Cancer in a Cold Climate

by Enid O'Dowd

  Enid: I attended a public meeting and I was just so impressed by the personal testimonies of patients and their families at the meeting and other speakers there raised the issue of the real agenda behind the whole thing, because we have here an 18 acre site in a very nice part of south Dublin and, obviously, it would be a developer’s dream and people have felt as well, you know, because why would you close an existing centre of excellence that everybody raves about. It just doesn’t make sense.

  PK: And who actually, who owns St Luke’s.

  Enid: As I understand it, it was given by the family who owned it in trust to the State. Now there is a certain lack of clarity about whether it was tied up to a cancer service use but certainly, you know, people have given huge amounts … (interrupted by Pat)

  Pat: Ok, well maybe Valerie might be able to clarify the facts of this. But as far as you are concerned the move to St James’ would be just simply wrong.

  Enid: It would be wrong. I mean we do need the cancer centre at James’. We really want to say that because unfortunately since the decision to close St Luke’s which was taken back in 2005 the projected numbers for new cancer cases have rocketed and we clearly need way more services because, you know, the key to good outcomes is early diagnosis and immediate treatment so we are NOT saying stop St James, we certainly need that unit there, but we do need to keep this, this wonderful hospital here.

  Pat: And presumably and we will hear in a few moments whether this is the logic or not that St Luke’s is very specific in what it does in terms of radiation for cancer treatment. Often people require multiple treatments and I suppose the whole idea would be that they would be more or less under the one roof in St James for various treatments including radiation and chemotherapy and perhaps other stuff that might need to be done, orthopaedics or whatever.

  Enid: The one thing that Luke’s don’t do, they don’t do surgery. Now increasingly surgery isn’t used for cancer patients anyway because it is not appropriate and sometimes chemo and radiotherapy isn’t either. There are a lot of new drug treatments. Now my husband comes here for drug treatments and he spends half a day, a day here, as he was saying, having tests, waiting then to know the results and then they administer more treatment and he has this day in the most beautiful unstressful surroundings which is so important for recovery. And I stress that we do need James’ for those patients who need surgery or who might prefer to go there but the volume of demand for people with cancer is that we need to keep Luke’s open as a satellite of James’. The expertise is here. I mean this is not some little place where they have the odd case and they really don’t have the knowledge to keep going. Patients just weren’t consulted and it’s all about patients and best outcomes for patients. Six experts advised the Minister on which hospital should be the cancer centre of excellence and I would challenge that and I think that decision needs to be looked at. Six experts, three of them were Irish public servants, one was an HSE manager actually and three were medical people outside the State. Now, I’m sure they acted in good faith but the point is there was no patient input whatsoever and this is all about patients and their perception. We have over 10,000 members on our Facebook Save St Luke’s Campaign. If listeners look it up they will see personal testimonies about this place and when you read them you become emotional and you think how can we close this hospital? It is the success story of our health service.

  Pat: Alright.

  [Cheers from supporters in background]

  PK: Ok and clearly you have a lot of support there.

  Enid: I mean .. we have…

  Pat: Yeah go on Enid.

  Enid: Yeah I mean we feel that we have been totally let down by the politicians generally. We handed in 150,000 signatures. It was ignored. We lobbied politicians extensively. We attended the debates in the Dail and Seanad and the government TD’s just didn’t turn up. They just trooped in to vote. Now, John Gormley, the Minister who is a TD for this constituency is on record as a Minister for saving St Luke’s. He got a lot of lobbying, he didn’t answer some of the letters, I know that from personal experience, and then he just led the 6 green TD’s into the Dail to vote to close St Luke’s. We lost by 4 votes. If the Greens had supported us, as they had indicated they would, Luke’s would have been saved.

  Pat: Alright thank you Enid.

  Pat: Joe Guilfoyle in 2006 he was a patient. He set up the Save St Luke’s Campaign and, I believe Valerie, you have Joe with you.

