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 John Perry

I wish to echo the sentiments of many of my colleagues in paying tribute to the many years of outstanding work carried out in the field of cancer care at St. Luke's Hospital. Many of my constituents have been treated at St. Luke's, which was a recognised centre of excellence for Ireland. The sense of care, concern and support was outstanding. However, its inception into the HSE fraternity exposes the deep flaw in the current national cancer care strategy. Dublin has four cancer centres of excellence while there are none situated north of the line from Galway to Dublin. Sligo has a regional hospital, with a staff of 1,400 providing a range of highly specialised services extending to 250,000 people in Sligo, Leitrim, Donegal, north Roscommon, west Cavan, and east Mayo. Sligo General Hospital bore the brunt of HSE cutbacks in terms of cancer service cuts as well as budgetary cuts over the past 12-24 months, affecting all services across the hospital, from oncology to orthopaedic care. The hospital has already been dealt a severe blow with the removal of breast cancer mammography and surgical services under the national cancer control programme. This move came despite the clear scientific and medical evidence that Sligo General Hospital was providing cancer care outcomes that compared favourably with, and indeed in some cases exceeded, those obtained in top cancer care clinics in the United States.

Upwards of 4,000 mammograms were carried out at the hospital each year, which was well in excess of the critical mass required for the establishment of a centre of excellence. This is relevant also to the outreach service if there is not to be a dedicated centre. When Fine Gael is back in Government, I hope it will re-establish the outreach service working with Galway. The multi-disciplinary team headed by a consultant, Mr. Tim O'Hanrahan, was responsible for the highly favourable and top level outcomes for breast cancer care at Sligo General Hospital.

The decision also ignored the demography of the region. The reality is that most cancers are age-related. The north west region, served by Sligo General Hospital has the highest percentage of elderly people in the country. The patients of Sligo General Hospital and the people of the north west have been categorised as second class citizens by the Minister for Health and Children, Deputy Harney and the HSE.

I quote from the mission statement of Sligo General Hospital: "Sligo General Hospital is committed to the delivery of a high quality patient centred service in a safe, equitable and efficient manner". With the best of intentions from hospital staff and management, the hospital is severely curtailed in delivering upon this mission statement because of the policies of the Government, and the HSE. Clearly there is nothing equitable in the draconian budgetary and service cuts being applied across the hospital. The Government and the HSE have a clear and deliberate policy to downgrade the hospital from one which provides essential acute services to over 250,000 people in the entire north west region, to one that will only provide for non-essential and elective services on a local basis. This is the agenda being pursued.

Notwithstanding the current €12 million budgetary cutbacks being implemented in the hospital, a further €12 million budgetary cut is now being proposed by the HSE in Sligo General Hospital, meaning the overall cutbacks will total €24 million. This is a massive cut. It will have a devastating impact on the cardio and angiography services in the hospital. Up to now, Sligo General Hospital offered a three week turnaround time for patients, which is excellent. Under the cutback proposals, coronary angiography patients will have to be referred to St. James's Hospital in Dublin, meaning what was once a three week turnaround time for patients in the north west will become a six month waiting time. Lives will be lost.

This is a critical service. I appeal to the Minister to examine it, which is provided by an outstanding team led by a top consultant. The team is recognised in the region. The hospital serves 250,000. I emphasise the three week turnaround, which will have an extraordinary impact. Patients will have to be referred to St. James's Hospital to be placed on the waiting list. Lives will be lost.

This is just another example of the contempt in which patients in this region are treated by this Government and the HSE. I appeal to Deputy Scanlon and the former Minister of State, Deputy Devins, who knows the importance of this service to Sligo. Next week, Deputies will have a unique opportunity to vote on the motion of confidence in the Government to be taken next Tuesday. The two Deputies are not members of the parliamentary party and say they adjudicate on every decision as it arises. Between now and Tuesday they should talk to the Taoiseach. The most critical infrastructural development of patient care in Sligo provides them with an opportunity to put a clear marker down to the Taoiseach. It is bad enough to lose cancer services but now the coronary care, cardio care and angiography services are threatened. We want a clear statement from Deputies Devins and Scanlon prior to the vote on Tuesday that the Taoiseach has given assurances these services will be ring-fenced and funding secured at Sligo General Hospital. This matter is critical.

Not alone will coronary care be affected by the current proposals but every essential acute service across the facility will suffer as a result. This is where politics counts. It is where we exercise the mandate we were given when we were elected to this House. Deputies Scanlon and Devins have a unique opportunity because they have a clear assessment of the local position but I have not seen much of it on the ground.

Acting Chairman (Deputy Brian O’Shea)

I have given you latitude, Deputy. I ask you to address your remarks to the Bill, please.

