Cancer in a Cold Climate
Page 18
My party’s spokesperson on health in the Dáil, Deputy Jan O’Sullivan, made a very strong case to the effect that we are not arguing for St. Luke’s as some sort of stand-alone centre. Rather, we are arguing that it should be linked to one of the designated centres for the Dublin area. This is because we support the centres of excellence policy that is at the core of the health strategy relating to cancer care. However, we understand that there are facilities such as St. Luke’s which have a unique character and which have been doing work to assist the recovery of cancer patients for many generations. We are of the view that these facilities can be incorporated into the centres of excellence strategy in a way that will allow them to continue the work they have been doing. We are not necessarily suggesting that surgery be available at the hospital. We propose that the hospital be attached to one of the designated centres of excellence.
During the debate in the Dáil, there was a great deal of assurance provided that the provision relating to St. Luke’s will not come into effect until 2014.
Perhaps the Minister of State can clarify whether that is the case. On Committee Stage in the Dáil, he appeared more sympathetic to the Labour Party’s argument to the effect that a different approach should be taken.
However, the current wording contained in the Bill — which was put in place on foot of an amendment the Minister of State introduced in the Dáil — is not satisfactory. It merely provides an empty assurance that there will be a stay of execution for four years. It appears that when this period has elapsed, the sale of the hospital will be carried out.
There are a number of other issues which must be addressed. I refer to the consequences to which the Bill will give rise if it is passed in its current form. If the legislation is enacted as it stands, additional pressure will be placed on St. James’s Hospital. It will also lead to further delays being experienced. There are already unacceptable delays in the treatment of cancer patients, especially those in the public system. In addition, issues also arise with regard to inequity in the health service. This is a matter to which the Labour Party has always been opposed, especially in the context of more favourable treatment being given to private patients.
These issues must be addressed. If they are not, adverse consequences will arise for patients at St. James’s Hospital. When one considers the extraordinarily high levels of cancer among people in this country, it is obvious that there is a need to be very careful about closing any facility which is recognised as a centre of excellence and where the atmosphere and the positive treatment provided appear to be especially conducive to the recovery of cancer patients.
Senator Geraldine Feeney (FF): As Senator Fitzgerald correctly pointed out, the Second Stage debate on this Bill, which took place last week when the Chamber was not, perhaps, quite so full, was very special. There was a real air of empathy in respect of the staff, board and friends of St. Luke’s.
Everyone recognises the wonderful, valued care that is administered to people at St. Luke’s, regardless of whether it is likely they will recover or whether their illness is terminal. One could almost have cut the air with a knife during that debate. The atmosphere which obtained in the House last week was very special. The Minister of State at the Department of Health and Children, Deputy Aine Brady, took the Second Stage debate and, as I understood it, she indicated that St. Luke’s will remain operative until 2014 or possibly 2015 and that radiotherapy services will continue to be administered there.
On Second Stage, reference was made to the terrible stories that have emerged with regard to misdiagnoses and the fact that by the time some women and men received their diagnoses, it was too late. We all know what happened in these instances. I was of the view that letters such as the one sent to me at my home by Ms Kay Coburn, which I received at the weekend, were a thing of the past. My immediate reaction was to ask how this could happen. I did not hear Ms Coburn this morning on “Today with Pat Kenny”. However, I believe her story about her beautiful young sister was heart-rending. I really do not think it is acceptable that a person in the late stages of cancer should have to go in through an accident and emergency department. I tuned into the final part of the programme, when Dr. David O’Keeffe, a consultant radiologist, was interviewed by Pat Kenny. I was grateful and glad to hear him apologise. He said there are changes afoot and it is not right that cancer patients in centres of excellence, or specialist centres as I prefer them to be called, have to come in through accident and emergency departments. There needs to be some other type of admission process, perhaps through an oncology ward with at least two or three beds for people, like Mrs. Coburn’s sister, who have to be brought in but are not in-stay patients.
I do not expect the Minister of State to accept these amendments. I would like to mention a question that has been raised with me about what might happen if St. Luke’s Hospital closes its doors in 2014 or 2015. I am speaking as someone who buys into the whole cancer control programme, as set up by Professor Tom Keane. I support him when he says we cannot have units here, there and everywhere. When I say that, I do not mean to undermine the great work that is done in St. Luke’s Hospital. If the hospital’s lands and buildings are to be sold, both Houses of the Oireachtas should ensure the moneys in question are ring-fenced so they are not used for anything other than the treatment of cancer for public patients.
Senator Feargal Quinn (Ind): The Minister of State is welcome. This Bill presents a great deal of difficulty. On many occasions recently, I visited two relatives in hospital, one in St. James’s Hospital and one in St. Luke’s Hospital, on the same day. The relative in St. Luke’s Hospital did not live; the relative in St. James’s Hospital is alive and well. I was reminded of the contrast between the two hospitals. I am a great believer in centres of excellence. I believe the policy of developing centres of excellence is correct. However, I am not convinced of the merits of bringing patients from St. Luke’s Hospital to the busy hustle and bustle of St. James’s Hospital.