  Valerie: Yes, Pat, I do and Joe is typical of the many patients who travel from all over the country to attend Luke’s. He, in fact, travelled up from Waterford which is where he came from this morning.

  Pat: Joe good morning to you. Now Joe what difference would it make to you to make your end point destination St James’ rather than St Luke’s given that you are coming all the way from Waterford any way.

  Joe: I would safely say if I was going into James’ for my treatment I would only get half of it because I would be dead. I wouldn’t survive the rest of it. It’s a concrete jungle and you have a dysfunctional minister handing over this wonderful hospital and grounds to a dysfunctional HSE board who are out of control monsters who could not run a bath between the two of them.

  [Cheers from supporters in background]

  Pat: It is the density of St James, I mean, it is a massive hospital, it has been redeveloped consistently over the last couple of decades with buildings being knocked down and more buildings going up and, I mean, it is in many areas absolutely state of the art. I mean is it it’s location, is it the difficulties with parking, is it the traffic - congestion around both entrances to St James’ around rush hour? What is it that particularly bothers you?

  Joe: Everything you mentioned there Pat would bother me about St James’, parking. You walk out the front door and you are going to be hit by a Dart train or Luas. St Luke’s hospital and there are a lot of doctors in favour of closing it, those doctors did not take into consideration the patients, this idea was flawed from day one. There wasn’t one iota of a patients input put into it.

  Pat: Alright, let’s try and figure out exactly what’s going on. I am joined on the line now by Dr Jerome Coffey, radiation oncologist at St Luke’s who is taking the clinical lead nationally in the development of the national radiation oncology plan.

  Dr Jerome Coffey good morning.

  Pat: Can you explain, you know, the logic of this decision because obviously 150,000 people who signed a petition don’t see it.

  Dr Coffey: Well, Pat, I would like to acknowledge the comments made by Tom, Enid and Pat and there is a lot there that we agree on but actually the facts are that a process was entered into, a decision was made and actually the more important thing was the investment happened. St Luke’s is now expanding to a network model and it is going to in December have clinical presence, it is going to be operating in two new state of the art facilities in Beaumont and St James’ hospital sites and these are purpose built, they have the best equipment in the world, they are large buildings, they are three storeys, they are 35,000 sq ft each. They are designed with the patients in mind.

  Pat: And what is going to happen to St Luke’s itself?

  Dr Coffey: St Luke’s hospital is going to continue what it does best, for now. It’s going to continue … (interrupted by Pat)

  Pat: Until when?

  Dr Coffey: The plan is that St Luke’s hospital network will be three locations in Dublin across the city in post codes 6, 8 and 9. The hospital ethos will be protected, it will be perpetuated, it will be developed, I mean, it’s a national brand we all agree on that. It has earned that. Its’ ethos is providing care and compassion for patients and families heading on for fifty years, that isn’t going to stop. We see on average three and a half thousand patients per year so it’s earned an enviable reputation and it’s one that the clinical and non-clinical staff in the hospital (interrupted by Pat)

  Pat: Ok, what will be left there when the other two centres open up?

  Dr Coffey: W
ell, the facility continues. There are treatment machines. There is the lodge which is an important facility and that will stay active, emm, parts of radiation therapy, I’m talking about brachytherapy, the highly specialised stuff that has been happening here for years, that will continue for now and the quality of care and the standard of care would be enhanced with these facilities coming online. We are providing a geographical spread across the region and that will be of huge importance to patients who live near St James’ or near Beaumont hospital.

  Pat: St James is in relative terms only a stones throw from St Luke’s so, I mean, there is no great geographical advantage, in fact there is a great geographical disadvantage in going to James’. Anyone who has had interface with James’ at any time around rush hour will know it’s an impossible place to get in and out of.

  Dr Coffey: It’s important to realise these are added facilities. We are not shoehorning this into existing structures. This is more space, it’s purpose built.

  Pat: Yeah but have you driven in and out of James’ at rush hour?

  Dr Coffey: I’ve worked there. I know it well.