Deputy John Perry

This is very much part of the Bill. We are talking about the provision of cancer services and this concerns the extended services at Sligo General Hospital. There was no curtailment of previous speakers who mentioned their local facilities. This concerns the mandate I was given. We are discussing St. Luke's cancer services and the regulation regarding their removal but cancer services were removed from Sligo. This is phase 2. Given the demographic profile of the north-west region, with its high population of elderly people, it is critical that oncology services are adequately resourced to cope with an increased demand. Oncology was very much part of St. Luke's but the service is now being transferred to other centres in Dublin. I am worried about the removal of services from the north west. North of a certain line there are no services and I wish to put that clearly on the record today.

The geographic location of the hospital also means it is ideally situated to perform as a centre for many regional services, especially now, in light of the roll-out of the national colorectal cancer screening programme. However, under the watch of the Government, Sligo General Hospital will not have the resources to provide these critical services. Oncology and palliative care services at the hospital, under Mr. Merton and his team, provide an outstanding facility. Decisions will have to be made on this in light of the colorectal cancer screening programme. It is very important that the matter be addressed in a clear manner.

To date, budgetary constraints imposed on the hospital have resulted in a reduction of the orthopaedic bed capacity to 24 beds. In the past 12 months a reduction of 72 beds has taken place in medical, paediatric, orthopaedic and surgical wards. This reduction does not take into account the proposed further €12 million cutback. The hospital simply cannot operate under such conditions. The critical services it provides to so many people across the wide geographical region it serves will be severely restricted.

Next week there will be an opportunity for Deputies Scanlon and Devins, the latter a doctor and former Minister of State, to vote against the Government unless they receive assurances that further attempts to curtail Sligo Hospital services, especially in the areas I mentioned, will not take place. One may consider the entire cancer strategy and the issue of the four centres of excellence in Dublin. However, to the dismay of many people, there are cutbacks in the north west region especially with the removal of essential services such as surgical and mammographic facilities. There will be the impact of further curtailment imposed by budgetary cutbacks. I have met the hospital management and seen the commitment of the 1,400 staff in carrying out an outstanding service. Even the emergency facility at the hospital has been curtailed, as has facilitation of services for many people who are referred there. Cutbacks have been immense.

The Health (Miscellaneous Provisions) Bill 2010 provides for the dissolution of St. Luke's and the transfer of its employees and their abilities to the Health Services Executive. This arises from the national plan for radiation oncology under which there will be four radiation oncology centres, two in Dublin, one in Cork and one in Galway, with two satellite centres in Waterford and Limerick. The Bill also provides for the amendment of the Health (Nursing Homes) Act 1990, the Health Act 2000, the Medical Practitioners Act 2000 and the Nursing Home Support Scheme. It also repeals section 44 of the Health Act 1947 and section 36(2) of the Health Act 1953.

This debate draws together a wide range of information from the Department of Health and Children, National Cancer Registry Ireland and St. Luke's Hospital. It is comprehensive legislation. The most important aspect is the development of radiation oncology services in Ireland, on which there is a critical mission statement. When one considers the statistics on the incidence of cancer in Ireland, it is frightening to think that the disease will increase dramatically over the next number of years. With that level of development and the roll-out of services in the country it is extraordinary there is little or no facilitation of services in the north west. The roll-out of services in a fair and equitable manner is not served by the loss of those in the north west and west regions.

For cancer patients, radiation therapy is critical. It is not so long since there was a major campaign in the region for the facilitation of radiotherapy in the north west but now there is removal of the current services. Although this is comprehensive legislation it is regrettable there is to be such a massive cutback, given the demographics of the region and the services provided by Sligo General Hospital for a population of 250,000.

For every action there is a reaction. The removal of the cancer surgical facility at the hospital more than a year ago has had a severe impact on other facilities at the hospital. The threatened removal of coronary angiographic services at the hospital is frightening. Lives will be lost if people are left with a three-week turnaround. If they are referred by a general practitioner to a consultant at Sligo General Hospital they can have an angiogram or other services, as identified, but if they are to be referred to Dublin, with a consequent waiting time, that is frightening for coronary patients with threatened heart attacks.

I am delighted to speak on this very important Bill. Enough is enough when it comes to critical and outreach services, the ambulance service and the size of the vast region covered by Sligo General Hospital, the main hospital in the region, serving 250,000 people. It does not compete with any other hospital and provides an opportunity for cross-Border care with Northern Ireland. That has been discussed but is very much a long-term plan of investment in connection with Fermanagh Hospital and Altnagelvin Hospital in Derry. The big disappointment would be curtailment at the hospital which is the backbone of the north-west region. This is why people pay their taxes. They expect to have a service and be able to support the 1,400 staff who work at Sligo General Hospital. One must recognise the outstanding commitment of the doctors, nurses and all supporting staff of the hospital who are totally committed, as I know from visiting the hospital.

