Cancer in a Cold Climate

by Enid O'Dowd

  When I got home, elated by the broadcast, I found the email from the President’s office saying she had already signed the Bill.

  THE MYSTERY OF THE WEAFER REPORT

  Back in 2008, Luke’s patients and supporters co-operated with a research project commissioned by the Board of St Luke’s and the Friends of St Luke’s from a consultant named John Weafer.

  The Dublin group met him on 19 February 2008. He asked each of us to talk about what St Luke’s meant to us and he taped our interviews. We were unsure as to his brief, but we were delighted that his research included patients and their families. Country patients, including Joe Guilfoyle and other committee members also took part in his research.

  We forgot about it until after the Pat Kenny Show when committee member Nancy Browne recalled driving to Portlaoise to meet Mr Weafer. Joe Guilfoyle asked Pauric White for a copy on 22 July. Five days later, it arrived in his inbox.

  The 153 page report was a revelation. Weafer backed the retention of St Luke’s Hospital for cancer patients. His report included a detailed literature review on the effect of the wider environment on healing. He also commented on cancer centres outside Ireland. St Luke’s compared very favourably with the centres he reviewed, and which he regarded as models of best practice.

  In his concluding comment, John Weafer used the words of three of our committee members to summarise how patients felt about the hospital, and in his chapter 7 sets out a possible future for St Luke’s Hospital. In it, the author comments that St Luke’s ‘is an entity which is more than the sum of its parts. St Luke’s is effectively a centre of excellence.’

  Two days after receiving the Weafer Report the committee met the outgoing Chairman of St Luke’s, Pauric White, CEO Ann Broekhoven and Director of Nursing, Eileen Maher. Towards the end of the meeting the committee asked Pauric White whether the report had been sent to Minister Harney. They felt they didn’t get a clear answer to what is a simple question, and they left the meeting confused.

  I could not attend that meeting due to holidays. While the committee was meeting the St Luke’s management, my mobile rang. It was the Sunday World looking for cancer patients to interview as the paper had decided to take up the cause of St Luke’s. The paper has been running patient stories since then and has set up their own Facebook page for its campaign.

  On my return from holiday, I discovered that the Minister had never received the Weafer Report. I found that hard to believe so I asked the Press Office to check that the report had not been sent instead to a senior aide in the Cancer Control Programme, and again the answer was no.

  At our committee meeting the following week, Mary Reynolds pointed out that the Weafer Report we had received (as a Word document) was entitled Final Report May 2010 when we understood it was completed in 2008. Were there two Weafer reports she asked? As it transpired, there were indeed two reports. When we asked, we were informed that there were two documents, one in produced in 2008 that reflected patients and staff views on the hospital while a second Weafer Report, finalised in 2010 incorporated the earlier work, adding significant sections on how the environment promoted healing and how St Luke’s compared with top cancer centres internationally.

  So in May 2010, the very month when Minister Harney introduced the Bill that would ultimately close St Luke’s, both the Board and the Friends had a newly completed expert report, containing ten pages of academic references, which they did not submit to the Minister. Nor did they apparently seek to publicise the report in any way. Nor did they bring the report to our attention. It would have been of immense benefit to our Dail lobbying activities. It later emerged that the report was effectively finished in November 2009: this was the date of the final invoice submitted for the research.

  Why the Minister did not get the report remains shrouded in mystery: we found it incomprehensible. Given that the Board of St Luke’s is appointed by the Minister some might argue that the Board is not independent. Some people have suggested to us that the fact that long serving Board Chairman Pauric White is married to a Fianna Fail senator potentially created a perception of a conflict of interest when it came to fighting to retain St Luke’s.

  The Friends of St Luke’s are an independent group; a company limited by guarantee with charity status operating from an office within the hospital. The Friends’ Board works closely with the St Luke’s Board. We could not understand why, from the end of 2009 onwards, the Friends did not use the Weafer Report to try to save St Luke’s, or so it seems.

  Instead, in late April 2010, the Luke’s Board and the Friends jointly commissioned a report on the future uses of St Luke’s from a consultancy firm, Prospectus Ltd. This report had not been completed at the time the Bill was debated in the Dail, and only went to the Minister on 29 July 2010.

  Interestingly, minutes of a meeting on 16 December 2009 between Pauric White, the CEO and staff of the Department of Health’s Cancer Control Unit record that the report jointly commissioned by the Luke’s Board and the Friends on the future of the site will be available shortly. The minutes note Mr White as saying that ‘this (report) will be submitted as soon as possible to the Minister’ (my emphasis). This could only have been an oblique reference to the Weafer Report; as it was the only one then in existence and the Prospectus Report is very unlikely to have even been conceived then as its formal commissioning in late April 2010 shows.

  We delivered the Weafer Report by hand to the Department of Health and Children on 6 August. That report was subsequently copied and distributed to eight officials in the Cancer Control Unit.