  Pat: Isn’t it abysmal trying to get in and out of St James’? You have to admit that. You can’t tell me, because I went in and out of it for months, often at rush hour, happily on a motorbike but if I was in a car it would have been absolutely ridiculous.

  Dr Coffey: Pat the patients who don’t have a voice here today are the patients who are actually in hospital. They need care on site and what is going to happen from December onwards is that patients will be able to get all their cancer care delivered at a single site and that is of immense value to patients and that hasn’t been expressed this morning.

  Pat: You’ve got 18 acres to spare in St Luke’s. I mean why not develop it?

  Dr Coffey: The model that is coming into effect, that’s being realised, I mean, it’s based on best practice internationally and the strength here is that cancer care is getting more and more complex. Every patient goes through a multidisciplinary process through diagnosis, through management plan and through follow-up. Now that is being done with great effort by doctors shuttling between hospitals by having a full time presence in the cancer centres at Beaumont and St James’ site would … ( interrupted by Pat)

  Pat: Ahh, so this is to suit doctors really?

  Dr Coffey: No.

  Pat: To stop you having to move from A to B.

  Dr Coffey: No, Pat, Pat that’s a misinterpretation. The process is that the patient’s management plan needs to be agreed between different specialists, medical oncologists, surgical oncologists, radiation oncologists, who need access to onsite diagnostics, that all needs to happen.

  Pat: But hang on a second

  Dr Coffey: No, Pat.

  Pat: No hang on, no, no, no, no, aren’t we told all the time that you are doing everything over the internet now, that is someone is diagnosed in Point A an expert in Point B can look at it, the scans and all that. Isn’t that so?

  Dr Coffey: Pat, you can not have an effective conversation over a faulty video conference line. You need to be in the room with your colleagues making the best plan for every patient, for all patients, and that will happen when we’re on site all the time and this is not for the convenience of doctors whatsoever. This is an increase in the workload but the doctors involved are very enthusiastic and want to see this open as soon as possible.

  PK: Just to give you some of the comments —

  From Anne “my elderly mother had to queue for 5 hours in the breast clinic at St James. The atmosphere in St Luke’s is so much better for people who are already under a lot of stress.”

  From Joan Kelly “ keep St Luke’s open, it’s an abomination to plan to close it. James’ is jammed and unsuitable as it is. Luke’s is a real time centre of excellence today.”

  Pat: Now, you know … (interrupted by Dr Coffey)

  Dr Coffey: Pat, we are addressing excellence. We are providing increases, huge increases in treatment capacity and treatment quality. This will be on a par with the best in the world. It will be better than the rest of the world. This will be … there will be space, there will be capacity. Patients will not be waiting around. In the second phase when expanded further we are planning for the next 20 years. We will have the space to deliver patients care faster than any guideline you care to mention.

  Pat: You don’t have a lot of space in St James campus at the moment.

  Dr Coffey: Well, I’ll have to invite you onto campus to see the building as soon as it is open. You’d be more than welcome.

  Pat: Yeah, I mean the building you have the site for it there but I mean the actual campus of St James’ is absolutely choc-a-bloc, isn’t it?

  Dr Coffey: Well, the new building is on its own site. It’s big enough to meet its purpose and will be expanded by 2014 so I have no worries about that whatsoever.

  Pat: Emm, I’d just have worries if people need to get in there early in the morning which a lot of the cancer treatments require, you know, that the clinics open at whatever time I’m just thinking of a dirty winter morning in Dublin trying to get at St James either from the upper entrance or the lower entrance very very difficult.

  Dr Coffey: Access to St Luke’s Hospital is not easy. We see patients coming here saying they left at dawn and got lost on the M50 so I’m not under estimating the access, access is a problem for any hospital in Dublin but the quality and the quantity of care will be vastly enhanced by these centres.