Given the statistics on incidence of cancer in Ireland and projections for the future the situation is frightening. As Deputy Ring stated, cancer affects every family. This is frightening but it is reassuring to know that if the disease is diagnosed at the initial stages and correctly treated people can make a very good recovery. It is very important that all the concerns of people be heard. They do not want to have to go to the hospital in Galway to be diagnosed. That is where the mammographic service is but there is difficulty getting into University Hospital Galway because it is over-pressurised and its budgets are being curtailed. There is only one surgical bed for the north-west region at that hospital although the Minister, Deputy Harney, stated there would be two.

I hope my two Oireachtas colleagues are listening to this debate which is very important. I appreciate the tolerance of the Acting Chairman. This has been one of the most important issues in the region for some time and is a cause of concern for everybody. While I recognise the importance of ensuring value for money and increasing efficiency in the delivery of services, a curtailment of €12 million, followed by a second budgetary cutback of an additional €12 million, is difficult to bear. Although the overall budget for Sligo General Hospital is €100 million, without taking account of the additional reduction of €12 million, that includes staffing costs for 1,400 personnel as well as the cost of maintaining critical services.

The threatened curtailment of services at Sligo General Hospital has not been adequately debated in the public domain, particularly in the case of cardiological and angiographic services. Up to now the hospital has managed a three-week patient turnaround. Under the cutback proposals, however, cardiological and angiographic patients will have to be referred to St. James's Hospital in Dublin, with associated waiting times of up to six months instead of three weeks. I appeal to the Minister to give this matter serious consideration as what is proposed is a frightening prospect. The wonderful team being led by Dr. Donal Murray has been doing excellent work and the coronary care facilities are the best in the country.

It is bad enough to see the removal of cancer services; it is time now to say that enough is enough. People in the region will not tolerate any more curtailment of critical services. Everybody understands the importance of careful management of financial resources. The hospital is adamant about giving value for money but there is only so much curtailment it can endure. I appeal to my Oireachtas colleagues who are outside the Fianna Fáil Parliamentary Party and have power to influence this issue. All they have to do is to inform the Taoiseach that their support is conditional on this situation being rectified.

Deputy Jimmy Deenihan

This Bill provides for the dissolution of the board of St. Luke's Hospital and the transfer of its employees, assets and liabilities to the Health Service Executive. The dissolution arises from the national plan for radiation oncology under which there are to be four radiation oncology centres, two in Dublin, one in Cork and one in Galway, and two satellite centres in Waterford and Limerick. The Bill affords us an opportunity to discuss not only the dissolution of St. Luke's Hospital board but also to examine services throughout the State, including in Members' own areas.

I join with previous speakers in recognising the work that was carried out in St. Luke's Hospital over the years. We have all had occasion to visit patients there — in some cases, family members — and we all found it an example of how hospitals should be run. Patients suffering from cancer experience various stages of trauma during their treatment and these are trying times for them and their families. St. Luke's Hospital catered for such patients in a sensitive way. The dietetics department in the hospital has built up expertise in the area of diet and its relation to cancer treatment. I acknowledge in particular the work of Eimear Finn, head of the dietetics department, as well as the senior dietician, Catherine O'Connor, who is from north Kerry and over whom I had some influence in directing her towards dietetics through Listowel food fair. They have built up an excellent department and I hope their expertise will be utilised in Beaumont and St. James's hospitals. As I understand it, services will remain at St. Luke's Hospital until 2011, while phase two will be confined to Beaumont and St. James's hospitals.

In the debate pack supplied by the Oireachtas Library & Research Service, reference is made to a report on the development of radiation oncology services. In referring to the existing and short-term plan, it is noted that the increase in treatment capacity within the State is "significantly below" the equivalent guidelines recommended by international agencies and authorities in other western countries. It goes on to say that during the late 1990s and early 2000s, major investment in new and replacement clinical treatment services took place in Dublin and Galway while, during the same period, a more limited investment programme in replacement equipment took place in Cork. The service may have improved since that report was published. It is also noted in the information pack that the current utilisation of radiation therapy for various common adult cancers, as indicated by comparable data, appears "considerably less" than in several European Union countries and in North America. As regards patient case load analysis and projections to 2015, we are told that the total number of new cancer cases is increasing annually, with some of that increase a consequence of growth in the population and a significant element of it attributable to our aging population. I will come back to that later.

