at the end as members had to leave for other commitments. Marion O’Dwyer had to leave to get to the Abbey where she had a leading role in Bernard Farrell’s play Bookworms. Ulick O’Connor was able to stay for most of the debate and his presence was recognised by Senator David Norris in his speech. As we entered the main Dáil lobby on our way out, coincidentally, all six Green TDs appeared.

  We shouted Shame almost in tune. I was really tired and emotional. My husband is attending St Luke’s after a cancer diagnosis this May. I had believed in the legislative process. I was for many years an active member of the Green party and years ago had stood for the party in the Dublin City Council local elections. I had written to the three green senators; but no replies. I had heard Minister Gormley’s representative Ryan Meade address a march in 2007 about his (Gormley’s) support for the Campaign to save St Luke’s. I felt betrayed. I shouted ‘Shame’ twice more.

  The usher said he would summon the gardai if I persisted. I was tempted to. Meanwhile the six Green TDs made their escape from this ‘threatening’ middle aged group of five (four women and one man). Outside I found Green TD Ciaran Cuffe who I have known for years as I have four of the 6 TDs. Our brief unsatisfactory conversation is already recorded in Section 1

  We had actually left the Seanad before the Bill as a whole was voted on. We could not stay any longer. Had we been there, we would have heard Seanad leader Donie Cassidy successfully propose that the house agree that the Bill be taken under Article 25.2.2. of the Constitution. The significance of that would however, have been lost on us. We learnt later that yet again Luke’s had been shafted.

  The debate -

  Senator Frances Fitzgerald (FG): I raised this issue during our last discussion in the House. My colleague, Deputy James Reilly, tabled an amendment proposing that any changes to be made from the commencement of the Bill, or any review of services, including of lands and buildings, at St. Luke’s hospital should be laid before the Dáil and the Joint Committee on Health and Children for approval.

  The Minister for Health and Children, Deputy Mary Harney, had said in previous discussions in the Dáil and at the committee that she agreed with this proposal. I asked that she come back to the House today to inform us whether there had been a change of opinion or whether she still intended to do this. The value of the amendment would be that we could have a detailed discussion at the Joint Committee on Health and Children about any change of use proposed at the point where it was envisaged this would happen. It is envisaged that this happen in 2014.

  This debate has particular relevance. While I did not hear the discussion, I understand the question of centres of excellence was discussed on “The Pat Kenny Show” today, arising in particular from a letter from Mrs. Kay Coburn. It is a very sad story. Mrs. Coburn’s sister died from ovarian cancer and she wrote a four-page letter about what her sister had experienced in one of our centres of excellence. This is the very point I was making last week when I suggested we were removing a well proven centre of excellence.

  There is a page on Facebook which over 2,000 people have signed to support the continuation of the service in the hospital. There have also been numerous e-mails sent to public representatives. One cannot but be moved by their quality and how people speak about their experience of St. Luke’s Hospital.

  What Mrs. Coburn writes can only be described as disgraceful. If we are talking about moving patients from a proven to an unproven centre of excellence in terms of the quality of the experience, we have a real problem. My plea to the Minister on the last occasion was that if we were intent on removing the service, we should offer an equivalent service elsewhere. That is what all of the people who have contacted us are so concerned about, namely, that such a service will not be available, although it has been for so long in St. Luke’s Hospital.

  What we are trying to restore with the amendment is control for the Minister in front of her colleagues at the Joint Committee on Health and Children and in the Dáil before further radical changes are made.

  I want to return to the centres of excellence supposedly available. Mrs. Coburn’s sister was not admitted directly to an oncology ward; in fact, she never reached such a ward. She was on a trolley in the accident and emergency department for 25 hours where she was subjected to various indignities and unacceptable treatment, including a delay in being seen. Mrs. Coburn refers to her sister being on a trolley which was most uncomfortable, narrow and restrictive when she was not well enough to sit in a chair. She goes into further detail in her letter. It is the saddest story one could ever read. She asks why, if we have dedicated oncology wards, there are patients who have been diagnosed with cancer in wards all over the hospital in which, potentially, they are exposed them to infections which in their compromised state could have a serious or fatal outcome. It is a reasonable question to ask, if we say we are providing specialist centres and at the same time doing away with a specialist centre that was providing high quality care. How can we describe these as units specialist units if half of the patients that should be in them are in medical, surgical and geriatric wards around the hospital?

