Health (Miscellaneous Provisions) Bill 2010: Second Stage

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

I am pleased to have the opportunity to introduce the Bill, which has several purposes, to the House. Its main purpose 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. The plan will result in the expansion of public radiation oncology services, integrated with surgical and medical oncology. It includes the integration of St. Luke's Hospital, Rathgar, into the HSE's national cancer control programme. Accordingly, this Bill dissolves the board of St. Luke's hospital and transfers the hospital and its staff to the HSE.

The Health (Miscellaneous Provisions) Act 2009 provided for the integration of the national cancer screening service into the national cancer control programme. Cancer screening is an intrinsic component of cancer control and integrating it into the cancer programme ensured that services and resources were co-ordinated in the fight against cancer. Similarly, the provision of radiation oncology services is an intrinsic component of cancer treatment. This Bill makes provision for the integration of St. Luke's into the HSE's cancer programme along the same lines as last year's legislation for the cancer screening service. The legislation also provides for the discontinuance of the infectious diseases maintenance allowance, which was introduced in 1947. Nobody is currently in receipt of this allowance and financial and other supports are provided to such persons under a number of other schemes.

The Bill contains a number of minor technical amendments. First, it 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. Second, it makes a technical amendment to the Health Act 2007 which relates to decisions taken under section 55 of that Act. Third, it makes textual amendments to the Medical Practitioners Act 2007 to correct typographical errors. I propose to give an overview of the main policy areas of the Bill and then to set out its provisions in more detail.

The HSE's national cancer control programme, NCCP, was established and approved by Government in 2007 to give effect to the national cancer control strategy 2006. The strategy set out the future framework for delivery of cancer treatment in Ireland. It also endorsed the national plan for radiation oncology which had been approved by Government in 2005. Implementation of the programme involves the transfer of diagnostic, surgical and radiation oncology services to designated centres each with a critical mass of expertise, sufficient throughput of cases and a high concentration of multidisciplinary specialist skills. This approach is supported by international evidence, which demonstrates that the concentration of cancer services in large volumes in specialist centres produces superior outcomes.

The reorganisation of breast cancer diagnosis and surgery into the eight cancer centres has been the most high profile aspect of the work of the cancer programme to date. This has been a significant and challenging task and its completion late last year marked a major milestone for the cancer programme.

Considerable progress has also been made on other cancer services. One important development is the establishment of rapid access diagnostic clinics for lung and prostate cancer patients in each of the eight centres. These clinics will speed up access to diagnosis and multidisciplinary decision-making for patients whose symptoms are indicative of these cancers. So far, we have six lung clinics and five prostate clinics and the remainder are due to be established this year.

Good progress is also being made on the reorganisation of surgical services for pancreatic and rectal cancer patients. There will be one national centre for pancreatic cancer surgery, at St. Vincent's Hospital in Dublin, while rectal cancer surgery will be carried out in each of the eight centres. The community oncology programme is a more low profile aspect of the cancer programme's work but an extremely important one. The major focus of this programme is on creating capacity and knowledge among health professionals in the community to promote best practice in cancer control. These initiatives are all part of the overall implementation of the cancer control strategy.

Demand for cancer services, including radiation oncology, will continue to increase in the coming years as the population ages. The report of the expert group, Report on the Development of Radiation Oncology Services in Ireland, in 2003, the Hollywood report, recommended the development of a clinical network of large centres. The national plan for radiation oncology services was approved by the Government in 2005 and, as I said, endorsed in the 2006 cancer control strategy. Its aim is to provide new or additional radiation oncology facilities in four cancer centres: St. James's Hospital, Beaumont Hospital, Cork University Hospital and University Hospital Galway. There will also be satellite facilities at two other cancer centres, the Mid Western Regional Hospital, Limerick and Waterford Regional Hospital.

With regard to the north west, it is Government policy to promote a cross-Border solution in the provision of radiotherapy services. The Minister has offered to contribute to the capital cost of the proposed new radiotherapy centre at Altnagelvin Hospital in Derry. A final decision by the Northern Ireland Health Minister, Mr. Michael McGimpsey, on this proposal is expected in the near future.

The implementation of the national plan for radiation oncology services is under the governance of the cancer control programme. Construction of new facilities at St. James's and Beaumont hospitals will be completed at the end of this year. When these new facilities come on stream, they will increase radiotherapy capacity significantly. We will have 12 linear accelerators in the public system in the eastern region, compared with eight currently in operation at St. Luke's Hospital. The two new facilities at Beaumont and St. James's hospitals will come together with the facilities at St. Luke's Hospital to form the St. Luke's radiation oncology network. The new facilities will be under the governance of the cancer programme, not the individual hospitals. To facilitate the establishment of the St. Luke's network, the former director of the national cancer control programme, Professor Tom Keane, advised that there be a single governance model and that, therefore, St. Luke's Hospital should also come under the governance of the cancer programme. St. Luke's Hospital was established by statutory instrument in 1999 as a voluntary hospital under the Health (Corporate Bodies) Act 1961. It already receives all its operational funding from the HSE.