We have seen, therefore, that while our services have improved considerably, they are not comparable to those of our neighbours in Northern Ireland, the rest of Europe and elsewhere in the developed world, including North America and Canada. Nevertheless, according to data from the national cancer control programme, published this year, survival rates for almost all types of cancer improved for people diagnosed between 2000 and 2004 compared with those diagnosed between 1994 and 1999. We all know of people who have survived cancer following treatment. It is critical that once people are diagnosed, they receive treatment without delay. Unfortunately, however, that is not the case even for patients with private health insurance. Lives have been lost because people have not been diagnosed and treated in time. The value of screening and early detection is that they help to save lives. As other Deputies said, it is vital that people are encouraged to monitor their health on an ongoing basis and to have check-ups on an annual or six-monthly basis. Sometimes people do not recognise or act upon symptoms of cancer, diabetes or other diseases. Early detection is vital in all such cases.

Ireland is on a par with Europe and the United States in terms of survival rates for children diagnosed with cancer. We have made remarkable progress in this area and young children's lives have been saved as a consequence of early intervention and treatment. Approximately 22,500 new cases of invasive cancer are diagnosed every year. The current trend indicates that the number of cancers diagnosed each year is likely to double in the next 20 years. This will impose a significant burden on our health budget which currently is 12% of GNP and is primarily funded by the taxpayer. The financing of services will be a major challenge in the future, as we will have an ageing population and there will be more detection of cancers.

I commend the excellent cancer screening programme in Kerry General Hospital. However, people bought into the centre of excellence in Cork on the promise that services would be provided locally. These are being put in place, albeit rather behind schedule. Politicians should support these services. I hope that women in Kerry will not be disadvantaged because of the change in services which means they will have to travel to Cork for major surgery with follow-up chemotherapy treatment in Tralee. The jury is still out and some people are rather concerned, including doctors, that this system may not work. However, we must ensure it will work.

Cancer screening for women in Kerry commenced in April 2009, in the grounds of Kerry community services headquarters in Rathass. Women living in the greater south Kerry area, including Tralee, Ventry, Dingle and Listowel, were invited for screening in Tralee. The initial take-up was low because, for whatever reason, women were not encouraged or were discouraged to avail of the service. However, the numbers have increased considerably.

The statistics on cancer screening should be readily available, such as the numbers of women availing of the service, but, apparently, this is not the case. In preparation for this debate, I looked for statistics on the number of women who availed of the BreastCheck service in Tralee. This information was not available. The free mammogram service for women aged between 50 and 64 years, will be carried out every two years on an area basis. I suggest this service should be expanded. Cancers can be detected by screening in GP surgeries and in hospitals such as the Bon Secours Hospital in Kerry. However, it is crucial that all women carry out a personal breast check on a regular basis to ensure they have not developed cancer. Lumps in the breast are common and they may not always be cancerous but it is very important to have these diagnostic services available and women should be encouraged to use them. Approximately 13,000 women between 50 and 64 years live in County Kerry and these will be invited to avail of BreastCheck which will remain in County Kerry until all eligible women have been offered an appointment.

The most recent statistics available for 2008 and early 2009 show that 92,061 people were screened by BreastCheck and 672 cancers were detected. This means a large number of people were saved. Screening for cervical cancer seems to be working very well. This is available for women between the ages of 25 and 44.

I have an interest in screening for colorectal cancer. Anyone whose parents died from colorectal cancer or stomach or bowel cancer, should be screened regularly. It is obvious that this cancer is genetically transmitted from one generation to another.

The Minister announced last December the NCSS would proceed with preparations for the national colorectal cancer screening programme for men and women aged 55 to 74 years and that preparatory work is well under way. However, this will not happen until 2012. Deputy James Reilly referred to this programme in his contribution. It is hoped this programme will not be postponed beyond 2012 but there is no reason it could not have been put in place in 2011. The earlier, the better as more lives will be saved.

Colonoscopy can be carried out as an outpatient service and people should be encouraged to avail of this service. Early detection can save lives. We all know of people who went in for a routine check-up and discovered they were in the early stages of cancer of the bowel. Procedures and treatment can commence immediately and this means a colostomy bag is not required afterwards. Early intervention means that people can live for years.

I refer to the National Cancer Registry of Ireland which last 23 December published an atlas of cancer incidence. This was not a very auspicious publication date for receiving publicity. It outlined the geographical status of cancer sufferers across the country. It showed that poorer areas are more likely to record higher incidences of the disease than other areas. For example, poorer rural and urban areas have higher incidences than other areas. This is a very important fact. A Combat Poverty report showed the two counties with the least income per capita were Donegal and Kerry. A National Cancer Registry report mapped where the sufferers of specific cancers were located across the country and those diagnosed with the disease between 1994 to 2003. It found that socio-economic factors such as high deprivation levels as well as population density often correlated with higher levels of particular cancer diagnoses.

