Adjournment Debate. - Hospital Services.

The National Children's Hospital, when based in Harcourt Street, Dublin, was a tertiary centre for the diagnosis and treatment of paediatric leukaemia. At the time of the transfer of the hospital to Tallaght, it was understood that this specialist service provided by it would be maintained and developed in the wonderful new unit provided in Tallaght Hospital. In June last there was a smooth transition from Harcourt Street to Tallaght, and there are currently 40 children suffering from leukaemia being treated in Tallaght Hospital. The new unit in Tallaght was built at considerable public expense and, like its predecessor in Harcourt Street, is a tertiary unit providing diagnostic and treatment services not only for children living within the specific catchment area of the hospital but also for many living outside it.

The parents of children currently in receipt of treatment in Tallaght and the hospital staff with specialist expertise in this area have been greatly concerned by reports that the paediatric haematology unit in Tallaght is to be closed down and transferred to Our Lady's Hospital for Sick Children in Crumlin. For some weeks meetings have been sought with the Minister for Health and Children by a group representing these parents calling itself CHILD, Children's Hospital in Leukaemia Drive. Until today the Minister had, in his usual insensitive and high-handed fashion, refused to meet them to discuss their concerns and worries.

This week I sought from the Minister's Department the report of the National Cancer Forum on which it was understood the Minister had based his decision. I discovered there is no report as such but a letter of 12 November 1998 written by the chairperson of the National Cancer Forum, Mr. James J. Fennelly, to the Minister. In this letter the forum details deliberations it had undertaken and concluded that:

all paediatric oncology cases should be referred to the specialist paediatric oncology unit at Our Lady's Hospital for Sick Children, Crumlin, for initial diagnostic work-up and treatment planning.

The letter states that both solid tumours and acute leukaemias should be referred to Crumlin but that "this does not mean that all cases would necessarily have to be treated there". The letter continues that, after diagnosis, "treatment, including chemotherapy, could then be delivered in the child's most appropriate local hospital, on a clearly defined and agreed shared care basis, subject to proper supervision."

The letter also states:

there exists a high level of expertise in this area and the Forum recommends that the personnel involved in Paediatric Oncology would explore the potential of utilising their skills for optimum patient benefit. This would involve discussion between Our Lady's Hospital for Sick Children, Crumlin, and the Adelaide and Meath Hospital, incorporating the National Children's Hospital, Tallaght, with a view to seeking agreement on revised structuring of existing Consultant posts in order to permit access to the Paediatric Oncology Unit at Our Lady's Hospital for Consultants who have special training and expertise in Paediatric Oncology.

The letter concludes stating that its author "would be glad if [the Minister] would consider transmitting this view to the relevant agencies (including Hospitals and Consultants) who deal with childhood cancers."

It is clear from this letter that, before any changes of any nature were put in place and before final decisions were made, the National Cancer Forum envisaged that detailed discussions would take place involving the consultants who specialise in paediatric leukaemia in each hospital and the hospitals themselves. Unfortunately, a medical body, when making recommendations of this nature, does not always focus on the additional need for consultation with patients or, in this instance, with the parents of children who are concerned that new arrangements could impact on the provision of essential treatment and ongoing care for their children.

This letter was received by the Minister from the chairman of the National Cancer Forum at a time when other issues concerning Tallaght Hospital were under the public spotlight and a cause for controversy. In the period November-December 1998 matters concerning Tallaght Hospital and its medical services were the subject of both Dáil debate and questions. For reasons unexplained, the Minister did not give any indication in the Dáil that consideration was being given to the downgrading of the paediatric haematology unit at Tallaght or its transfer to Crumlin, or to changing the procedures in the context of initial investigation of the possibility of leukaemia. I understand that, only two weeks ago, the Minister wrote to Tallaght and Crumlin hospitals and that the discussions recommended in the letter of 12 November 1998 have yet to commence.

The Minister should explain his delay of over two months in communicating with the hospitals concerned. He should also explain to the House his reasons for refusing until today to meet the concerned parents or to issue a detailed public statement as to the Department's policy in this context. He should also clarify, as it is a matter of concern to parents, whether Crumlin, like Tallaght, is currently participating in international paediatric leukaemia trials which ensure the most recent advances in the treatment of leukaemia are available and immediately communicated to both hospitals.

The manner in which the Minister has dealt with this matter has caused unnecessary alarm to already stressed parents of children undergoing critical treatment in Tallaght Hospital, has upset parents of children undergoing similar treatment in Crumlin Hospital, and has distressed both medical and nursing staff in Tallaght and Crumlin hospitals who are, on a daily basis, providing excellent care for children suffering from leukaemia. It is time the Minister for Health and Children realised a patient-centred approach is required in the job to which he has been appointed. It is long since past the time for him to understand that people expect to be treated with decency and insight.