  Mrs. Coburn asks where is HIQA in all of this. She thought her sister was entering a centre of excellence, but she did not receive excellent treatment. Mrs. Coburn asks why patients who are suffering from cancer have to be readmitted time and again via an accident and emergency department process when the name of the doctor who will be dealing with them is known. Unfortunately, her beautiful sister died on 23 June “at home in the loving care of her family, and I had the privilege of nursing her.” The letter continues: “I have never written to a TD, Minister or anyone else before but I am going to bombard everyone because of what I witnessed and what my sister endured over the past 48 hours and indeed may have to endure again”. That is her experience of a centre of excellence in 2010. This adds weight to the point that so many of those who have contacted us about St. Luke’s Hospital have made. We have a centre which provides excellent care. I absolutely support the provision of high quality and specialist care. However, it is reasonable to ask what standard of care will be provided in the specialist centres of St. James’s and Beaumont hospitals when services are transferred from St. Luke’s Hospital.

  Senator Phil Prendergast (Lab):I speak to amendment No. 2 in the name of the Labour Party that the HSE “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”.

  Like other Senators on all sides of the House, I have received communications from many people who have themselves, following a diagnosis of cancer, received treatment at this centre of excellence in Rathgar or a family member or close acquaintance. There are so many clichés about St. Luke’s Hospital and its surroundings being such a unique gem in the provision of such excellent care.

  As someone who has worked in a hospital setting, I know that when people are diagnosed with cancer, it is very difficult for them if the other patients in the ward have not received the same diagnosis. Their psychological, medical and treatment needs are different and often they are very sick. Having a centre dedicated to the treatment of such patients allows staff to become expert in providing treatment. Many people took great comfort from the staff and, in particular, the surroundings. Time and again people were delighted with such surroundings in a centre of excellence, if that was possible when diagnosed with cancer. Each e-mail we received was different and detailed either a personal story or that of a close family member.

  The nub of the matter is that the HSE is always seen in a negative way but we have an opportunity to keep something truly wonderful.

  There are not many places
about which we can say that. I know everybody works very hard in the HSE and some people on the front line suffer extraordinary difficulties at the moment with the moratorium on staff recruitment. It is having a serious impact in the delivery of some services. There has also been a major impact from the way doctors can be employed, and just last week there was a difficulty because there was talk of closing one of the main accident and emergency units in Cork because of a lack of doctors.

  These are serious issues but the system in St. Luke’s is working very well. We will press our amendment and I hope we will get an opportunity for reasoned debate before the amendment is accepted. We are not looking for the world and the Government’s action will not save money; it will only put people at a disadvantage and make people who are already having a very difficult time in their lives unhappy. Those people with family members who have already passed on having been treated in St. Luke’s will take great solace and comfort if we can retain this facility and keep it for what is good. We cannot say that about many places in the country.

  St. Luke’s is a centre of excellence taking in the same old clichés on what is a centre of excellence. Such a centre is where people feel they get all their needs met in a holistic way. This unit and hospital provides for people and I ask that the House accept the amendment.

  Senator David Norris (Ind): I strongly support these two amendments, which are very important. If the amendments are not agreed I will call for a vote, and if such is granted I will vote against the entire Bill. I will do so because there is something profoundly undemocratic about what would happen today without these amendments. I say this for a number of reasons. There is a clear wish on the part of patients that this service be retained.

  Those campaigning for St. Luke’s are very rational, reasonable and moderate in their demands. The principal demand I have come across is the idea that people should listen to patients, and as a result of the patient’s views, St. Luke’s should at least be retained as a satellite hospital.

  I know St. James’s Hospital to be excellent as I was a patient there for a while because of medical silliness. An investigative operation went wrong and I was given the benefit of septicemia. I cannot speak highly enough for the care I received and it is a teaching hospital of Trinity College, where I used to work. I have the highest regard for it and the staff working there.

  I wonder how appropriate it is to concentrate all the work done historically in St. Luke’s — it has a very special place in the hearts and minds of people not just in Dublin but around the country — in St. James’s Hospital. A new building will be required, which will be fairly tall.

  People will no doubt have the kind of comfortable accommodation I eventually received in St. James’s Hospital but that is not the same as what one would get in St. Luke’s. If one is considering an holistic approach to medicine, it is interesting to note what so many people have commented on to me. In St. Luke’s, extended families could stay in the facility or visit easily. The patients could enjoy the health-giving surroundings and wonderful gardens.

  This may sound sentimental but it is not because the state of mind of a cancer patient is extremely important.

  There is also the risk of cross-infection.

  All of us have been touched in some measure by cancer and we all know that after chemotherapy or radiation therapy, a significant impact is the reduction in the effectiveness of the immune system, leaving people open to infection. That can be extremely dangerous. Will the Minister of State respect the views of the patients? Will he understand and respect the fact that the patients, their families and supporters have raised €26 million? To a certain extent, the ownership of the hospital, at least morally, is vested in them.

  Is it the intention to dispose of the land, as this has been happening all over the place and people are being forced from nursing homes on ridiculous and specious arguments about health and safety concerns that involve nothing more than a lick of paint? Such action occurs so land and planned facilities can be sold to realise money for the central Exchequer.