The report also claimed:

Some geographical variation in cancer incidence may be due to differences in health awareness, in participation in screening, or in access to cancer services. However, it is generally accepted that it is predominantly the result of differences in well-known risk factors such as tobacco smoking, alcohol drinking, obesity, diet and sexual behaviour.

The report provided a breakdown of where particular forms of the disease are found across the country. Breast cancer, for example, showed little variation in the location of sufferers across Ireland but the highest density cases were found in west Cork, north Kerry and the east midlands. This is why north Kerry should be singled out for special treatment with more awareness campaigns for breast cancer screening.

When general cancer treatment services were moved from Kerry General Hospital, Tralee, a commitment was made for a digital mammography unit to be established there. While it took some time for the unit to be provided, it will be opened on 14 June and will allow follow-up treatment for treatment done in Cork.

Every year 200 people die from cancer caused by radon gas. This is an area that must be examined more seriously.

The country faces major challenges in the delivery of health services, particularly cancer treatment. The annual health care budget is €19 billion of which the Government contributes €14 billion and the outstanding €5 billion has to be borrowed. Prevention of ill health will become an important element of health strategy. Between now and 2033, the overall number of invasive cancers is projected to increase annually by 6% for females and 8% for males. Early intervention, improved diagnostics and immediate treatment will reduce the cancer casualty rate. However, we must be far more aware of ways of preventing the disease too.

Deputy Ulick Burke

I welcome the opportunity to contribute to this debate on the Health (Miscellaneous Provisions) Bill. I regret provision is being made to dissolve the board of St. Luke's Hospital. While we are told this will lead to improved access and outcomes for cancer patients in the new cancer treatment strategy, it has always been acknowledged St. Luke's staff, both clinical and non-clinical, provided excellent care to their patients. All patients who attended the hospital from around the country were always afforded the greatest care possible. My regret is the HSE will now include the hospital in a network of cancer care centres with the two Dublin centres of excellence located in Beaumont and St. James's hospitals.

While many of these centres of excellence have only started to operate recently, the experience so far has not been satisfactory. For example, in Galway's centre of excellence based at University College Hospital, Galway any claim we have better access and outcomes resulting in better cancer care would have to be examined thoroughly. One would get fantastic treatment if one got access to the services. However, the provision of extra staff and beds has not happened in Galway. Members from Sligo and Mayo have raised the problems their constituents have in gaining access to services at Galway as a result of this lack of provision. It is claimed the Irish scheme follows international best practice. If the Government believes it has established centres of excellence by putting a brand on a hospital, it should think again.

I know of a person who was diagnosed with cancer three years ago. He has had to repeatedly enter University College Hospital, Galway for treatment. Each time he must go through the accident and emergency department and give all his personal and medical details on each occasion. There is something wrong in a centre of excellence maintaining such a cumbersome delaying tactic. Neither is it acceptable that this person, suffering from cancer and who has been treated in the same hospital, must wait six hours in the accident and emergency department for attention. One must query any claim this is a centre of excellence. While the treatment and personnel are first class, the problem is getting access to the services. This is not isolated to Galway but is happening in the other centres of excellence across the country. That is what is taking place there and it is not an isolated incident. It takes place on a constant basis. The management must be restructured or the centre of excellence for cancer care must be streamlined in some way and focused directly on access rather than having to go through the accident and emergency department, which is unnecessary and creates repetition. If one queries why this procedure is necessary, one is informed in no uncertain terms that the routine in place applies and that is it. It is an obvious waste of time, manpower and effort and it is costly and painful for the patients who must wait and go through that torture.

The report indicated that on average some 23,000 people in Ireland suffer from cancer annually. They must be treated. We are informed that figure will double between now and 2020. We have identified only four centres of excellence and we are dismantling the other centres that were in place. It is unfair that established treatment centres in other parts of the country should be dismantled on a regional basis. Dismantling those centres and directing people to the major centres is unfortunate and represents short-term thinking. Let us consider the far end of Donegal or, as Deputy Deenihan remarked, County Kerry. Such geographical situations must be considered. We have broken up a network that could have been developed. Much of the trauma with regard to access at present would not exist had we continued on the existing basis. For this reason, I regret that St. Luke's is being brought into the network. It has been recognised by the Minister and the Department that the personnel relocated under the reconfiguration play a pivotal role in the continuation of services, which is important. The personnel in St. Luke's have a pivotal role in the new structures.

I refer to the centres of excellence to be established and how they should be defined. The term should not refer to a physical building, but should represent the people and personnel involved. In her identification of the centres of excellence, the Minister should have given consideration to the fact that the label should be earned, not simply applied. If people were in competition to earn that label, there would be a far better delivery of service to many patients throughout the country.