Although patient treatment is very good at St. James’s Hospital, there is a difference between the manner in which the requirements of cancer patients are met there and at St. Luke’s Hospital. St. James’s Hospital is a very busy hospital. I am sure the medical care provided there is excellent, but it does not have anything like the calmness and serenity of the 18 acres of St.Luke’s Hospital. While I support the concept of centres of excellence, I also support the view that St. Luke’s Hospital must be allowed to continue, in whatever form is required.
An old Irish seanfhocal, éist le fuaim na habhann agus gheobhaidh tu bradan, which means “listen to the sound of the river and you will catch a salmon”, is a great reminder of the importance of listening. In this instance, not only should we listen to the patients in St. Luke’s Hospital, but we should also listen to the experts.
I appreciate that the Minister for Health and Children employed experts to examine a number of hospitals. Earlier today, I saw some of the figures they produced after they had engaged in one-off examinations of certain hospitals five years ago. It is amazing that St. Luke’s Hospital did not get what would be regarded as an acceptable recognition from its patients. It runs contrary to my entire understanding of the hospital that it was ranked in a much lower position on the list than it might otherwise have been. I suggest that much has changed in the intervening five years. Much more is required if we are to meet the challenges involved in the treatment of cancer in the years ahead. I have seen figures which predict that the number of cancer patients requiring treatment of this nature will increase by 50%, from 28,000 to 42,000, between now and 2020. Those people will need the services of the 500 staff who are employed in St. Luke’s Hospital at present. We cannot do without the incredible experience and expertise of the staff in question.
I take the point that is made in the amendments before the House. Senator Feeney has suggested that we should provide for ring-fencing. We should all accept that the grounds of St. Luke’s Hospital, like the expertise that has been built up
at the hospital, must not be lost. These facilities should continue to be used for cancer care. If the hospital is not developed as the centre of excellence — I understand the centre might be required somewhere else — it should be maintained as a centre for the treatment of cancer patients. These 18 acres need to continue to serve as a valuable haven in this city for people who are suffering from cancer. We must not lose them. I have no problem with supporting entirely any amendment that proposes that this hospital should continue to be involved in cancer treatment. Just as it has achieved so much in the past, it can continue to achieve so much in the future alongside the centre of excellence at St. James’s Hospital. It is time to renew our thinking to ascertain whether we have made the right decision.
I urge the Minister of State to accept amendments Nos. 1 and 2, which are worthy of acceptance and represent the correct direction in which to go.
Senator Fidelma Healy Eames (FG): Unfortunately, cancer remains one of the top three killers in this country and, given the figures Senator Quinn recounted, it appears it will remain so for some time. What is the most important thing to consider in cancer care? It is the quality of the care the patient receives, the environment and atmosphere in which that care is delivered, and whether the staff are tense or can genuinely offer care. There is also the ethos in which the care takes place and the quality of outcome.
For these reasons, I support the amendments of Fine Gael and the Labour Party and compliment Senator Fitzgerald and the Labour Party team on tabling them.
This gives us a chance to think about the matter. In 1990, my father was in St. Luke’s. Thank God he is still alive and very well but he was a difficult man to convince he needed treatment. He had surgery and subsequent treatment but I could not believe I was in a hospital. This man came and went whenever he wanted and spent more time at the bookie’s shop than in the hospital. The staff knew how to manage him. After having major surgery he came and went as he pleased but they were able to manage him. He got exceptional care, thank God, and here I stand 20 years later, speaking of a man who is fit and well, aged 80 years of age.
In 1990 I saw St Luke’s had developed into a specialist centre for cancer care long before that term was ever known in this country and I know the same from friends and relatives and thousands of e-mails we have received since. It developed through experience and throughput, namely, the very reasons we want the centres of excellence.
Most important, it is because of patient feedback that we know it developed into a centre of excellence. As my colleagues, including Senator Quinn, stated, we must listen to the patient. I believe it will be time to close St. Luke’s only when we receive as much positive feedback from patients regarding the new centres. They are only in transition, learning how to manage, and in many respects are lost at present.
I refer to the situation in Galway which greatly saddens me because I live there. It is my constituency and University College Hospital, Galway is my local hospital. Senator Fitzgerald read into the record and Senator Feeney referred to the letter from Kay Coburn. I am shocked and devastated to think that our designated centre in Galway is not yet a centre of excellence.
It is so in name but is very much in transition and only learning how to cope. One can consider a few basic matters. I have spoken to people in the centre such as Professor Kerin who told me that dedicated beds were needed in one place. What is a centre, after all, but a dedicated place to which one can go and know it is for the care of the cancer patient? If that dedicated centre exists, why admit patients through accident and emergency departments? Why would Kay Coburn’s lovely sister have to spend 25 hours in the emergency department? We do not yet have that centre.
Senator Feeney asked, rightly, why Galway does not have a centre with two, three or four beds instead of having the beds spread throughout the hospital, in geriatric and other wards where patients are at risk of cross-infection. The answer is a policy decision by the Minister for Health and Children, Deputy Harney. When responding on this matter on “Today with Pat Kenny”, Dr. David O’Keeffe said it was because of the moratorium. How can there be beds in a single place when the hospital has neither the beds in the first instance nor the staff to service them?