Providing for the effective delivery of radiation oncology services as a fully integrated component of the cancer control programme is the main purpose of the Bill. Accordingly, it provides for the dissolution of the board of St. Luke's Hospital and the transfer of its staff and facilities to the HSE. This means that all staff of the new network will be employees of the HSE, not any individual hospital. This will facilitate the transfer of employees between locations, subject, of course, to the usual industrial relations arrangements. It will allow for a single referral facility, a single management structure and shared support services across all three sites. Additional development funding and 54 posts have been provided for the cancer control programme this year for the new centres. In addition, some staff and resources will transfer from St. Luke's Hospital to the new centres in the second half of this year.

In 2014, when the national plan for radiation oncology services is completed and further capacity has been developed at St. James's and Beaumont hospitals, all remaining staff and resources will transfer from St. Luke's Hospital to St. James's or Beaumont Hospital and radiotherapy services will no longer be provided at St. Luke's Hospital. From 2014, therefore, all publicly funded radiotherapy services in Ireland will be provided as part of an integrated multidisciplinary service involving surgical, medical and radiation oncology services. This is in keeping with the recommendations made in the Hollywood report.

As many will be aware, there are organisations which are very closely associated with St. Luke's Hospital but which are at the same time separate entities. They are not encompassed within the legislation, nor should they be. The Department of Health and Children has liaised closely with the board of St. Luke's Hospial on the future of these organisations — the St. Luke's Institute of Cancer Research and the St. Luke's Cancer Research Fund. The focus of both entities is on cancer research and the continued development of expertise and knowledge and there is widespread agreement that this should continue into the future. The Minister understands the board of St. Luke's Hospital is taking the necessary steps to ensure these organisations continue to have legally sound structures following the enactment of this legislation. She very much welcomes this.

The Minister is also very aware of the significant work done by the Friends of St. Luke's Hospital for many years. To date, it raised more than €26 million in funds for various projects within the hospital. It has been a major force in fund-raising for radiation oncology services during the years and the Minister understands those involved wish to ensure the great goodwill and support for St. Luke's Hospital in the community can continue to benefit cancer patients into the future. This is also to be welcomed.

Another key policy area of the Bill is the reallocation of certain functions from the health sector to the Department of Social Protection. The Government decided some time ago that to increase the effectiveness of the health service generally, it was important that the service concentrated fully on addressing its core health objectives. Accordingly, it was considered there could be scope to transfer certain functions from the health service and locate them more appropriately within other Departments. The subsequent Core Functions of the Health Service Report in 2006 found that there were a number of schemes which were seen more as offering income supports than personal social services.

A number of implementation groups were set up to carry out the transfer of functions. One of these, the interdepartmental implementation group on non-supplementary welfare allowance payments, was given specific responsibility to examine the transfer of responsibility of income supports to the Department of Social Protection. A total of 25,000 domiciliary care allowance cases transferred from the HSE to the Department of Social Protection in 2009. In this context, the infectious diseases maintenance allowance, IDMA, was examined by the group. The IDMA was originally introduced in 1947 for a specified list of diseases, including tuberculosis.

In a situation where policy is moving towards mainstreaming supports for people with a disability, the sustainability of a separate income support payment for a prescribed set of diseases must be questioned. The group found that the key objectives of the IDMA were met by other allowances, in particular, disability allowance and supplementary welfare allowance. The incidence of the specified infectious diseases has been steadily declining and the number in receipt of the allowance in 2009 was very small — fewer than 20. The group, therefore, decided to ask the HSE to examine the small number in receipt of the IDMA with a view to establishing their eligibility and suitability for transfer to an appropriate equivalent Department of Social Protection income support. The HSE completed its examination of the small number of recipients in 2009. It found that some were no longer eligible for the allowance and that others were suitable for transfer to an appropriate Department of Social Protection payment. It should be noted that the weekly payment rates for IDMA, disability allowance and the supplementary welfare allowance were the same and, therefore, those who transferred to a new payment were not disadvantaged. The HSE has informed the Department that no one is currently in receipt of the infectious diseases maintenance allowance and that there are no applications or appeals in hand. Therefore, it has been decided to remove the infectious diseases maintenance allowance from statute by repealing section 44 of the Health Act 1947 and section 36(2) of the Health Act 1953.