Any discussion of cancer and cancer centres must include a mention of Our Lady's Children's Hospital, Crumlin. I refer to the centre in Crumlin under the direction of Mr. Finn Breathnach. The Minister and the Government have repeatedly starved that centre of excellence. The term or classification "excellence" was earned by the centre because of its commitment to the treatment of children. Although Mr. Finn Breathnach and many of his colleagues have indicated the importance and potential of Crumlin as a children's hospital, all their experience and requests were ignored by the Minister when she reconfigured children's hospitals and under what she is proposing to do now. That was regrettable. I am aware of the service that has been provided from first-hand experience and from being involved in Crumlin hospital for six years. Thankfully, the outcome was 100%. I refer to the dedication of the staff there led by Mr. Finn Breathnach. It is a pity and regrettable for the many people who will have to attend there on an ongoing basis that he has retired. However, he continues his commitment to the treatment of children's cancer at the Robertstown centre. As he had done at all times in Crumlin, he continues to deliver the absolute dedication and care needed for the treatment of children with cancer.

Parents fundraised on a national basis to make good the deficit and to provide reasonable conditions in Crumlin hospital. This was ignored by successive Fianna Fáil Ministers with responsibility for health during the past ten or 20 years. The hospital received only a paltry subvention from Government, far short of what was necessary because the Government and the Ministers were aware that the parents had a commitment to that hospital and that they would raise funds. Many individuals including sporting individuals and others in society have given commitments to raise funds for that hospital. It is regrettable that we are demolishing what was and is a first class service and would continue to be were it allowed and supported by the Minister and the Government of the day.

Regarding the HSE moving in and taking over an institution or a hospital, the hospital nearest to me is the Portiuncula Hospital in Ballinasloe which has lost its cancer treatment facility. It was taken over some six or eight years ago. In the meantime, it has been stifled of funding and personnel because of Government policy. We are waiting for the appointment of two consultants at present. Senior medical people have referred to the dangers in the accident and emergency department in some hospitals such as Portiuncula hospital because of the lack of consultants. This is ironic given the controversy of recent days involving a mother who went to the centre of excellence in Galway and was misdiagnosed there. Eventually, following advice from a friend she was referred to the maternity services in Portiuncula. There, thankfully, her condition was confirmed and we are all aware of the outcome in this regard from the media reports of recent days.

When discussing centres of excellence we should consider the record of the very large centres. They have lost contact with patients. Patients are no longer individual people; they become numbers and statistics, which is regrettable. Report after report from the HSE refers to statistics. They do not refer to people as such or as patients or to their outcomes. Until a change comes about in the statistical delivery of health services and until we return to the idea that people and patients are important, the HSE is on a wrong course. Unfortunately and tragically, many cases will be affected by this approach.

Portiuncula Hospital in Ballinasloe has been starved of support by the Government and the HSE. I refer to one simple example of what is taking place. We are informed that, as of last month, the hospital must save €1 million each month. Even at this, the hospital will have a deficit at the end of the year.

I refer to a previous provision of the Minister. If one goes to a general practitioner, one pays him or her €50 while the statutory fee in a hospital is €100. The general practitioner might do nothing other than refer the patient to the hospital but the hospital will lose the €100 even though it does the work, which might be expensive.

It is important that anomaly is rectified. Hospitals, such as Portiuncula Hospital, are losing scarce resources because of this anomaly. We hear much about the out-of-hours service, including West Doc and all the other doc services. The same is happening there. A patient goes to the out-of-hours service but nothing is done there and the patient is referred to the hospital. Once the patient produces a receipt showing he or she paid the general practitioner, the hospital will lose out on the €100 statutory fee. Perhaps the Minister will look into that anomaly. If €50 is paid to the general practitioner, the other €50 should be paid to the hospital for the work it carries out.

Each year 23,000 patients seek cancer treatment and that figure will probably double. The strategy in place must be revised. We must reconsider the decision to close centres against the people's wishes. It is regrettable that we have taken a short term view which will have to be reassessed in the near future in order to cater for the numbers. The downgrading of the oncology section in Our Lady's Hospital for Sick Children in Crumlin, St. Luke's Hospital and the hospitals in Sligo and Mayo and elsewhere is short-sighted. If we are following this international model, which has been referred to, in regard to this reconfiguration, we are overlooking so many factors which are important for the delivery of a proper cancer service.

Deputy Andrew Doyle

I am glad to speak on this Bill and wish to preface my remarks by saying that 15 years ago, I had first-hand experience of St. Luke's Hospital as an outpatient. While I was not being treated for cancer, I got a good insight into the role of, and the atmosphere in, the hospital. The first time I was scheduled to go to the hospital I went with a certain amount of trepidation about what St. Luke's Hospital was but as I became more familiar with it, I realised what a wonderful facility it was and how lucky the people were to have a hospital run by a board of directors and with such an ethos and governance structure.

