Dáil Éireann debate -
Thursday, 10 Jun 2010

Vol. 712 No. 1

Health (Miscellaneous Provisions) Bill 2010: Second Stage (Resumed)

Question again proposed: "That the Bill be now read a Second Time."

Deputy Bernard J. Durkan

As I said last evening, I disagree with the concept set out in the proposal for the selling off and transferring of the assets of St. Luke's Hospital to the HSE. I set out the grounds on which my disagreement rests. I should add that my confidence in the HSE to deliver the health services as set out in its original mission statement has sadly waned, as has the confidence of everyone else in this House. I have a theory which has been proven in other jurisdictions. There is a notion developing with regard to delivery of health services in this country that big is beautiful and that everything should be concentrated in a number of major centres. That concept has failed in other jurisdictions. It has been shown that where smaller, more compact units were upgraded and modernised, they delivered a higher degree and quality and a more readily available service to the public. They delivered it more conveniently to the needs of the general public which should be paramount in such cases. The health board's replacement, the HSE, has done little in improving the delivery of services. The current system is unworkable and unacceptable, representing a daily waste of money.

This will continue until such time some health Minister decides to dissolve the HSE and return to a more workable structure that is accountable to the House. A Minister must be made accountable to questions in the House on the expenditure and day-to-day, month-to-month and year-to-year delivery of health services across the country. No attempt must be made to centralise services in such a way as to make it more cosy for those providing them while at the expense of those for whom they were intended.

From the evidence we have seen so far, no attempt has been made to take account of patients' needs. Neither has there been an attempt to utilise modern medical technology to ensure higher quality services can be delivered to the remotest areas in the country. It actually appears that we have slipped down the technological ladder when compared to other jurisdictions. I am saddened that so many dedicated people who work in the health services and have made it a vocational commitment are frustrated by this.

This frustration also manifests itself in the replies to parliamentary questions we raise in the House. We ask the Minister for Health and Children simple questions that cannot and will not be answered. A Cheann Comhairle, I have noticed references creeping into all replies to parliamentary questions of a website where the information is available. They often run along the lines of, "The Deputy can avail of the information on the Department's website". A website is simply an advertisement in the media. I have never known before of a Member being referred to a newspaper advertisement in a reply to a parliamentary question. An attempt is being made to foist on Members the acceptance of an answer on a website for which the Minister is not accountable.

Anything one wants could be on a website. One could go to Senator Dan Boyle's Twitter page and get all the information one likes off it. Shortly, we will be getting answers to parliamentary questions which will state, "We refer the Deputy to Dan's Twitter". The Ceann Comhairle will have to go to Dan's Twitter himself to get information too the way this has gone.

It saddens me to see the way the whole process is breaking down. It is an absolute disgrace to Members on all sides of the House. What about the unfortunate Government backbenchers? What function they do have anymore?

Deputy Finian McGrath

They could Twitter the Minister of State, Deputy Moloney.

Deputy Bernard J. Durkan

What function do Members have if they cannot get straightforward answers to the questions they raise?

Refusals by a Minister to address issues raised in the House and the avoidance of ministerial responsibility will bite back later. If it is not dealt with in the first instance, it will be dealt with later when it becomes a scandal and there is an inquiry into it. Will Ministers recognise, to protect themselves and the country, that ministerial responsibility, particularly in the health services, must be taken?

I suspect I have not much time left as the Ceann Comhairle is looking at me with a kind of jaundiced look.

Deputy Finian McGrath

He wants to give me more speaking time.

Deputy Bernard J. Durkan

I am saddened by what is proposed in the Health (Miscellaneous Provisions) Bill. I do not believe anyone could have confidence in the HSE's ability to use and value the facilities and staff of St. Luke's Hospital or be able to continue the work done by the staff and its voluntary support group in the past. They certainly will not be able to do it to the same benefit of the wider community.

Deputy Mary O’Rourke

I welcome to the opportunity to speak on the Health (Miscellaneous Provisions) Bill which provides for the dissolution of the board of St. Luke's Hospital and the transfer of its staff to the HSE. As other Members have done, I wish to praise St. Luke's Hospital for what it has achieved for patients through the years. People diagnosed with cancer went to St. Luke's for treatment with a heavy heart. That was until they entered into the hospital which was a kind environment, if one can call a cancer treatment centre such. The staff were interested in patients' well-being and recovery. An air of welcome, courtesy and hospitality was evident in St. Luke's. Anyone who went there as a patient or visitor would know they were entering a house of well-being.

Now the hospital will enter into the centres of excellence treatment programme as laid out by the Minister for Health and Children, Deputy Harney, and Professors Tom Keane and Brendan Drumm. I hope these intangible qualities of welcome, courtesy and hospitality and the well-being evident to all who entered the portals of St. Luke's will be enabled in a real way after this transfer to the HSE. I hope the board and the staff will bring with them this aura which is necessary to a patient's well-being during cancer treatment.

Even in this day and age with all the advances in cancer treatment, when a person is diagnosed with it, it still causes immense dread. All these advances are set at nought for the patient, his or her immediate and wider family and circle of friends. It is amazing this primitive feeling of dread is still strong.

I also want to commend the work done by the Friends of St. Luke's Hospital. For many years I had dealings with the group, participating in some of its fundraising events. I know the energy and dedication of those who worked on behalf of the organisation. I salute them for raising up to €26 million over the years, which was put into hospital facilities, research and ongoing treatment including radiation and oncology. They are a great bunch of people and I understand from the Minister's speech and from speaking to some other Members that they intend to continue this fine activity which they have undertaken and to which they wish to continue. They are imbued too. Earlier, I referred to the staff and the aura within St. Luke's but each of the Friends of St. Luke's are imbued with those same qualities. "The quality of mercy is not strain'd, it droppeth as the gentle rain from Heaven upon the place beneath". This sentiment is the way they treated their job or vocation.

We are discussing the transference of all of this to the HSE but I hope those fine qualities are not smothered by the HSE and that during this transference those qualities are not lost, smothered or sent off on another route, which can happen in large organisations. Deputy Durkan was right when he maintains that small is beautiful. I am a firm advocate of the centres of excellence for cancer care. When she embarked on the road of setting up centres of excellence, the Minister embarked on a very tortuous Via Dolorosa along which many people attempted to throw stones at the idea and objective.

There is no doubt that if one wishes to have excellence in cancer care the experience gained by many prognoses and treatments stands to the test when a person presents for treatment. If the doctor, clinician and all such people in charge do not have a vast array of experiences within their grasp, which they can use for the curative good of the patient who presents himself or herself, then the care will not be as thorough or far-seeing as it would be within a centre of excellence of cancer care.

