Cancer in a Cold Climate

by Enid O'Dowd

  However, they are purpose built and feature

  Main Receptions

  Radiation Treatment Areas

  Simulation Suites

  On Treatment Support Suites

  Outpatient Suites

  Allied Health Support Services

  Administration Accommodation

  We are working towards developing one of the most advanced networks of radiation oncology in the world and by the end of 2014 anticipate that we will be well advanced in that ambition and will be able to provide patients with significantly enhanced service that is accessible and delivered in a timely and appropriate manner. We are still in consultation regarding the full level of allied health support services that will be available and this will include physiotherapy, dietetics and social work. But this is not an exhausted (sic!) list – other services will be available….the radiation oncology facility is a day care/outpatient facility which is being designed to provide the most advanced care in a setting that is the most appropriate spacious and comfortable for the patient.

  So, no beds! And no food! Moreover, it’s totally unclear from the above – I have asked for clarification – whether these facilities even include comfortable seating areas where patients can relax during and after treatments.

  In addition to several attractive sitting rooms, St Luke’s offers a range of complementary therapies. It also offers catering at reasonable cost which can be accessed without going outside the hospital; spacious grounds with seating; a putting green; and ample free parking. Day patients including family members get a free lunch if they are there when Grainne brings around the home made soup and sandwiches’ trolley. I remember the first time I was there with my husband who was recovering from a treatment, and I told her, I’m not a patient. I’m just with my husband, and she said ‘you’re just as important’ and fed me. And she is right; looking after the carers is important.

  On the issue of beds, St Luke’s has 179 beds comprising 110 overnight beds in the hospital as well as 20 beds in the day ward. Crucially, the hospital also provides 49 beds in Oaklands Lodge which is in the St Luke’s grounds. During the day there are three nurses in Oaklands Lodge, while overnight, there are two. Patients and their families stay there free of charge.

  It has now emerged that these 179 beds are to be replaced by 12 dedicated cancer beds at St James’s Hospital in the main building. This represents a massive cutback in public cancer beds. Many non surgical patients need overnight beds – so where will they go? Another twelve dedicated cancer beds are to be provided at Beaumont Hospital, the so-called centre of excellence for the Eastern Region North. That’s 24 beds for the whole Eastern Region area where one third of the population lives- to cope with ever-increasing cancer cases.

  The taking out of 179 beds from the public health system and their replacement by a meagre 12 in James’s is a material fact, one that should have been made clear by the Minister. Surgical and non surgical cancer patients will be forced to compete for these beds if St Luke’s is closed.

  I had assumed – wrongly it now appears - that the whole point of these state of the art units was that all cancer services were to be provided together on site, in line with best international practice. What about the risk of cross-infection when non surgical patients, their immune systems possibly compromised by cancer treatment, are placed in the main hospital? And bearing in mind that not all of the area surrounding James’s is super safe, if the patient is not from Dublin, where will family members stay, and at what cost?

  Finally on the issue of food: there isn’t any.

  No kitchen features in this large three storey state of the art building designed to meet the needs of patients, it seems. The press office only released this information courtesy of Joe Duffy, as it were.

  Outpatients do not need such services apparently.

  Yet the reality is that cancer patients can feel very weak after chemotherapy and other treatments. The last thing they need is to have to brave the elements and vie with the constant stream of traffic through the campus to queue in the nearest café which is located in the main reception area at the main hospital entrance. This cafe is fine if you are healthy. It serves food at commercial prices unlike St Luke’s where prices are reasonable. But it’s also extremely busy and somewhat impersonal, like an airport lounge – where the anticipation of travel has been replaced by the anxiety of illness. Hardly the stuff of healing for cancer patients.

  Parking charges for cancer patients at James’s are currently ‘under discussion’ we have been told. Like many other hospitals James’s charges hefty commercial parking fees to patients and visitors. Unlike them, Luke’s does not charge.

  If government TDs had been given these facts before they voted to close St Luke’s, would the vote have been different?

  PUTTING PATIENTS BEFORE POLITICS

  On the same day that we appeared on the Pat Kenny Show, 12 July 2010, Cavan County Council unanimously passed the following motion:

  That Cavan County Council call on the Minister for Health to reverse the decision to remove the oncology service from St. Luke’s Hospital, Dublin

  The motion was proposed by Councillor Maura Maguire Lynch, and seconded by Councillor Andrew Boylan.

  It was heartening to learn that the motion had been supported by Fianna Fail councillors – proof that it was possible to put patients before politics. Our experiences in the public gallery in the Dail and Seanad had made us cynical.

  This gave us the idea to lobby to have other councils pass similar motions. Councillor Michael Fitzgerald, Chairman of the General Body of County Councillors, promised us his support. He has already put down a motion for his own council, South Tipperary County Council, and will raise the matter at the next meeting of all the councils with a view to having motions in every council.

  We had received strong support from the opposition parties during our campaign to stop the Bill from going through the Dail. We now sought commitments in writing from the party leaders. (Letters from Fine Gael, Labour and Sinn Fein are included in the appendix.) We also decided to make contact with government deputies at constituency level, by arranging for TDs to meet constituents.

  This is an opportunity for you to play a vital role in our campaign to save St Luke’s.

  START A LOBBYING CAMPAIGN LOCALLY

  Health analyst Marie O’Connor’s chapter on the galloping privatisation of health care, including cancer services, should make us all sit up and shout stop. Her researches, and ours, reveal that the decision to close St Luke’s was not about best outcomes for patients or best international practice. It was and is about profit for private medicine.