The hospital was established by the Cancer Association of Ireland with a view to taking care of people with cancer and engaging in cancer research and awareness. It has developed from that to being recognised as the prime centre for cancer care for the country. As recently as 2008, there has been significant investment in new and replacement linear radiotherapy units. The suspicion was that when St. Anne's and St. Luke's hospitals were merged, there was an exit plan which would result in St. Luke's Hospital being amalgamated into St. Vincent's University Hospital in Elm Park. That has probably changed now with the plan that it will be amalgamated into St. James's Hospital and Beaumont Hospital.

It is difficult to understand why we are trying to transfer the assets, staff and governance of an area of the health service which is working excellently — I have never heard anyone criticise St. Luke's Hospital — to the HSE, an organisation which has all sorts of problems. That is ironic on the day when a headline reads that the HSE would be better without an arm of responsibility. Child care and child welfare may not be directly associated with health care in the same way as cancer care but it is ironic that we are looking to transfer a significant piece of cancer care into the arms of the HSE. It reminds me of the plans for the Central Mental Hospital in Dundrum. Given that Dundrum and Rathgar are two leafy suburbs and that the real estate of the Central Mental Hospital and St. Luke's Hospital is very valuable, one would have to be suspicious that there is an attempt to relocate both institutions and capitalise on the assets.

That in 2008 St. Luke's Hospital was upgraded and given the most modern facilities in the country when money was probably not as plentiful as it had been is a recognition of its role. It is nice to know that St. Luke's Hospital will remain there until 2014 but one must ask what its future is after that. What is the plan? Will it continue until then with its current ethos? Will it be governed centrally by the HSE cancer care service? I wish the new director of cancer care and the incoming chief executive officer of the HSE the very best.

I was chairman of the former East Coast Area Health Board at the time of the dissolution of the old health boards and I always opposed the manner in which it was done. I agreed that the health boards needed to be reformed but believed that the model whereby the former Eastern Health Board became the Eastern Regional Health Authority with three area boards probably should have been replicated throughout the country. At least primary care could be governed locally while many aspects of the roll out of health care and the management of the health service could have been governed centrally, although not all of them. The chickens are coming home to roost in that regard. Inevitably when the review of the HSE comes to a conclusion, it will revert to four or six regional boards of administration with a central authority for payroll, quality, etc.

Like other speakers, I will mention my constituency of Wicklow which does not have a hospital. St. Columcille's Hospital in Loughlinstown, which is very close to the Wicklow border, serves Wicklow but it has not been upgraded in the manner in which Naas and Blanchardstown hospitals have been. Mental health services are delivered from Newcastle hospital but it has been starved of funding and resources. There was a comprehensive plan for both hospitals but it was never progressed. That would possibly have meant the provision of a new facility on the grounds of Newcastle hospital which would have incorporated mental health services, some general hospital facilities and perhaps a dedicated Alzheimer's unit which was identified for it. None of that has happened. The affordability of all this now comes into question but for many years the plan was in abeyance and nobody considered it.

I will not speak for much longer other than to say that I understand the miscellaneous provisions of the Bill and I have no problem with them. Deputy Ulick Burke mentioned Crumlin hospital. When a service is working, why should it be changed? The approach being taken is to ensure all the boxes are ticked in regard to service provision, which should be consolidated into a centralised service provided by the HSE. Can the Minister of State honestly say that the service being delivered in St. Luke's will be improved when it is moved? I do not believe the service being delivered in St. Luke's can be delivered better anywhere else under any authority or structure. The model of service delivery in St. Luke's is as good a model as one could find. Rather than taking St. Luke's out of the system, we should consider replicating that model throughout the country. The service delivered in St. Luke's has stood the test of time. That hospital was established 56 years ago and it has developed as needs required over that time. Money has been invested in it. It has an excellent team of surgeons, consultants and medical care staff and other staff.

I ask that this Bill be reviewed and rejected, and that people examine and concentrate on the services within the HSE that need to be improved. Under the cancer review that took place and the rollout of cancer services in the eight centres of excellence throughout the country, four of which are in Dublin and four are outside it, the working group recommended that there should be no fewer than eight and possibly ten such centres. A centre of excellence should have been provided in the north west to allow people from that region to have logistical access to cancer treatment services relatively nearby and even at that many people would have to travel quite a distance. It makes no sense to have no centre of excellence north of the line from Dublin to Galway. The cost of establishing one further centre would not have been exorbitant and would probably have involved very little additional cost.