I refer to what should take place now. The idea of centres of excellence should be extended to other areas of ill-health in our population. I speak particularly of the Alzheimer agenda. The work of the Minister of State, Deputy Moloney, touches upon this as well. There is a case to be made now for the road of the Alzheimer agenda to be travelled and to have centres where the finest research can be undertaken. It is evident that where centres of excellence exist, research can be channelled and, if it is not already undertaken in these centres, it can be channelled to work for the good of the body of patients who go there.

There is no doubt that in the modern world Alzheimer's is a complaint widespread and terrifying in its implications. In a way it is as terrifying, not so much for the patients, but for those who mind them, as cancer was in its horrific impact on people. I commend Deputy Michael Noonan who, on "The Frontline" programme, spoke so feelingly and from the heart of the journey he travelled with his dear wife towards Alzheimer's and towards the oblivion towards which people who suffer from Alzheimer's travel. He spoke so feelingly that he unlocked a well of feeling and support towards that complaint and towards anything that could be done to address it.

I am keen to see progress made with cancer care such as that spearheaded by Professor Tom Keane and the Minister, Deputy Mary Harney and well done to them. It was a very difficult task. Naturally, the places where cancer care had been well given and received would wish to hold on to that, a natural wish and feeling. However, from the outset I was in favour of the centres of excellence because I took the view that if I were ill I would rather go where I could be assured of top quality exploration and curative care and I could be there for the receipt of ongoing research.

In that vein, we should take the same path for the Alzheimer's agenda. It is pervasive and I do not know what we used to call it long ago. I am aware of the man who gave his name to the condition, which is well documented but the prevalence of it now is amazing. There is strong ongoing research into the Alzheimer debate and it has yielded some very positive results. One cannot lift up a newspaper at the weekend but to find a snippet about new research into Alzheimer's and how it could, hopefully, have an effect in time on the work of those who work for and with people with the complaint and as they travel onwards in life.

I commend Deputy Michael Noonan who opened his heart to us all in that television interview. He gave a personal and acute insight into what it has meant to him and to many other people throughout the country who have faced that terrible dilemma. I trust the Minister of State will take from my remarks that the time has come for an agenda for Alzheimer's. If that could be married to the work of the Minister of State, so much the better because much of his work is relevant in this regard. I commend the Minister of State on his work as well.

It would be wrong of me to finish my contribution by not restating my admiration for the years of work carried out by the staff in St. Luke's, including the work of the medical and nursing staff, the ancillary staff and the Friends of St. Luke's, who have set up so many benefits for those who went to that hospital. One such benefit was the facility whereby one could go and stay in a nice guest house on the grounds. Relatives could be near their loved ones who were entering on an unknown journey and who would surely benefit from the warmth and love of their dear ones as they embarked on it. There can be no higher accolade than that the Friends of St. Luke's have stated that they will continue their good work for patients on the road ahead, no matter what else happens.

The Minister, Deputy Harney, referred to other aspects of the debate, including matters relating to the Department of Social Protection and the culmination of the infectious disease special payments. I refer to one other matter. I understand from what the Minister has stated in the debate that there is to be a specialised centre for the treatment of pancreatic cancer in St. Vincent's Hospital. I was very pleased to read of that development. Such a centre is much needed. I commend the Department of Health and Children, Professor Keane, the Minister and all who work within the Department and the HSE on the dedication that has given rise to the setting up of all of these centres of excellence. Make no mistake about it, that project — the centres of excellence — would not have succeeded if somebody very determined and with a strong political will and engagement had not been at the helm, but succeed it did. I wish all those who work in St. Luke's well but my abiding wish is that the fine work carried out there is not smothered by the entrails of the vast bureaucracy which is the HSE.

Deputy Michael Creed

I wish to share time with Deputy Shatter.

The primary purpose of the Bill is to provide for the dissolution of the board of St. Luke's Hospital and the transfer of its staff, properties, functions and liabilities to the Health Service Executive. I listened with interest to numerous speakers who are more familiar with the operation of St. Luke's Hospital than I am and who highly praised the staff and the service they deliver.

My contribution primarily concerns the miscellaneous amendments in the legislation but I would like to comment on St. Luke's Hospital and perhaps go from the particular to the general. There is an increasing trend of the HSE taking small State-funded hospitals under its remit and I am not altogether sure that is welcome. I have no doubt that in years to come we will reverse this process and recognise that small does not necessarily mean inefficient. I accept the need for centres of excellence and I am not opposed in principle to the reconfiguration of the health service, but the HSE is a monolith and is unaccountable and this just adds more fuel to that fire which I am not sure best serves the public.

The primary purpose of my contribution concerns the miscellaneous amendments in the legislation, nursing homes and the new fair deal scheme which, broadly speaking, has been widely welcomed by all parties in the House. There was much uncertainty for families with ageing relatives in need of full-time care, how affordable it would be for them and what would happen when their financial resources ran out. This scheme has brought some certainty in regard to their entitlement to support from the State, which I welcome.

As I was coming into the House, I saw the retiring chief executive of the Health Service Executive, Professor Drumm, presumably heading into the dungeons of Leinster House to a meeting of the Oireachtas Joint Committee on Health and Children. I wish him well in his retirement and I welcome the new chief executive designate, Mr. McGee, who I understand has a history in the health service in the north west where he was involved in the provision of community facilities which, I believe, will be the next battle ground.

Reconfiguration has happened in respect of centres of excellence for cancer services. It has happened in the mid-west in Ennis and Nenagh and in the north east. It is now happening in the south and there are question marks over the future of Bantry and Mallow General Hospitals. What is relevant to this Health (Miscellaneous Provisions) Bill and the nursing homes legislation is that the reconfiguration process is moving into the delivery of community-based nursing home facilities. I wish to put down a marker here for the HSE that it should make haste slowly.

Community-based medical services can thwart the onward march to acute hospital facilities if properly structured and delivered. A key component of that is community nursing facilities — the district hospitals. In my constituency, there is Kanturk, Millstreet and Macroom District Hospitals and on the fringes of my constituency, there is Dunmanway District Hospital. I see a threat hanging over those district hospitals. When concluding the debate, I would like the Minister to reassure me about their future.

It is important we have a public-private mix. The fair deal scheme does not differentiate and people now have a choice. It is not right that we phase out these community hospitals by stealth and I would like an assurance that will not happen. What is happening is that the Health Information and Quality Authority is carrying out inspections in these district hospitals and there is a real danger that a combination of HIQA and patient choice about whether to choose a private nursing home or a HSE run facility could mean district hospitals will be starved of funding to meet the HIQA standards and that, ultimately, the HSE will say it does not have the capital budget to spend to meet the HIQA standards and that patients have a choice and can go to the private nursing home facility. Maintaining a public-private mix in terms of provision for elderly people is critical.