It is only some months since I spoke in this House about the scandal concerning cancer drugs in UCHG, our centre of excellence. A sum of €12 million that had been promised for cancer drugs was not given to the hospital. Did the patients get the drugs? They did but only because the money came from 100 hip operations and elective surgeries that were cancelled and from the gynaecological ward. We are living on a shoestring in this country but there is St. Luke’s Hospital, working it out and doing so for generations.
I support what other speakers have said. I ask the Minister of State to confirm that the year in question is 2014 because that would give us four years to think about how to turn St. Luke’s into a satellite centre of St. James’s Hospital, as others recommended. Let us not consider closing it until there are centres of excellence in practice and reality throughout the country and not only in policy. The Government’s policies are not working. There is a contradiction here, with St. Luke’s about to close and UCHG struggling without the necessary resources.
Senator Pearse Doherty (SF): I support both amendments. The Minister of State will be well aware that I opposed this Bill on Second Stage and called a vote on it although that vote was not able to proceed as there was no one else to act as a teller in the time allotted. I welcome the amendments, both of which are important. The first deals with the bringing of any decision before the Houses of the Oireachtas. The second, in the name of the Labour Party, is the crucial one. Ultimately, any Government or whoever has a majority could decide to do whatever it wanted with St. Luke’s after 2014. We should nail that in the legislation by making it clear that St. Luke’s will remain, with its land and buildings, as a treatment centre for cancer patients in the public sector.
I oppose the Bill because, fundamentally, it closes St. Luke’s Hospital after 2014 but it also implements a flawed plan in regard to the provision of radiation oncology, as the previous speaker observed. This plan discriminates against people who live in regions north of the line between Galway and Dublin, such as those who live in my county, Donegal. We have passed Second Stage, the Government is hell bent on pursuing this issue and, therefore, the amendments proposed by Senator Fitzgerald and the Labour Party are worthy of being accepted by the Government. I support them wholeheartedly. If this Bill is passed, the least that can be done is to ensure the lands and buildings of St. Luke’s remain in the provision of the health services after 2014. They should be used in the provision of public health services. The Government has pursued a policy of health services privatisation and attacked public health service provision. That has been the agenda, particularly of the Minister for Health and Children. Sometimes the Government has been happy to hide behind the Minister and state it is her agenda. The reality is that the privatisation of health services is part of the agenda of Fianna Fail, the Green Party and the former members of the Progressive Democrats. It was signalled last year that after 2014 St. Luke’s Hospital would continue to be used for the benefit of cancer patients. We heard the chairman of the hospital board, Mr. Padraic White, say as much. I ask the Minister of State to confirm if that is still the case, that after 2014 St. Luke’s Hospital will continue to be used for the benefit of cancer patients?
Many have spoken about St. Luke’s Hospital. Thank God, I have never been a patient there, but I have visited relatives and friends in the hospital which is rightly regarded as unique in the health service because of its fine setting on its own grounds, its peaceful and tranquil atmosphere and, above all else, its excellent staff, all of which combine to ensure there is a positive health care experience for patients suffering from very serious conditions. That is the reason none of what I have mentioned should be lost.
Senator Norris made a point which I also made on Second Stage and was attacked for doing so by the Green P
arty. The point is that to a certain degree Senators are elected - we are elected by county councillors. We sometimes pass legislation that has life and death implications. If the right treatment is not provided for a patient at the right location and at the right time, it can have life and death implications. Therefore, we have to carefully scrutinise the legislation we pass and weigh up the pros and cons. It would be remiss of us, as legislators, not to listen to the patients who have passed through the system and the staff and others who have had a positive experience of the hospital, the stories of many of whom have been related in the Chamber today and previously on Second Stage. The voices of 180,000 people are very loud. The Government can bring forward any Bill it wants and as long as its members toe the party line, it can change the position in whatever way it wants. However, just because it can do something does not mean it should do so. In this case, it should listen to the 180,000 voices calling for the Bill to be rejected. At the very least, the proposed amendments, particularly amendment No. 2, should be accepted.
Senator David Norris (Ind): The urgency of this matter is indicated by the fact that I understand there were plans to start moving staff from St. Luke’s Hospital in November this year, at which time there would be reduced services for an increased number of patients. The feeling expressed on this side of the House — I know there is some sympathy on the other side of the House — is echoed by many, including patients and the Friends of St. Luke’s. We have a distinguished group of persons representing the patients and the Friends of St. Luke’s in the Visitors Gallery.
I also recognise the presence of a very distinguished member of the artistic and intellectual community who lives in what has been described as the leafy suburb of Rathgar just across the road from St. Luke’s Hospital, the poet and biographer, Mr. Ulick O’Connor, the biographer of a great doctor and wit, Oliver St. John Gogarty. He has authorised me to say on his behalf that he strongly supports the retention of St. Luke’s Hospital and the proposed amendments and that were he, as Oliver St. John Gogarty was, a Member of this House, he would be voting with us.