I urge the Government to consider this Bill. I am aware the Minister of State, at a personal level, knows the workings of St. Luke's quite well. I ask that he consider the matters that have been raised by the Opposition.

Minister of State at the Department of Health and Children (Deputy Barry Andrews)

I thank Deputies for their participation in the debate. The main purpose of the Bill is to give further effect to the Government's cancer control strategy and, in particular, the development of radiation oncology services under the national plan for radiation oncology. It also provides for the discontinuance of the infectious diseases maintenance allowance, which was originally introduced in 1947. The Bill makes technical amendments to the Nursing Homes Support Scheme Act 2009 and the Health (Nursing Homes) Act 1990 to assist in the interpretation of these Acts. It also makes a technical amendment to the Health Act 2007, which relates to decisions taken under section 55 of the Act. It also makes textual amendments to the Medical Practitioners Act 2007 to correct typographical errors.

It is clear that if appropriate radiation oncology facilities are not available to meet the need for these services, then outcomes for cancer patients, including survival rates and quality of life, may be seriously compromised. By the beginning of 2011 with the establishment of St. Luke's network with radiation oncology services at St. James's Hospital and Beaumont Hospital, the number of linear accelerators will increase from the current number, which is eight in St. Luke's, to 12 in the network. High quality radiotherapy services will be delivered in an integrated fashion across the three sites in Dublin by the network, which will report to the director of the national cancer control programme.

The Hollywood report on the development of radiation oncology services in Ireland noted that optimal treatment outcomes are achieved through the close co-ordination of radiation oncology, surgical oncology, medical oncology and palliative care services. Effective treatment for patients will often require the different treatment modalities to be combined at the same time or at different stages during the management of illness. Single modality radiation therapy is curative in certain situations, however, combined modality treatment uses radiation therapy in combination with chemotherapy surgery and other treatments. In advanced cancers and in conjunction with palliative care, palliative radiation therapy often offers quick and effective relief from pain and other difficult symptoms. It is therefore essential that radiation oncology services and expertise operate side by side with surgical and medical oncology and palliative services. The integration of these services provided at designated centres under the programme should result in best outcomes for patients.

As the Minister has stated, St. Luke's will continue to provide radiotherapy services until at least 2014. She looks forward to receiving proposals from the friends of St. Luke's and board on possible future uses for the hospital. She has previously stated that she believes St. Luke's has a future within the public health service and has indicated that she will consult the friends, the HSE and other interested parties on how the site could best be used for the benefit of patients in the future.

During the debate on this Bill Deputy Reilly requested a briefing on the national plan for radiotherapy. The current Bill relates to a significant element of phase one of the plan whereby adequate radiotherapy capacity will be available up to 2015 with the development of the radiation oncology centres at St. James Hospital and Beaumont Hospital. Phase two involves further expansion at these hospitals and also at Cork University Hospital and Galway University Hospital and the development of satellite facilities at Limerick and Waterford hospitals. The Minister will shortly brief Government on the public sector benchmark for this phase, which will be delivered by public-private partnership.

In regard to comments made by Deputy Ó Caoláin regarding patients in the north west, the Minister is awaiting approval of the business case for new radiation oncology facilities at Altnagelvin Hospital by Minister McGimpsey in Northern Ireland. She has agreed to make a capital contribution to the project, which will address the needs of patients in the north west and significantly improve access and travel time for patients. Approximately 30% of patients will be from the Donegal area.

St. Luke's network model will provide a single clinical governance and management structure across the eastern region and will allow for the most efficient use of resources to deliver a service to patients in line with best international standards. Because staff at St. Luke's will become HSE staff on the enactment of this Bill, they will be able to work across the other hospitals in the network under this single governance structure. This enables the new facilities at St. James's Hospital and Beaumont Hospital to tap into and emulate the successful patient centred model that St. Luke's represents. At many Deputies have stressed throughout this debate, a key aim is to ensure that the ethos and spirit of St. Luke's pervade into the broader St. Luke's network.

While St. Luke's site will be transferred to the HSE, under the legislation the HSE will not be able to sell or dispose of the land without the permission of the Minister for Health and Children. That was a concern raised by one of the Deputies.

I thank Deputies again for their contribution. The Minister looks forward to the further Stages of this Bill at which time the views put forward will be considered in detail. I therefore commend this Bill to the House.

An Leas-Cheann Comhairle

Is the question, "That the Bill be now read a Second Time", agreed to?

Deputy Aengus Ó Snodaigh

It is not agreed.

Question put.

Deputies

Vótail.

An Leas-Cheann Comhairle

In accordance with the Order of the Dáil on Thursday, 3 June 2010, the division is postponed until immediately after the Order of Business on Tuesday, 15 June 2010.