  My concern is that this will ultimately be a fund-raising exercise so will the Minister of State address what will happen to the money that may be raised from the possible sale of the hospital and its grounds?

  In addition to the €26 million raised, a petition was handed in at Leinster House last Wednesday containing 150,000 signatures, which is a massive vote by the ordinary people, whose representatives we are, against this unqualified move and in favour of, at the very least, the two amendments put before us.

  The first amendment is in the name of Senator Frances Fitzgerald and the Fine Gael Party. It deals with the modest requirement that any review of services and alteration in the use of land and buildings should be laid before the Oireachtas. That is accountability, and this Government has quite rightly preached to us about openness, transparency and accountability.

  The second amendment is in the names of Labour Party Members. It deletes part of the Bill and includes instead a proscription preventing the Minister disposing of any land or buildings except in a manner informed and determined by the executive, with the consent of the Minister, which must contain medical services related to the treatment of cancer. I have no difficulty in strongly supporting these amendments. I will, with regret, be forced to call for a vote if these are not accepted and have to vote against the Bill. I do not like doing so because I like to vote in favour of positive and progressive measures in health and treatment sectors. I do not see this Bill as such without the amendments put down by my colleagues.

  Senator Nicky McFadden (FG): We are also afraid to suggest that there should not be such firm adherence to the policy relating to centres of excellence. What constitutes a centre of excellence?

  I wholeheartedly agree with Senator Norris’s assertion that it is a place where a person is provided with holistic treatment and care. People can only recover if they are not exposed to infection and are treated in a relaxed atmosphere where they can be loved and cared for in a compassionate manner.

  That has not been my experience of the new centres of excellence. This is a matter about which I feel strongly.

  Senator Fitzgerald read into the record a very emotive piece about a lady who is dying from cancer and who was left to wait on a trolley. I assure the Minister of State that a patient would not be treated in that way at St. Luke’s Hospital. That is the bottom line. St. Luke’s Hospital should remain in place as a satellite facility of St. James’s Hospital. The Minister of State has made the point very well that there is a need for intensive care services to support St. Luke’s. That is fine, once it remains in place as a satellite facility of St. James’s Hospital. St. Luke’s should remain in place, in the leafy suburb of Rathgar, as a public facility for people who are ill and who need care.

  Members of my family and some of my friends were treated at St. Luke’s Hospital. I cannot say enough good things about the place. My constituents have been discussing this matter with me and sending me e-mails. They stated that it would be terrible if the service on offer at the hospital were to disappear.

  Senator Norris also stated that €26 million has been collected through fund-raising efforts. It has come to my attention that St. Luke’s Hospital was donated to the State. How, therefore, do we have a right to sell it off to pay for the bailout of Anglo Irish Bank and for the various mistakes that have been made?

  I suggest that for once there should be all-party consensus in the House. In that context, I am aware that some colleagues on the Government side of the House share my view that St. Luke’s should be retained in its present form in order that its staff can care, in a compassionate manner, for people who are sick.

  Senator Ivana Bacik: I support both amendments which were tabled by the Labour Party and Fine Gael and which clearly address the major problem with the Bill. We are of the view that amendment No. 2 is critical and we will not be supporting the Bill if it is not accepted.

  Amendment No. 2 provides, as Deputy Ruairí
Quinn stated in the Dáil, that St. Luke’s should be retained as a centre of excellence and should not be sold. It is a simple but critical amendment. We are aware that St. Luke’s is more than just a local institution in what Senator McFadden referred to as a leafy suburb.

  As the Senator stated, some of her constituents have travelled to St. Luke’s for treatment. People travel from all over the country to be treated there. St. Luke’s is recognised as a national centre of excellence, which is evidenced by the many thousands of people who have argued for its retention. The Minister of State will be aware that a petition containing more than 150,000 signatures has been handed in and approximately 5,000 people have signed up to the Facebook page. We have all received e-mails and messages from people in all walks of life in which they related the most heart-rending stories. Senator Fitzgerald, quite rightly, read some very tragic human stories into the record. While their stories may indeed be tragic, the people to whom I refer have been assisted by the calm atmosphere that obtains at St. Luke’s and the excellent treatment they have received there.

  There are people in the Gallery — many of them with direct personal experience of this matter — who have been arguing for the retention of St. Luke’s.

  In excess of 71,000 treatments were delivered at St. Luke’s in 2009 and large numbers of patients were provided with care. Those who support the hospital are formidable fund-raisers and I understand a new extension costing €15 million was opened there in the past 18 months.

  I am very familiar with the hospital, having visited friends there. I have always been impressed by the high levels of care and treatment patients receive there. This is a centre worth retaining.