The new fair deal scheme is very much in its infancy. I support the idea of patients having choice but there is some evidence that patients initially opted for private facilities in large numbers but are now opting for community-based nursing facilities. It is vitally important that the Minister assures us that the combination of HIQA inspections and the fair deal scheme is not the pretext under which the HSE will say it does not need community facilities. I acknowledge the tremendous service those community hospitals have delivered on a shoestring for large numbers of patients over many years.

There is another matter about which I am concerned in regard to the HSE's tactics on this issue. Almost all the patients in those community nursing facilities are high dependency and, therefore, the rate per patient could prove higher than the rate in a private nursing home. Will the private nursing homes cherry-pick and say the high dependency patients can go to the district hospital and that they will take the low dependency patients where the care requirements are not as complex and where they can meet their profit demands which the community-based facility does not have? I would like an assurance that agenda is not afoot in the HSE and that the community hospitals will continue to play a role.

Deputy O'Rourke mentioned Alzheimer's care. There is a great and growing need for facilities to care for patients with Alzheimer's. There is also a great need for respite care places. The reconfiguration process has been undertaken in acute hospital services in HSE south and is beginning to happen in respect of these community hospitals. That process must be open and transparent and I would like communities to be involved in it. I do not want closure by stealth, which I fear.

The Minister cannot hide behind the HSE in this regard. She must clearly state that she supports the principle of retaining a public-private mix in terms of choice for patients in terms of long-term care. I would like to be reassured that the great and growing need in regard to respite care places and care for patients with Alzheimer's is met whether through the community hospitals or otherwise. That can be dealt with in the context of reconfiguration. However, due to a combination of factors, including the fair deal provision, patient choice, HIQA inspections and the cost of care having regard to the high-dependency nature of the patient in community hospitals, I do not want the HSE to arrive at a juncture and decide that such provision could be done better in the private sector. The straws are in the wind in that regard.

The HSE has recently built a new community nursing facility, paid for by public funds, in Ballincollig in my constituency. It is very welcome but no sooner was the building completed than the HSE decided to put it out to public tender. It will now be given to the private sector to operate. I am not opposed to that — there is a role for the public sector and the private sector in such provision. If that is a signal of where the HSE is going in respect of its own facilities, it raises the most serious questions in respect of the future of the aforementioned community hospitals in Kanturk, Millstreet, Macroom and Dunmanway. There are 21 public long-stay HSE operated facilities in the south west in which local communities have significantly invested. I want to be reassured by the Minister of State, when she replies to this debate, that the HSE, at her direction, will not be allowed to wind down its involvement in community nursing facilities for the elderly.

Deputy Alan Shatter

I am greatly obliged to the Ceann Comhairle for this opportunity to contribute and I thank my colleague, Deputy Creed, for sharing his time with me.

I was anxious to briefly speak on this legislation because of the many people in my constituency of Dublin South, across south Dublin and from outside Dublin who have used the facilities in St. Luke's, who admire the medical care available there, who regard it as a centre of excellence in the area of radiotherapy, who greatly fear for the future in the context of the Government's intention to transfer the facilities and services provided by it to St. James's Hospital and who have fears, in the context of the future management of that hospital, not only about how matters will develop but also about its accessibility and the nature of relationships with patients. St. Luke's has truly been a centre of excellence in providing for many thousands of people going through the trauma of cancer care and oncological treatment. It has an ethos, to which many other speakers have made reference, whereby the patient is absolutely put first. Unlike the HSE dealing with people as if they are anonymous nuisances whose situations have to be addressed and who frequently seem to lose to sight of the humanity of the individuals and their health concerns, St. Luke's deals with people on a one to one basis. There is an ethos about the hospital and a support system within it not only for cancer patients but for their families. Accommodation arrangements are made of a nature that certainly are not currently available in St. James's Hospital and there is no indication that they will be available when the services are moved from St. Luke's. It is only right that we in this House reflect the concerns that are inherent in the Government's proposal. I am saying this from the position of someone who supports the concept of centres of excellence and believes that we must provide the best possible medical care of a specialist nature to patients not simply with regard to the area of cancer but also in other areas. However, in this context, we are talking about cancer patients.

In the context of St. Luke's in Rathgar, a major criticism is that surgery is not provided for there and that it cannot deliver the multidisciplinary care that many believe is necessary to ensure the best possible care for cancer patients. This is seen very much to be the Achilles' heel of St. Luke's. While the centralisation of technology and expertise is important when it comes to diagnosis and surgery, radiotherapy can be delivered in a community setting. In many countries that is the arrangement. St. Luke's is a centre of excellence in that regard. I have grave doubts about the wisdom of Government policy. I see no reason there cannot be a linkage between the preservation of St. Luke's and the expansion of services in St. James's to incorporate both of them into the one centre of excellence. This is something to which serious consideration should be given.

I have grave doubts about the Government's timeframe for its proposal. When it was first proposed that St. Luke's essentially be closed down and its services transferred to St. James's, I recall the date of 2011 was given for the move. The target date of 2011 then became 2012, and that target date has now become 2015. I am not clear at this stage what is the credible timeframe for the move and the financing of it. This is creating a level of uncertainty that is undesirable. However, what I am particularly concerned about, and I want to emphasise this point, is that St. Luke's — which currently has an independent board — a well-managed hospital albeit one that on occasion has a waiting list, is to be replaced by management provided by the HSE. I regularly talk in this House about the complete incapacity of the HSE to manage our child care services. Professor Drumm in the Irish Examiner this morning almost bewailed the fact, that, as chief executive of the HSE, he has had to deal with child care services. If I could say this within this Chamber, he has managed the child care services with unprecedented incompetence as a chief executive during his term of office and we are seeing the consequence of that in all of the revelations of the past 18 months. However, equally, despite all of the good work done by Professor Keane, and I acknowledge he has done good work, we have seen the extent to which there are endemic problems within the medical service managed by the HSE, namely, the failure to ensure proper patient care, to treat individuals, to acknowledge the stress individuals suffering serious ill health are under and to provide a response to them of a humane and rapid nature when required. I have huge reservations about the HSE taking over the management of St. Luke’s, be it St. Luke’s as it is currently positioned within Rathgar or the new St. Luke’s to be in St. James’s.