I understand that, subsequent to my seeking this Adjournment debate yesterday, the Minister finally agreed to meet the concerned parents. I am glad he has done so and I understand the meeting is to take place tomorrow morning. I do not believe these parents, already under pressure and strain and greatly concerned for the health of their children, should, in the circumstances in which they find themselves, have been compelled by the Minister's attitude to publicly campaign to meet with him. He should, for once, have put patients first and agreed to their request for a meeting without the necessity for the publicity they have been forced to seek and the campaign they have been forced to launch. I hope, when the Minister meets with the parents tomorrow, he will be able to ease their concerns, that the issue of the future of paediatric leukaemia care and diagnosis will be discussed in comprehensive detail and that final decisions will not be made without consultation with parents, between the hospitals and between the consultants involved.

I am pleased to have the opportunity to correct serious inaccuracies which have arisen in relation to this issue over the past few days. There is no question, nor was any proposal put to me, of transferring the haematology unit at Tallaght Hospital to Crumlin. Contrary to some completely inaccurate media reports, I have no intention of closing the unit at Tallaght. No proposal in this regard was ever made to me nor have I ever considered this step. It simply does not arise.

I wish to clarify the situation. The only change to current paediatric oncology and haematology services will be that, in future, children diagnosed with cancer will be referred for an initial assessment to Our Lady's Hospital for Sick Children, Crumlin. This does not mean that all cases will be treated in Crumlin or that the unit at Tallaght will no longer treat them. Instead, the initial assessment of newly diagnosed cases, including their diagnostic work-up and the planning of their treatment, will take place at Crumlin. Children will then continue to be treated, as now, either in Tallaght or at other centres which deal with such cases, these being Crumlin, Mercy Hospital, Cork, and University College Hospital, Galway.

The change in assessment policy is as a result of a recommendation by an expert body on cancer services, the National Cancer Forum. The forum, which was appointed by my predecessor, Deputy Noonan, advises me, as Minister, on, among other things, best practice in relation to cancer treatments. The sole focus of its recommendation is improved patient care. If Deputy Shatter is accusing me of not having a patient focus, he levels the same criticism against the National Cancer Forum because I have accepted its recommendations in full. Clearly there is no basis for that attack. The forum comprises some of the most eminent cancer specialists, including in the areas of oncology, haematology, cancer surgery, cancer nursing and a range of other specialties. Deputy Monica Barnes is an esteemed member of the forum. The forum is entirely separate from, and completely independent of, the Department of Health and Children. It has no axe to grind in relation to this or any other issue on which it has offered its expert advice.

I emphasise that, in examining this issue, the National Cancer Forum's major and paramount concern was to identify how best to provide a high quality service for children, from the time a child is initially diagnosed, right through to all appropriate forms of treatment. It took account of expert international evidence that because of the need for a minimum throughput of patients to ensure high quality, there should be only one specialist paediatric oncology unit per five million population. The forum also noted international evidence that a specialist paediatric cancer unit should have the appropriate infrastructure of services, personnel and equipment to provide the optimum level of service to children, and that the treatment of solid tumours, which is currently carried out in Crumlin, should not be separated from the treatment of children with leukaemia.

In these circumstances and with a vital emphasis on quality of care, the forum recommended to me that all paediatric oncology cases should be referred to the specialist paediatric oncology unit at Crumlin for initial diagnostic work-up and treatment planning. The forum indicated that this recommendation does not mean all cases would have to be treated in Crumlin. It indicated that subsequent treatment, including chemotherapy, could then be delivered in the child's most appropriate local hospital, on a clearly defined and agreed share-care basis, subject to proper supervision.

I accepted this decision and the Department notified the hospitals involved. In doing so, the Department stressed the need for close working relationships between all hospitals treating children with cancer. In recent months the three Dublin children's hospitals have agreed to put in place a mechanism for joint decision-making on major policy issues relating to the provision of acute hospital services for children. I have strongly welcomed this development. I see it as a means of facilitating the continuing provision of high quality services for children.

I have arranged to meet tomorrow the organisation CHILD, which was formally launched last Monday. I will be accompanied by the chairperson of the National Cancer Forum to deal with its queries.

There is no question of closing or transferring the paediatric haematology unit at Tallaght, nor was there ever any question of doing so. The Deputy had better ask those who promulgated that myth the basis of their proposals since they have no foundation in reality. I am committed to the continuing provision of high quality cancer treatment services for children. I am confident the new arrangements for assessing newly diagnosed cases will be to the benefit of children, who are at the centre of these services.

No distress should be imposed on parents or patients who have this problem. The Deputy had better check with those who made statements. I made a public statement and explained the basis of the decision. The criticisms that have emanated – certain things have been said at press conferences, obviously from a position of ignorance – which suggest that in some way I made a political decision, are without foundation. These are medical decisions based on expert medical evidence, provided by a forum appointed by my predecessor, Deputy Noonan, which is doing excellent work. His legacy from his tenure in the Department of Health is the national cancer strategy, an important initiative which results in better cancer services than in the past and which I support. I ask Opposition Deputies to inform themselves before trying to play the type of game played in the past few months.

The Minister should communicate with the people and not cause them distress.

Shame on the Deputy.