  Speaking of the new public private partnership cancer units, Ms Harney said in the Dail that it was ‘important that the units are appropriately designed, laid out and structured and that there are garden and outdoor areas and the sense of calm and peace that patients need’. Commenting on these new units at James’s and Beaumont on the Pat Kenny Show, Dr Jerome Coffey claimed that they were ‘purpose built and designed with the patients in mind’. Dr Coffey was introduced by Pat Kenny as a radiation oncologist at St Luke’s ‘who is taking the lead nationally in the development of the national radiation oncology plan.’

  Given the overwhelming ugliness of the new unit at James’s, that interview rings hollow. A visit to the James’s campus on 17 September 2010 revealed a monumentally ugly building that resembled a low-budget industrial bunker. It is crammed between two buildings of wildly differing architectural styles. Immediately adjacent to one side of that building lies the entrance to the hospital’s underground car park, demand for which is so high that pedestrians cross the road at their peril. Another unsightly-looking prefab, which also looks as though it were sourced in the bargain basement of a bankrupt builder, stands very close to the main entrance. This low-cost industrial landscape will do little to engender ‘the sense of peace and calm that patients need.’

  Dr Coffey also claimed that this unit is ‘based on
best practice internationally’. Do cancer units outside Ireland not feed their patients then? Do they not make the slightest effort to have a pleasant environment, both internally and externally, for cancer sufferers and their families?

  Warming to his theme, he continued: ‘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’. Pat Kenny then astutely asked him if the new plan was about suiting doctors rather than patients. Dr Coffey wisely denied that this was the case.

  Claiming to speak for cancer patients currently in hospital, Dr Coffey also stated that ‘what is going to happen from December onwards is that patients will be able to get all their cancer care delivered on a single site. And that is of immense value to patients’. He omitted to tell Pat Kenny, however, that there would only be twelve dedicated inpatient cancer beds at James’s and twelve at Beaumont Hospital, after the 179 beds at St Luke’s had been taken out of circulation. Allowing for the fact that 20 of those beds are, in fact, day beds, this represents a total loss to the public hospital cancer service in the Eastern Region of 159 inpatient beds.

  Cancer is on the increase, unfortunately. Speaking on RTE Radio One’s Drivetime in September 2010, oncologist Seamus O’Reilly of Cork University Hospital said one in three families in Ireland are affected by cancer. He predicted that, by the time he retired, this figure would be one in two families. This is a frightening vista.

  Since the 2005 decision to restrict cancer services to just eight public hospitals––and to close St Luke’s––the National Cancer Registry has revised its projections upwards for new cancer cases. By 2020, it reckons, we could be seeing as many as 42,000 new cases; this represents a huge increase on their previous estimate of 28,000.

  These estimates alone warrant a review of the Minister’s decision to close St Luke’s. Our hospital system cannot cope with the current demand for cancer beds. With so many new cases expected, how can it possibly benefit patients to close St Luke’s, a proven centre of specialisation? How will the Eastern Region, with just 24 dedicated inpatient beds, cope with the massive increase in patient numbers now anticipated? When a cancer outpatient at St James’s Hospital needs a bed in an emergency, will there always be a dedicated cancer bed available in the main hospital? Will that sick person end up on a trolley? Or does best practice mean treating cancer patients side by side with general patients, leaving them at grave risk of cross-infection in overcrowded and MRSA-infected wards?

  This has already happened in other cancer ‘centres of excellence’, such as Galway University Hospital and Limerick Regional.

  The Minister takes the view that retaining St Luke’s as a satellite of St James’s Hospital would be a breach of her cancer strategy, yet she has no difficulty in giving cancer contracts to UPMC Beacon, an infinitely smaller private for profit hospital. She has said the Luke’s site will be used for health purposes. But what does that actually mean? Under the banner of ‘health purposes, for example, the land and buildings could be sold to a developer in tandem with a private health care corporation, who would, naturally, be prepared to treat public patients at considerable cost to the taxpayer.

  Only the brand is to survive, on current plans. The new facilities at James’s and Beaumont are to be known, cynically, as the St Luke’s Network. This is tantamount to misleading the public, who generally respond generously to all fundraising initiatives. After 2014, however, Luke’s Hospital is not intended to form any part of the acute service. And it is now abundantly clear that the new network will not provide the same ethos of high quality care, the same wide range of holistic therapies, or, indeed, the same tranquility and space offered by the green garden environment that is Luke’s.

  Minister Harney insisted that she had to take the experts’ advice back in early 2005. She now has the benefit of the 2009 expert advice of the Weafer Report to guide her, as she ponders the future of St Luke’s.

  Public interest demands the reversal of the Minister’s decision. Vital new information has come to light since TDs and senators voted on the Bill to close St Luke’s. This book has exposed the reality behind the rhetoric. The case for retaining the hospital as a centre of specialist cancer care for public cancer patients is overwhelming. Luke’s is a unique site with an unrivalled capacity to offer the best in clinical expertise and holistic care to patients suffering from for the long-term illness that is cancer.

  We can save St Luke’s with your help.

  But we have to move fast. While St Luke’s is not scheduled to close until 2014, some staff will almost certainly be transferred from the hospital to other sites this year. Negotiations are currently taking place between the unions representing staff and the Labour Relations Commission. As staff are redeployed elsewhere, the services at Luke’s will shrink, and the wonderful team that has built up there over the years will begin to fragment. So unless this process can be reversed, the winter of 2010 will mark the beginning of the end for a marvellous hospital.

  DON’T LET THEM CLOSE IT!

  APPENDICES