  Pat: Some more comments. “Mary Harney’s mantra is what can be closed down regardless of the consequences for people”. That’s from … ( interrupted by Dr Coffey)

  Dr Coffey: Pat, this is not a cutback on efficiency, this is a huge and very significant investment. Tens of millions of euro.

  Pat: Alright, a 10 minute rush hour wait to get into the car park at St James’ is nothing in comparison to the three hour trip from Letterkenny to Galway or the two hour trip from Clonmel to Cork.

  Dr Coffey: Pat, there are two points here … (interrupted by Fat)

  Pat: Dublin people need to wake up and realise …( interrupted by Dr Coffey)

  Dr Coffey: Pat, there are two positive points to make here, one is the Taoiseach last week mentioned in the Dail the commitment of the government to a joint initiative with health authorities in Northern Ireland to develop new cancer centre at Altnagelvin. That would be hugely positive for the people in the northwest. The next issue is access, parking etc in the Dublin centres. This issue is not new, this is happening in every place in the world where they put in new hospitals. It happened in Belfast when they opened a new cancer centre in City Hospital, a solution was found quickly. Patients got their treatment, they weren’t spending fortunes on car parking and at the end of it the solution was found everybody was happy and it was on to the next challenge.

  Pat: Yeah I mean these solutions though, Jerome, they should be designed in at the beginning.

  JC: They are.

  Pat: Are they? So you think there is, there is no way.

  JC: There are processes ongoing to address all of these foreseeable issues:

  Pat: Ok, I’ll go back finally, thank you very much Jerome. I’ll go back to Joe Guilfoyle to just give us a response. I mean you are getting more, not less. St Luke’s stays open particularly with some of the more sophisticated and difficult treatments that it currently is expert in. What do you say to that?

  Joe: What Doctor Coffey says is all poppycock! Especially for the people in the north west and Donegal. If they go to City Hospital in Belfast for the treatment how many patients a day are they taking, a week I should say, are they taking from Donegal? One patient per week! And that’s what …..(interrupted by Fat)

  Pat: He did point out though that with Altnagelvin hospital there will be a joint service, a joint initiative there which will ease the burden for people in the North West.

  Joe: It will ease the burden but at what cost? You know, all these things come in under the Good Friday Agreement. We were sold o
ut. The Irish government sold the taxpayer out. But you can check an article online for any more quotes and that’s a full quote from Dr Ian Frazer which is on Facebook and he is an oncologist here in St Luke’s and I would rate him above anybody else and all the experts that Mary Harney has brought in. If I want something said, I can pick 5 experts that will say something for me in my favour.

  Pat: But sure, it happens in the courts every day. There are experts on either side of every argument, both of whom will swear blind to the truth of what they are saying which is the exact linear opposite to what the other person is saying, that’s the nature of the beast.

  Joe: I wouldn’t believe, I’m sorry Pat, I wouldn’t believe one word out of Mary Harney’s mouth. In one breath she is saying that the hospital is saved for palliative care, she doesn’t tell us what, but then in the next breath she says the HSE cannot dispose of it without the Minister’s consent.

  Pat: Alright there.

  Joe: That’s leaving it wide open.

  Pat: Alright, we’ll leave it there, Joe, thank .舰

  Joe: The fight is only starting Pat.

  Pat: You’re only starting, well you’ve got until 2014 before the transition but you are promised that in the interim that, and beyond, that St Luke’s will remain open. We must check as to the ownership of St Luke’s and whether or not cancer care is part of the bequest that gave it to the State because that might be instrumental in its ultimate fate.

  But thank you to Valerie and to all of those who are protesting at the moment outside of Luke’s.

  From the interview with Dr Coffey, it’s obvious that Pat Kenny’s experiences accessing St James’s hospital have not been pleasant!

  After the broadcast we adjourned to the café in St Luke’s and it was there I suggested writing this book to give the recent history of the campaign, a picture of this wonderful hospital in the words of patients, and our future plans. The book was to make ordinary people angry that at a time of deteriorating health services, something really good was to close — and to persuade them to join us in the campaign.