In terms of the level of patient care at a human level — I am not being critical of nurses or doctors in St. Luke's — in the context of the administration of the hospital in Rathgar, the manner in which the hospital interacts with patients and their families, the types of services it provides for them that go outside the medical area in providing the supports necessary to ensure that people avail of the medical care and that their family members understand the nature of the illness being suffered and the impact of treatment, I am concerned that when the HSE replaces the current board, there will be a deterioration in that area. The facilities in St. Luke's which has beautiful grounds — a tranquil setting where there is an opportunity for those undergoing treatment and their visiting families, particularly when the weather is good, to go for walks in the grounds — will not be available in the grounds of St. James's, which may be a hospital of excellence but is essentially turning into a huge hospital factory covering a broad range of areas. The types of facilities available to patients undergoing treatment in St. Luke's will not be available to such patients in St. James's. I do not understand why we cannot ensure that St. Luke's remains open as part of a centre of excellence interlinking with St. James's Hospital. That is something I would like to see happen and to be reconsidered. In the context of current economic catastrophe confronting this State and the financial dilemmas of where we will find money to spend on projects, previously deemed desirable, I suspect that, as a matter of practical economics, what is now being proposed may have to be reviewed. However, as a matter of ensuring medical excellence, there is no reason there cannot be the type of linkage between the two to which I have made reference.

It is important that if one is a cancer patient and requires radiological treatment that is available as rapidly as recommended by the consultant whose care one is under but there remains a problem in so far as there are those on radiation oncologists waiting lists in circumstances which are not acceptable. Such waiting lists are simply not acceptable in any civilised state not only because of the worry and anxiety it causes to patients, but because of the life and death implications of radiation treatment that is required being unnecessarily delayed. At the moment when that occurs and there are waiting lists, there are arrangements in place and, in recent times, a number of patients on waiting lists in St. Luke's Hospital have been referred on and been provided with the treatment they require.

My concern is that when this administration is taken over by the HSE these individuals whose care is catered for will simply become more HSE statistics on a list that someone in HSE central views as one among hundreds of people on waiting lists for a variety of reasons across the country. We must ensure that does not happen and that the best treatment possible in the quickest time it can be provided be made available to cancer patients who require the type of treatment that to date has been so excellently provided in St. Luke's Hospital, Rathgar.

Deputy Aengus Ó Snodaigh

Tá sé thar am go mbeimid ag déanamh plé ceart ar cheist ríthábhachtach na hailse, sa chás seo i gcomhthéacs Ospidéal St. Luke's, atá lonnaithe i Ráth Garbh sa chathair seo. Thar na blianta, d'aithnigh éinne a d'fhreastal ar othar a bhí san ospidéal le haghaidh obráide, nó aon ghnáthamh eile bainteach leis an ailse, gur áit speisialta a bhí ann. Tá na céadta míle othair imithe tríd St. Luke's ón lá ar oscalaíodh é, breis is 56 bliain ó shin. Tháinig a lán dóibh amach ar an taobh eile ina lán-bheatha, ach níor éirigh le go leor dóibh teacht tríd an chóir leighis a cuireadh orthu san ospidéal.

Tá na haltraí, na dochtúirí agus an fhoireann iomlán i St. Luke's speisialta freisin. Déanann siad i bhfad níos mó ná gur chóir dóibh, i mbealach amháin, agus iad ag déileáil leis na hothair. Tá siad sásta gach rud gur féidir leo a dhéanamh chun cuidiú leis na hothair atá faoina gcúram. Is áit speisialta í St. Luke's freisin mar gheall ar an suíomh deas ciúin atá aici. Nuair atá daoine buartha faoin ailse atá tar éis iad a bhualadh, tá sé tábhachtach go mbíonn an ciúnas sin acu i suíomh atá leagtha amach chun a thuairimí a tharraingt chucu féin. Bíonn buairt ar dhaoine a bhíonn an "C mór" acu agus ar a muintir.

Is trua go bhfaigheann i bhfad Éireann an iomarca daoine bás de thairbhe ailse sa tír seo. Dá bhrí sin, aontaím leis an Rialtas go bhfuil gá ann radiation oncology a chur ar fáil lasmuigh de Bhaile Átha Cliath. Ní dhéanfaidh mé aon troid i leith an chinnidh sin. Dar ndóigh, tiocfaidh mé ar ais chuig na fadhbanna móra leis an bplean. Sa deireadh thiar thall, ní chóir go mbeadh gach rud lonnaithe i St. Luke's nó in aon ospidéal eile. Is fíor sin ó thaobh radiation oncology, paediatrics agus gach gné eile de chóras leighis na tíre seo.

Labhair mé faoi St. Luke's agus an suíomh atá ann. I gcomparáid le hospidéil eile, tá an ciúnas sin ann. Níl sé chomh ghnóthach sin go bhfuil gach rud ag tarlú ar luas ró-thapaidh. Measaim go bhfuil cinneadh mícheart déanta ag an Rialtas sa chás seo. Ní chóir dúinn glacadh leis an Bhille seo, os rud é gur céim siar atá i gceist.

I have a problem with parts of the national plan for radiation oncology not because of the four centres and two satellite centres that have been identified, but because none of them is north of a line between Dublin and Galway and that still has not been properly addressed. There are ways to address it and they should have been announced before we dealt with this legislation. An all-Ireland approach to health services would also have helped to address this with greater co-operation between the HSE and the health services in the Six Counties. That would help to address some of the problems in counties Mayo, Sligo and Donegal and north Leitrim, which will not be properly served by the plan as it stands.

I cannot understand the logic of decisions the Government and the HSE have taken in recent years to close hospitals which are known the length and breadth of the island for the services and treatment they have provided and in which the State has invested significant sums in the recent past to upgrade facilities. For example, there was quite a financial investment in St. Luke's Hospital in recent years to upgrade it and make it, as was announced by Ministers at the time, a world class treatment centre that would stand out above others. That was true in 1996 when major investments were allocated to upgrade the hospital and in 1997 when St. Anne's Hospital was closed and its services were transferred to the St. Luke's site. It was also true as recently as 2008 when two new and two replacement linear accelerators were installed, increasing the hospital's radiotherapy treatment capacity. The investments have been made and while I am not critical of them, I am critical of the fact that they will be undone at a time we can ill afford it.

St. Luke's Hospital is located in Rathgar, Dublin. It is renowned among patients and their families for the beauty of its grounds and I do not see the logic of concentrating all its services in centres of excellence. Why not make this hospital a centre of excellence, as was proposed in the past? In 1996 when the Government invested in it St. Luke's was to be made a centre of excellence. Obviously there is a requirement for additional moneys to be invested in St. Luke's. There is a requirement for additional moneys to be invested in the satellite centres and in order for treatment to be made available in the community, and I have no complaint about that.

However, there is no logic in abandoning a hospital in which so much public money has been invested to date, and leaving it without a proper future. I am not aware of what the future plans are for St. Luke's.