I will now outline the principal features of the Bill. Part 1, comprising sections 1 to 4, inclusive, contains standard provisions dealing with the Short Title, commencement, definitions and expenses. Section 3 removes the Health Service Executive's duty to provide an infectious diseases maintenance allowance and also revokes the St. Luke's Hospital Board (Establishment) Order 1999. Parts of the legislation will come into operation by ministerial order and different provisions will be brought into operation at different times.

The specific provisions of the Bill that relate to St. Luke's Hospital are in Part 2, comprising sections 5 to 13, inclusive. Section 5 provides for the board of St. Luke's Hospital to be dissolved. Section 6 provides for the transfer of the land and other property of St. Luke's Hospital to the HSE. The Bill also includes a provision that the site may not be disposed of in any way without the permission of the Minister. Many will be familiar with the location of St. Luke's Hospital and its very attractive grounds. How this site may be used in future will be on many people's minds. The Minister understands that the Friends of St. Luke's Hospital and the board have been considering the future use of the hospital after 2014 and that they intend to submit their proposals to her in the very near future. The Minister stated during the Dáil debates on the Bill that she is committed to St. Luke's remaining within the public health service and that she will consult the Friends of St. Luke's Hospital, the Health Service Executive and other interested parties on how the site could best be used for the benefit of patients in the future. To provide further assurance, the Government introduced an amendment to the Bill on Report Stage in the Dáil which ensures that St. Luke's will continue to be used by the HSE for the delivery of health and personal social services.

Sections 7 to 9, inclusive, are standard provisions dealing with the transfer of rights and liabilities of the St. Luke's board to the HSE, the preservation of contracts and pending legal proceedings.

Section 10 deals with the transfer of St. Luke's staff to the HSE. Staff are being transferred to support the future provision of radiation oncology services within the network model. For staff, some of whom will transfer to other sites in the network at the end of this year and some of whom will remain at St. Luke's for a number of years to come, this provision provides certainty on their future conditions of employment. All current employees of St. Luke's at the date of transfer will become employees of the HSE on conditions and pay that are no less beneficial than those they have currently. All superannuation benefits and reckonable service transfer with the employees. Furthermore, the Bill provides that the pension liabilities of St. Luke's will now become the pension liabilities of the HSE. The Bill provides certainty, therefore, about the future for pensioners of St. Luke's also. These provisions are similar to those under which the national cancer screening service staff transferred to the HSE in April this year.

Sections 11 to 13, inclusive, are standard provisions dealing with the transfer of records and the preparation of a final report and final accounts of the St. Luke's board for submission to the Minister and the Oireachtas.

Part 3, sections 14 to 17, inclusive, deals with various miscellaneous technical and textual amendments. Section 14 updates the definition of "nursing home" in the Health (Nursing Homes) Act 1990 to reflect the new legal framework for the regulation of nursing homes, namely the Health Act 2007.

Section 15 is a technical amendment to the Health Act 2007 to enable a decision by the Chief Inspector of Social Services to take effect immediately in cases where the registered provider or applicant informs the chief inspector that he or she accepts the decision. Section 16 makes textual amendments to the Medical Practitioners Act 2007 to correct typographical errors.

Section 17 updates the definition of "proprietor" in the Nursing Homes Support Scheme Act 2009 to reflect the new legal framework for the regulation of nursing homes. It also amends the definitions of "allowable deduction" and "minimum retained income threshold" to ensure they take account of situations where both members of a couple enter long-term residential care.

The contribution of St. Luke's Hospital board and its staff to the provision of cancer services has been immense. The Minister acknowledges this contribution and thanks the board members, the management and staff for their commitment and dedication. It is also important to say that the board has provided great support and co-operation for the process of integration into the cancer programme.

The Minister looks forward to the ethos and sense of professionalism, which is so much a part of St. Luke's, contributing to the continued successful implementation of the cancer control programme and in particular the new St. Luke's radiation oncology network. I commend the Bill to the House.

I welcome the Minister of State to the House. This legislation, which changes the governance of St. Luke's Hospital, has evoked a strong reaction from the thousands of individuals and their families who have used the services in St. Luke's. That is clearly because of the quality of service those families and individuals have received in St. Luke's. It has led to incredible fund-raising of €26 million, the establishment of institutes and foundations to support cancer research, and an organisation called Friends of St. Luke's Hospital. All that has happened in the past 55 years while the hospital, in the absence of quality cancer care in other areas of the country, fulfilled a vital role.

Since its formal opening in 1954, hundreds of thousands of patients and their families have been through the doors of St. Luke's and experienced quality care. They have not just received medical care. They have received medical and psychological support and, at the most stressful of times, they have had a very good experience in the hospital. That is the reason we have had so many people reacting to the news in the Minister's Bill.