  We then set out to discover why the Weafer Report had been withheld, emailing questions to Pauric White and to hospital CEO Ann Broekhoven. We also wrote to Peter Byers Chairman of the Friends, requesting a meeting, and he subsequently rang Joe Guilfoyle. When Joe realised how busy Mr Byers was as Group Finance Director of Treasury Holdings, he suggested that perhaps Mr Byers would respond to some email questions and meet us at a later stage when he was under less pressure. Joe explained that he too was under pressure from some ‘militant’ ladies on the committee to get answers quickly.

  An automatic reply from Pauric White’s email told us he was on holiday until 2 September. A few days later, however, Pauric White phoned Joe from Vietnam to say he would be in touch on his return from holidays. On August 26 Joe received another call from Vietnam: Pauric White told him that Peter Byers had phoned him to express concerns. The possibility of Joe going public with the Weafer Report was clearly giving rise to acute anxiety.

  It goes without saying that the Weafer Report should be publicly available: it was paid for by public money. One can only speculate as to why this document, which pays such a handsome tribute to the work of St Luke’s, has never been published on their website, or promoted in other appropriate ways.

  Mr Byers subsequently emailed Joe to say he wished to get his Board’s view at its next meeting on 8 September on how to respond to our questions. He explained that since the abolition of the Luke’s Board on 31 July, the Friends had been thrust more into the broader public and political limelight and said we ‘are feeling our way to a degree.’ We asked him if his board would consider co-opting one of our committee members. He later informed us that, as there had been three co-options in the past six months or so, the Board did not intend to seek further nominations at this time, though it would revisit the issue. We were disappointed by this news though recognise the Friends’ Board has every right to appoint as it sees fit. Some of our committee have many years experience of fundraising for the Friends.

  Mr Byers also said, rather than answer our questions in writing, his Board would prefer a meeting to deal with the issues we had raised. We now hope to meet the Friends in the near future and look forward to working productively with them.

  We received the following emailed response from Luke’s CEO Ann Broekhoven -

  30 August 2010

  Dear Joe,

  Further to our recent telephone conversation, my understand
ing of why the Weafer report 2010 was not sent to the Minister was because the Chairman wanted to present the Minister with a business plan for the future use of St Luke’s hospital site. Prospectus were hired to take the Weafer report and effectively turn the recommendations into a business plan. Prospectus were hired after the Board and The Friends of St Luke’s considered the Weafer report and Prospectus were given a very short time frame to undertake and deliver the business plan.

  The Prospectus report was therefore the next stage in formulating the plan to be delivered to the Minister. I understand you now have the costs associated with the reports. These reports were jointly commissioned and funded by the Friends of Saint Luke’s Hospital and the Hospital Board. I cannot answer why you were not given a copy of the Weafer report. The Prospectus report has been acknowledged by the Minister and is under her consideration.

  With kind regards

  Ann Broekhoven

  Eight days after his return from Vietnam, we received this reply from Pauric White.

  ----- Original Message -----

  From: Padraic White

  To: ‘Joe Guilfoyle’

  Sent: Friday, September 10, 2010 12:00 AM

  Subject: RE: Response to Questions

  Joe:

  I sought to deal with all the issues at our meeting in St Lukes and I considered that we had dealt with the key issues. I have no status now in relation to St Lukes since my term of office expired on 31 July so it would be wrong of me to be giving formal answers at this stage.

  Best personal wishes,

  Padraic

  We were surprised by this reply. Mr White claims that the ‘key issues’ had been dealt with on 29 July when it was the lack of clarity about the Weafer Report at that meeting (and our subsequent discovery that it had not been received by the Minister) which necessitated the questions.

  We queried his reply. In an email on 22 September Mr White stated ‘the Weafer Report was commissioned by St Luke’s and the Friends for consideration by our respective Boards. It was up to our Boards to decide what to do with the recommendations. It was not the stated objective to commission Weafer for transmission to the Minister.’ He also referred to a commitment (by Joe) not to release the report without agreement. Such a commitment was never given. Again, we found the concern about the possible release of the report, puzzling.

  We also requested information under FOI from both the St Luke’s Board and the Department of Health and Children. The mystery thickened.

  We learnt that a meeting had taken place on 18 January 2010 between Pauric White and Peter Byers at which the Weafer Report was discussed but were not sent minutes. We asked for minutes and were told that no minutes existed. Extracts from the Luke’s Board minutes provided showed no evidence of any discussion as to whether or not to send the Weafer Report to the Minister.

  The final extract from the minutes provided related to a board meeting on 10 March 2010. At that meeting the Luke’s Board was told that a meeting had taken place between the CEO, the Director of Nursing, past and present Chairmen of the Friends and the Chair of St Luke’s but the minutes gave no clue as to what had been discussed or agreed at that meeting. The discussion must surely have been about the Weafer Report and a possible future use for St Luke’s. It was a second case of missing minutes. When we asked for them, the FOI officer told us ‘ I do not know why this meeting was not minuted. It’s not unusual for meetings to be held and not minuted.’

  We subsequently asked if an extract from a later board meeting had been accidentally excluded, only to be told that the original FOI reply had contained all relevant material.

  Curiouser and curiouser, to quote Alice in Wonderland.