This type of half thought out planning has also been the approach taken by the HSE to paediatric care in Ireland. Our Lady's Children's Hospital, Crumlin is in my constituency. There is another paediatric hospital in Tallaght, formerly Harcourt Street Hospital, and in Temple Street there is another. There is an enormous need for investment in paediatrics in Ireland and I am not disputing the logic that there should be one centre of excellence. Nor am I disputing the fact that there should be a centre of excellence for oncology services. I am, however, disputing the need for new build in all cases so that everything is moved into a centralised location, especially in paediatrics, without any plan as to what is to happen to the existing hospitals.

In my view, the only logical thing that can happen, given the current approach of the Minister for Health and Children and the Government as a whole to health services, is that those centres will be sold to private concerns. That question has not been answered here in terms of the site of Crumlin children's hospital. What is the future of that site? Only last month the hospital applied for planning permission to upgrade its ICU unit, despite the fact that it is going to be closed in four years time. There is absolutely no logic in continuously investing public money in upgrading facilities that will be closed within a few years. The same goes for St. Luke's. There is no logic in upgrading the facilities there if it is intended to close the hospital in a year or two.

I believe these hospitals should be upgraded and should not be closed. That is a question for the Minister of State to answer as regards the future plans for the site of St. Luke's once the national plan has been fully rolled out and the hospital transferred to St. James's or Beaumont by 2014.

We have a major problem in Ireland with cancer. The figures I was provided with show that there are some 23,000 patients annually, and this is expected to increase. As legislators we have to ensure that appropriate education is made available so that people can detect cancers early and avail of treatment locally. Of the 23,000 detected some 12,000 or 13,000 will require treatment annually. For all concerned, there is a logic to the fact that the treatment required should be made available at the nearest possible point to a centre of excellence. From a patient's viewpoint whatever services can be provided should be available as locally as possible. Everyone accepts that not all treatment can be provided on one's doorstep, and that there is a need for centres of excellence. However, the health services in Ireland have become more and more centralised over the years. Every small hospital around the country seems to be targeted for closure by the HSE, supposedly on efficiency grounds. However, I can guarantee that when a cost analysis is done in a year or two, it will show that the efficiencies which were meant to be achieved will be found wanting because people will be presenting at centres of excellence with problems that could have been addressed at an earlier stage, if the services were more locally available — or if they did not have to travel up and down to Dublin by taxi from as far afield as Donegal, for example.

I am opposed to this Bill, and I am asking that, even at this late stage, the Government thinks again about this and takes into account the financial constraints the country is under. I believe part of its policy objectives can be achieved by investing in St. Luke's. It would be cheaper to upgrade St. Luke's than to roll out all of the current plans.

I have visited a number of friends in the recent past who, sadly, have died, and who had undergone various radiation treatments. They were very proud of the work done in St. Luke's and praised its staff and the treatment they received. One of those treated at St. Luke's had previously been treated in St. James's for another ailment. He said that the difference in terms of his whole attitude to the problems he was facing, from being in a major general hospital to being treated in a dedicated small hospital, was immense, and it gave him some relief. Regrettably, he is not with us today.

Another friend who died recently, too, also was full of praise for the staff at St. Luke's. Now that staff is to be transferred by the HSE to wherever it decides. Hopefully, most of that staff will be able to stay together, because they have built up a good working relationship, regardless of whether they are transferred to St. James's, Beaumont or one of the four satellite centres so that the care and treatment they mete out to patients over and above their normal responsibilities will continue. I know this will be difficult, because I am aware of the problems experienced by staff from smaller hospitals when Tallaght General Hospital was set up. To this day there is a tendency among staff to identify colleagues as belonging to the Adelaide, Harcourt Street or the Meath. Sometimes it is difficulty for people to gel. That difficulty would be removed, however, if St. Luke's in its present form was maintained and expanded, while increasing and enhancing the services, as required.

I will not continue for much longer, apart from saying that every decision taken by the HSE of late seems to have been ill-conceived, and I cannot see how this one is any different. The HSE is running on a political platform to the effect that privatisation is good and should be facilitated. The Government has fully endorsed that platform and I believe it will be further endorsed in this case, because the plans probably will be carried out under a PPP. While I may be incorrect in this regard, I cannot envisage the Government changing its mind on its current approach to building an investment in the public health services, which is that it must have private investment. Public moneys should be spent on public hospitals and private moneys should be spent on private hospitals, if the latter are allowed at all. I am one of those who believe that Ireland should have a single tiered health service provided from the public purse and paid for by the public. It would be paid for by those who can properly afford it. This is the argument in respect of the need to change the taxation system. The taxes that are raised should be targeted specifically at public services such as hospitals and so on and public moneys should not be diverted from public services, as is the case at present under the National Treatment Purchase Fund.

I recently learned that €5 million, which would have kept open the St. Joseph's ward in Crumlin hospital, was diverted from public paediatric services to pay for private paediatric services. It is a living disgrace that a hospital cannot keep open its wards and operating theatre because the money is being diverted to private hospitals. Moreover, I believe the same is happening in respect of radiation oncology and that this is the plan for the grounds and buildings of St. Luke's Hospital once they have been transferred, if this Bill is passed, to St. James's and Beaumont hospitals.

I urge the Minister of State, even at this late stage, to reject this Bill and to go back to the drawing board. It is not a big drawing board and I believe this can be achieved on-site at St. Luke's Hospital.

Deputy James Bannon

Great sadness is attached to the legislation before Members today, which effectively sounds the death knell of St Luke's Hospital. It also is a Bill that gives more power to the HSE, which by any standards is a mixed blessing. I fully agree with the remarks made yesterday by the Minister of State, Deputy Barry Andrews, that not even the greatest fan of the HSE would fail to recognise that defects exist which must be addressed with regard to the management of and a uniform delivery of services within the HSE. All Members are aware of this on foot of their representation of people from their constituencies nationwide. I am particularly aware of this point from the perspective of my constituency of Longford-Westmeath, in which services have been destroyed by the present Government over the years. The most extraordinary thing is that this could be recognised by a Minister, as the lack of uniformity comes from the ill-conceived policies of the HSE, which is unfit for purpose.

The old saying, "Do not fix it unless it is broken" really applies in respect of the closure of St. Luke's Hospital. The destruction of a rare good within the health system, which definitely could not be described as being broken, begs the question as to the reason. Perhaps the Minister of State, Deputy Áine Brady, might explain this fully later. I acknowledge that Ministers of State who serve in various areas under the Minister for Health and Children, Deputy Harney, have different views on this issue. The Minister of State who is present in the Chamber might outline her concerns regarding the closure of this fine facility. Of course, the moment the word is out of one's mouth, the answer shoots up to hit one between the eyes. The patients of St. Luke's Hospital, who have received excellent care for the past 66 years, are being asked to pay for Government mismanagement. Unfortunately, the price is their ill health.

St. Luke's Hospital is situated on a prime site in Rathgar and therefore is a highly saleable asset and it is obvious that the Minister intends to sell it. The proceeds will be lost, as were the proceeds of the sale of St. Loman's Hospital, Mullingar, in the general chaos of the HSE. However, the like of St. Luke's will never be seen again and for what? No one can convince me that, excellent though St. James's Hospital is, it can replicate the personal and homely environment perfected in the smaller and more intimate settings of St. Luke's. I echo the welcome of my colleague, Deputy Reilly, for the Minister's decision to not move the radiotherapy services at St. Luke's until 2014 at the earliest. However, no matter how one considers this or what argument the Government puts forward, the closure of St. Luke's constitutes a failure on the part of the Government. It is a failure to provide for the people it represents and a failure to look after the health of the nation.

Country-wide, the first blow to cancer care was the withdrawal of local cancer services and the centralising of such, in so-called centres of excellence in Dublin. One was told that this would lead to an improvement in services and care. The reality has not been quite as promised and the closure of what probably is the most highly regarded cancer hospital in the country can in no way be considered a positive move. A major review of the eight designated centres of excellence for breast cancer care in February last demonstrated that the centres still do not have all proper measures in place to avoid missed or delayed diagnosis. The report found that despite scandals associated with breast cancer, there was as yet no national definition of delayed diagnosis or a consistency of approach across the centres for auditing such clinical incidents. The report also highlighted the fact that there still is no sharing of treatment outcome data between the eight centres to maximise patient safety.

From my own perspective, the closure of local services has caused untold hardship for the people of my constituency of Longford-Westmeath and the midlands as a whole. Previously, poor quality rural transport and a lack of designated transport services made the accessing of services in Tullamore hospital difficult but travelling to Dublin is a nightmare for the ill and terminally-ill patients who need ease of access to services. The main difficulty for those travelling from rural areas to Dublin is that city traffic makes the final leg of their journey almost as long as the time it takes to reach Dublin. It is frustrating and extremely upsetting for seriously-ill people to be obliged to sit for long periods in cars that essentially are going nowhere. Travel is one of the worst aspects of centralisation. Local services in local areas should be a right for everyone.

I met relatives of an elderly patient from south County Longford who left her home at 6 a.m. to travel to Longford to be picked up by an ambulance, which then made several stops throughout the midlands before continuing on to Dublin. The ambulance was obliged to visit several hospitals in the Dublin area that were caring for patients from the midlands. Eventually, she was brought in to the relevant hospital for treatment at 4 p.m. Having been obliged to spend some time in the waiting room, she received her treatment and started out for home at 7 p.m. She again encountered the hassle of visiting other hospitals to pick up patients and did not arrive back in her home until 11:45 p.m. that night. It is shameful and disgraceful that in this day and age, an elderly terminally-ill person would be obliged to endure such hardship. That is not good enough. It is necessary to examine how we treat people. Such situations should not be allowed to happen under the Minister's watch. What is happening in this country would not happen in the Third World.

My local area in Longford-Westmeath has been stripped of medical services, which has affected every man, woman and child in the constituency. Some health and health-related services have already been cut in Longford-Westmeath. I refer, for example, to the closure of Longford County Hospital in 1986. I refer also to the ongoing failure to complete phase 2B of the Midland Regional Hospital, Mullingar despite the fact that €57 million was ring-fenced for the project when I served on the Midland Health Board prior to 2002. Senators Camillus Glynn and Donie Cassidy both gave such a guarantee. We were told the funding to put the services in place by the end of 2005 would remain untouched but nothing has happened in that regard.

I understand that when the Taoiseach was Minister for Health and Children he intervened and had a cost-benefit analysis carried out. He put several obstacles in the way of the completion of phase 2B at Mullingar hospital. As I have said time and again, it is dangerous to have a Taoiseach in a neighbouring constituency because the constituencies bordering a Taoiseach's constituency will lose out on services. The current Taoiseach has been most political in the manner in which he directed the relocation of many services that were better placed in the Midland Regional Hospital in Mullingar to Tullamore hospital, to the detriment of the people of Longford-Westmeath. Political interference was also evident in the national spatial strategy when the Taoiseach designated three large towns in the midlands with city status when common sense would have dictated that Athlone would have received gateway status while the other towns were designated as hubs.

The ENT clinic in Longford was closed. In July 2006 there was a reduction in the number of agency nurses at the Midland Regional Hospital, Mullingar. In January 2007 the bus service to Mullingar and Tullamore came to an end although the service had been guaranteed when Longford hospital was closed. In November 2007 the breast cancer unit at the Midland Regional Hospital, Mullingar was closed. Also in November 2007 the geriatric ward in St. Joseph's Hospital, Longford was closed. Last year the consultant dermatologist in Mullingar retired and people were hoodwinked by bogus appointments for a number of months until I highlighted the issue in Dáil Éireann. I understand that the permanent position has not yet been filled. I urge the Minister to make a statement on the matter.

Dental services were cut back in Longford-Westmeath. The year 2009 also saw a threat of closure hanging over St. Loman's Hospital in Mullingar. Loughloe House was closed in 2010, which has resulted in the death of three patients. There has been a 50% reduction in beds at St. Joseph's care centre in Longford. The HSE is introducing the closures in a mean, sneaky way. According as patients move on or become deceased, beds are removed from wards. Wards are being reduced in size from eight beds to four beds and six bed wards are being reduced to three bed wards. That is a mean, sneaky way of closing down and reducing services in Longford.

That brings me to current developments in the health sector in Longford-Westmeath. On the principle that there is no smoke without fire, people are extremely concerned about talk of downgrading the Midland Regional Hospital, Mullingar. We protested in 2005 at the closure of the breast cancer unit and we are protesting again on Saturday against the perceived threat to the hospital. I assure the Minister that up to 10,000 people will be on the streets of Mullingar this Saturday to protest. We want a 24-hour accident and emergency service in the Midland Regional Hospital, Mullingar. We will accept nothing less because the people of Longford-Westmeath deserve nothing less. We also seek the completion of phase 2B of the hospital and no downgrading of services, which are essential to the well-being of local people and people in the midlands.