  It was very frustrating! The FOI Act cannot help you when important meetings are not minuted. It now appears that the Luke’s Board had no formal role in the non arrival of the Weafer Report on the Minister’s desk, that there was no discussion and therefore no decision not to send it. But all of this remains extremely unclear.

  Mr White maintained it was up to the two Boards to consider what to do with the Weafer recommendations but we were unable to locate from Luke’s board minutes any decisions on this crucial issue, and FOI legislation did not cover Friends’ board minutes.

  The FOI officer at St Luke’s rejected our request for a copy of the Prospectus Report under Section 20 of the FOI Act 2003. This section relates to the ‘deliberative process of public bodies.’ We queried this and were told that ‘these ongoing deliberative processes relate to proposals from hospital management on the future uses of St Luke’s Hospital. These proposals are under consideration by the Minister of Health and Children and it is not considered to be in the public interest to release this report at this time’.

  Fortunately, however, the FOI officer at the Department of Health and Children saw no problem in releasing the Prospectus Report to us. She explained that as the report was in the public domain, there was no reason not to release it under FOI. The information supplied by the Department of Health and Children was helpful.

  At a meeting with Luke’s CEO Ann Broekhoven on 15 April 2010 and various department officials she (CEO) was updated on the impending legislation. The following extract from the minutes is of interest: ‘the Friends of St Luke’s have received the Weafer Report on the future use of the site. They intend to request Prospectus consultants to review and develop an implementation plan which they would expect to receive in eight weeks (mid June). The focus is on models of non acute care. The Department stressed that a broad vision is needed at this stage rather than an implementation plan (my emphasis).

  This, the Department told the Luke’s CEO that it wanted a broad vision at this stage which was what the Weafer Report was – yet they never got the document.

  During the Dail debate the Minister announced she was meeting the Friends to discuss the Prospectus Report. That meeting was postponed until 15 July, we assumed because the Prospectus report wasn’t ready. However the minutes show that report wasn’t ready for the rescheduled meeting. At that meeting Friends Chairman Peter Byers explained that the Prospectus Report would recommend a palliative care facility for cancer patients and that such care was ongoing for cancer patients. Mr Byers was accompanied by three other Friends’ directors. They stressed to the Minister that a decision on the future use of the site needed to be made as quickly as possible because uncertainty would damage the Friends’ fund raising capacity.

  The minutes record that the Minister looked forward to getting the Prospectus Report, and that she would consider in conjunction with the HSE and other relevant parties.

  Were patients and their families to be considered ‘other relevant parties’? That remains to be seen, but given the total lack of consultation to date, that consideration seems unlikely.

  The Minister now has the benefit of both reports, Weafer and Prospectus, on the future uses of St Luke’s, to inform her decision on its future.

  BEST PRACTICE: NO BEDS, NO FOOD

  The Minister has said that the new cancer units including the one at St James’s will be state of the art facilities designed for cancer patients and guaranteeing best outcomes. That has to be good news for cancer patients, you would have thought. But when I tried to get information on these facilities from the cancer strategy press office, I was stalled! I got some answers yes, but after many reminders. Twice I had to threaten the press office with a call to Joe Duffy’s Liveline.

  Some answers are worrying: you’ll learn about those at the end of the chapter.

  On 4 August I emailed the following questions to the Cancer Control press office;

  Sent: Wednesday, August 04, 2010 3:41 PM

  Subject: New Cancer Unit at St James

  1) What is the anticipated opening date of the new cancer Unit at St James?

  2) Will there be a formal opening with press invitations? if so, could I have one?

  3) Could I have some information about the new building - e.g. how many floors/inpatient beds/facilities for da
y patients/what sitting rooms are available for day patients/any facilities for complementary therapies/any facilities for overnight stay for close family members?

  4) Will day cancer patients have to pay the car parking charges?

  5) Can you give me information on Phase 2 which I understand should be finished by 2010. What is involved - is it another building or an extension to the one that is almost completed? Have contracts been signed for this yet and if so, which company got the contract?

  6) When (and indeed if) the private co-located hospital at St James is built, is it true that cancer patients with private insurance will have no choice and have to attend the private hospital even though they may wish to attend the new public cancer unit?

  Press Office statement 16 September 2010 (extract)

  You will appreciate that the plan for the two new facilities at St James and Beaumont are for radiation oncology which is routinely a day service available on an outpatient basis. I know you fully understand that it does not routinely necessitate overnight or in patient treatment. However, as certain emergencies have arisen in the past in St Luke’s, our medical colleagues have explained that they would routinely transfer their patients usually by ambulance to the most appropriate acute hospital. While such transfers are not frequent, they naturally are quite stressful for the patients and their families. The development of the St James and Beaumont centres obviously ensures that all appropriate acute and emergency services are immediately accessible on the one site.

  Operating as outpatient centres, therefore the facilities being developed on the two new sites will be spacious and will meet the needs of patients and staff. There is no in patient ward or beds (my emphasis) in these centres – they will operate as dedicated radiation oncology facilities providing services to patients who will travel to the centre on an agreed basis (routinely once a week over an appropriate number of weeks).