The Minister is blaming the current reduction in accident and emergency hours throughout the country on the organisation of working time directive but I am deeply concerned that this is a precursor of the closure of accident and emergency services at the Midland Regional Hospital, Mullingar. I have been assured by the Minister when I raised the issue on the Adjournment that this is not the case but I am not reassured given past experience of what the Minister said and what she did. She will never convince me or reassure me on the issue. I do not like the cloak and dagger manner in which the HSE operates under the watch of the Minister. Any reduction in accident and emergency hours or any attempt to move the service to Tullamore will leave the people of Longford-Westmeath without life saving medical options. However, the Minister is fooling no one and is failing to cloak the closure of accident and emergency services in the guise of a reduction in hours.

The spectre of the closure or downgrading of services at the Midland Regional Hospital, Mullingar has hung over the midlands for some time. In an effort to avert that and secure the future of the hospital, it is necessary to designate it as a centre of excellence, with one speciality as its hallmark. I demand the Minister to make a statement to that effect immediately as the uncertainty is demoralising to medical staff and other staff who are conscious of services being removed from the hospital.

As a hospital that has consistently featured among the top three medical facilities in the country, the Midland Regional Hospital, Mullingar must be kept open. Despite the removal of the breast cancer unit and despite the Government's failure to complete phase 2B of the hospital, the hospital in Mullingar is a dynamic centre, which provides medical excellence to the people of Longford-Westmeath. The closure of St Luke's Hospital, which has been described as a haven in Rathgar for people from all over the country, and the potential downgrading of the Midland Regional Hospital, Mullingar, are proof of the HSE's wilful destruction of all that is good in our health system. It seems that the best performing hospitals are being axed by the Government.

When Longford lost its hospital in 1986, promises were made that all services would be available in Mullingar. That has not proved to be the case, as one by one, departments are being closed and specialist services removed. We have seen the scandal of patients being refused scans and X-rays at the Midland Regional Hospital, Mullingar, despite referrals by GPs. These doctors are then forced to send their patients to Dublin for private treatment.

This very serious matter was dismissed when I raised it in this House and there were sniggering comments from the Government benches, which is the common response by Fianna Fáil and the Green Party when caught with regard to another health-threatening cutback. I would appreciate it if the Taoiseach, who cannot take control of the country, took control over his party.

If patient safety is being compromised in this manner in Longford-Westmeath, it is more than likely that the practice is common to all parts of the country. It is disgraceful that doctors are being forced to refer their patients to private Dublin hospitals to have life-saving scans or X-rays. This is putting a gun to the heads of vulnerable people, who are once again being forced to put their hands in their pockets to access necessary procedures.

That the Government should apparently put in place measures to ensure that patients must either go without investigative actions or pay privately for scans or X-rays in Dublin hospitals is a disgrace. If this is a deliberately orchestrated response to GP referrals, then the Minister for Health is responsible for serious misconduct and should consider her position.

Over the past few months, we have seen patients at the Midlands Regional Hospital being given phantom appointments for a consultant that was no longer in employment. Now we see patients being refused scans and X-rays to which they are entitled. Cancer and mortuary services have been removed from the hospital. Longford-Westmeath relies on this hospital. It must be run in an open and fully transparent way.

I am pleased to see the Minister has finally agreed to introduce legislation on sunbeds, particularly on their use by individuals under 18. I have raised the publication of the public health (sunbeds) Bill many times on the Order of Business in the Dáil. I am disgusted that it has been on the legislative programme since autumn 2008, perhaps earlier. It is heartening to see that the Minister is at last taking seriously the matter of the danger to those under 18 years of age. The seeking of recommendations from a range of bodies, including the WHO, will lead to greater protection, particularly of the young.

However, the provision of health services under the tenure of the Minister has involved a litany of mistakes and missed opportunities. The key prefix has been "mis-" in that there have been mismanagement, miscalculation, misdiagnoses, misdirection of finances, misconstruction, misspending, misbegotten policies, miscarriage, misconception, misjudgment and a miscast Minister. The ill and vulnerable of this country have missed out to the detriment of their lives and their health.

We have a small population. We had a healthy economy and we can with conviction, and two reports for back-up, lay the blame for its demise firmly at the Government's door. The legacy of Fianna Fáil will be Government for a few at the expense of many. The quicker we get rid of it, the better for our country.

Deputy Michael Ring

I am pleased to have the opportunity to speak on this Bill. I am from an area even farther west than Longford, Deputy Bannon's county. Over the years, people had to use St. Luke's Hospital for services. I thank the management, staff and board of St. Luke's for the excellent job they did over the years. I spent many a sad night in the hospital. Every Wednesday night I used to go there until we got our own service in Mayo. The service was then lost to Galway and now there is a centre of excellence. I do not want to comment on the centre of excellence but on what happened in Mayo General Hospital.

I hope what is being proposed will be best for cancer services in Dublin and the rest of the country. St. Luke's hospital was run very well. It is the cleanest and kindest hospital I was ever in. The inpatients used to be dealt with during the day and the country patients and others who had to travel long journeys, and who were in the facilities on the grounds, used to be treated at night. My colleague, Deputy McGinley and I spent many nights at the hospital. I used to visit the patients from Mayo.

Some years later, the services in St. Luke's were moved to a location nearer the people in the west, which I welcomed. There was an excellent cancer service and team in Castlebar but the HSE, in its wisdom, then opened the centre of excellence in Galway. It was easier for people from the west to get to St. Luke's with their loved ones than it is to get to Galway. St. Luke's was farther but it was easier to find parking there and to get in.

Although I am sorry to see the services go from Mayo General Hospital, I hope the centre of excellence in Galway works. I hope the property in St. Luke's cannot be sold by the HSE without the permission of the Minister. I have no confidence in the HSE based on what has occurred over recent years. The increase in size of the organisation is not working. It is getting bigger and bigger and is having an increasing number of problems. This week, we heard about misdiagnoses of miscarriages. Every week there is a problem with the HSE. It is like the Government, the banks and everything else in the country in that nobody takes responsibility.

A group was set up that is very dissatisfied with what is happening in regard to St. Luke's. It was proposed that the hospital be closed and that its services be delivered from a hospital in the centre of the city. It was another idea proposed and forced through by the former Taoiseach that was not right for the health service. As Deputy Bannon said, the health service should not be about what constituency a Minister is in; it should be about what people need and where they need it. It should be a matter of what is best for the community, not what is best for the current Minister based on the location of his constituency. Basing decisions on the latter does not represent the way in which any service should be run.

Why is there such a high incidence of cancer, particularly in the west and particularly among women? I hope the Minister of State, Deputy Brady, will state whether there are any investigations into this and any statistics being compiled on cancer types and where they are prevalent. Is there any reason the incidence is higher in certain areas?

Some years ago I tabled a number of questions to the Department of Agriculture on the amount of radiation from Chernobyl and the consequent high incidence of cancer, particularly in sheep. If it was affecting animals, it was of course going to affect humans. Are the Departments of Health and Children, Agriculture, Fisheries and Food and others monitoring to determine whether there is radiation coming from various quarters, including England? Is radiation still emanating from the Ukraine?

What is the link between cancer and food? When I was in the bread business, bread used to go stale in a day. It now lasts for six weeks and develops blue mould before it goes stale. The same is the case with milk. I recently left a pint of milk in the garage at home and when I returned to it, about three weeks later, it had not gone sour but had just vapoured away. One must ask oneself whether it is good for consumption. Are we checking what is being put into food?

Why are so many dying from cancer and why are we not further down the line regarding its treatment? Although millions upon millions of euro have been invested in research and hospitals, do we investigate the cause of the high incidence of cancer in this country? This is of concern to my constituents and to me because there areas in Mayo where there are high rates of cancer. People worry about this, asking why the Government is not surveying to find out the nature and cause of the problem in certain areas in the west.

St. Luke's Hospital gave an excellent service, with a great staff. I hate that something that works is being broken and that is what will happen if St. Luke's is closed and the lands sold or developed by the HSE.

Front line staff are not being appointed but I recently saw an advertisement for four regional managers in the HSE. More managers, on huge salaries. What do these managers do? Manchester United, the most successful team in Britain, has had one manager for the past 25 years and he has got results. We have more managers in the west than there are in the entire Premier League but they cannot get the job done and no one takes responsibility when there is a problem.

I have written to the Minister of State many times about home help. This scheme has worked so why does the HSE insist on tampering with it? A constituent who gets one hour's home help per day contacted me this morning. She depends on it but the HSE is cutting it down to half an hour. A woman in Erris with no family in the area wrote to me, and I passed this letter to the Minister of State, saying she had a half an hour per day. Weekend services have been withdrawn and home help has been reduced to three days a week. She cannot feed or wash herself, she depends on the home help. How could someone withdraw that essential service? Everyone who was assessed has seen their home help hours reduced. The Minister of State should bring in the managers of the HSE to see what is happening. They will say that they must save money but they should not do it by cutting back on front line services like the home help. All they are doing is creating problems further down the line, which is exactly what will happen with St. Luke's. People who cannot look after themselves and who depend on their home help will finish up in nursing homes.

What good is that? We are far better off giving people the little bit of help to keep them in their homes. All reports on home help have shown people want to stay at home if possible. The Government is being short-sighted. This is wrong, because the service is working well. It might be costly but it is working and the Minister of State should bring in the HSE to deal with it.

There is a problem in Belmullet hospital — a hospital our emigrants paid for over the years. They raised money in Chicago, New York and Manchester for it and sent it home. They did not forget about their loved ones; they wanted them to be in a hospital that would look after them. Now the HSE is doing all it can to close that hospital. Yesterday, it closed an eight bed male ward and I doubt it will ever open again. That is wrong. It is all because of staff cutbacks and to save money. All that will happen is that those who need beds in Belmullet will have to go to Castlebar, Galway or Dublin. It does not make sense. The system was working and people were happy to be in their own area and I compliment the staff on the excellent job they have done there.

This week, we have seen the misdiagnoses of miscarriages due to the failure of equipment. If I had a car and it did not work, I would not keep it going for six months but the HSE blames the machinery for the mistakes. Will anyone take responsibility for what has happened? There is no point having an inquiry if no one pays the price for what happened. It is the same with the banks. There is no point telling us what the problems were; we must deal with the people who created the problems that we are paying for. Managers are well paid so why are they are not taking responsibility?

What has happened in the last week and to hear mothers on the radio telling their stories has been shocking. It does not reflect well on the health service, although I do not want to criticise it. I want it to work for everyone in the State. We all use it at some time so we want to see a good one. It does not work, however, when no one takes responsibility. The Minister for Health and Children has been in the job too long and has lost all control. She handed power over to the HSE and it has no responsibility to this House. That is the problem in the health service.

A bungalow in Áras Attracta in Swinford has been closed. It worked well but people are being upset and frightened because of the amalgamation. People must be shown the respect they deserve. I say to those running the health service that they must be sensitive as well as saving money. They cannot just close these units or double the numbers in them. These people are human and deserve some respect. I hope the decision in Áras Attracta will be reversed.

Westport has no hospital — the nearest hospital in Castlebar. There is now talk of weekend closure of the accident and emergency department in Mayo General Hospital and further cutbacks in services. When I was elected to the Dáil, the big issue on Mayo was the orthopaedic unit. That unit was agreed by the Government because it wanted to save its seat in the by-election and had to carry through. I take some credit myself, because I was so strong at the time that the Government thought it might not win the seat so it conceded the orthopaedic unit. Only last week, consultant Derek Bennett carried out surgery that was televised globally. That is now a centre of excellence.

The old Western Health Board did everything in its power to oppose opening the orthopaedic unit in Castlebar. People with broken bones had to travel from Belmullet to Galway for treatment but now there is a centre of excellence in Castlebar. The consultants there are to be complimented because no longer are people waiting for years for orthopaedic surgery. Over Christmas an unprecedented number of people broke bones because of the frost and Mayo General Hospital dealt with that professionally. People were treated and looked after. I am disappointed that the HSE is trying to reduce services in Mayo General Hospital instead of granting the staff there the resources they need to serve the people of County Mayo so well.

We lost the cancer services and the women were angry. They will adjudicate on that at the next general election because those women have not forgotten what was done with cancer services. This is short-sighted because in ten years time there will be more inquiries into the health services. More people will not get the services they are entitled to and they will sue the State, something that will cost a lot more money than these cutbacks save.

These cutbacks are hurting people. They are hurting the sick, the weak, the poor and the most vulnerable in society. It is wrong to attack frontline services. We should be supporting them and giving them the help and backup they need. We should be trying to keep people out of hospital rather than putting them into hospital. The latter is the policy of the Government and the HSE by closing down home help and essential services for people being cared for in their homes. These people will end up in institutions paid for by the taxpayer and the State. All we are doing is saving money now but we will pay later, which is crazy.

Cancer has affected every family in this country. I would like to see more research and resources to see what is creating the problem with cancer. I compliment the Department of Health and Children for upping its game in respect of some cancers. It has improved people's chances of surviving if cancer is caught in time. A good job has been done in respect of some cancers. Men have been left behind for the past few years with regard to prostate cancer. I am glad we are having an awareness campaign and are taking this seriously. Men do not take their health seriously but they should.

What is happening in the HSE is wrong. The Minister and the Government should examine the HSE again. It has not worked, it has failed the people of this country. The HSE wants to cut and this is not working because it puts people's lives at risk. Whatever cuts must be made should begin at the top rather than the bottom, as has been done.

Debate adjourned.