I will read one of the e-mails I got about St. Luke's; I am sure the Minister has received many also. It states:

1. Over 180,000 people have petitioned Dail Eireann to retain St Luke's and all its services.

2. History shows that decisions taken without due care and rationale have enormous consequence; [the person gives some examples].

3. Visit the Facebook ‘Save St Luke's Cancer Hospital'.

I looked at the website and 2,215 people have signed on to the Facebook page in an effort to keep St. Luke's as a viable entity.

It is important that we take account of the holistic and healing ethos in St. Luke's and do whatever we can to bring that forward into whatever new services are being developed. There is no doubt that it is a gem of a service. The quality of people's experience in the hospital has been very good, and the quality of care has been excellent. However, the medical context is now changed. As the Minister of State outlined, we are moving to specialist centres with inter-disciplinary teams where the quality of care is the very best possible, and we hope that will continue.

I welcome the approach the Minister has taken to the lands at St. Luke's, which will be kept for health services. However, I point to the contradiction in what the Minister said on Committee Stage in the Dáil when Deputy James Reilly moved an amendment to the Bill. Will the Minister's staff in the Department re-examine that? On 30 June Deputy Reilly said he would table an amendment on Report Stage to ensure that any review of services or new plan for St. Luke's Hospital would be brought before the health committee. The Minister said in reply that he was happy to agree to Deputy Reilly's suggestion. Before Committee and Report Stages of the Bill in this House I ask the Minister to look again at that amendment which she agreed to accept but which is not met by the amendment tabled in the Dáil during the debate yesterday. I ask that it be examined and built into the Government amendment because it appeared at the time that the Minister was happy to accept that.

I welcome that there will be ongoing discussions between the board of St. Luke's Hospital and the Minister to work out the future use. It is extremely important that we learn from the ethos in St. Luke's and that in developing HSE services that ethos becomes part of what is available to patients under the HSE services which, sadly, have been lacking in quite a number of cases. I do not have the time to go into the details of those now but, unfortunately, it is easy to recall the disappointment many cancer patients experienced at the hands of our medical services in the past six months to a year. I readily acknowledge that there have been very good experiences as well but the experiences of people like Rebecca O'Malley, the late Susie Long, the women in Portlaoise and the people whose X-rays were not read in Tallaght hospital was very bad and we must work constantly to improve the services available.

I support the role of specialist centres. I never had any doubt about it, particularly in regard to breast cancer services, for example. However, we must take account of geographic considerations which are important. Undoubtedly, the outcomes are better in specialist centres and it is vital that we all acknowledge that. I want women and men to have the best possible outcomes. Those affected by cancer deserve the very best care and if we are not engaging in best international practice, that is wrong.

We cannot move people to specialist centres before the specialist centres are properly developed and have the ethos and the support services that have been available in St. Luke's. Many of our general hospitals, for example, were not ready for the designation they got as a specialist centre. We have seen that in Galway and in other hospitals. I note that at the same time we are debating this legislation about moving radiation oncology to Beaumont and St. James's hospitals, 52 beds have been closed in Beaumont Hospital in the same number of weeks. A question arises, therefore, about the timeframe around the development of radiation oncology. Perhaps in her reply, the Minister of State, Deputy Áine Brady, could outline that. She commented on it in her speech. However, I note that the original plan for the development of those specialist centres had a different timeframe and it appears it is being pushed back, probably to 2015. We have stated that the radiation oncology services would move in 2014, but I understand that has already been extended to 2015. Is it likely that the services will continue for a longer period in St. Luke's than is currently envisaged in the Minister of State's speech today? For example, we had been told that there would be two new radiotherapy centres, at St. James's and Beaumont, at the end of 2010 under phase one of the national plan for radiation oncology. They all were supposed to be rolled out by 2011, but that timeframe seems to be in serious question. In principle moving people to specialist services is excellent and in principle outcomes are better, but in practice, if we are unable to develop the services and make them available because of cutbacks and if the support services are not in place, then obviously, it should not happen and the timeframes may well need to be revisited. I have no difficulty in supporting the principle of the Bill.

I also welcome the title St. Luke's Oncology Network. It is important that the title has been kept. It is a positive statement and a positive acknowledgement of the work done in St. Luke's. I hope every effort will be made to support the work of the two research institutes and foundations in their ongoing attempts to get more money for cancer services and to continue the fund-raising work.

I hope the volunteers who are terribly disappointed and the professional staff from St. Luke's will be able to make the transition envisaged positively, and no doubt they will do it in a professional way. I hope their disappointment at the changes being made today will not hamper their ongoing work or will not make them feel disillusioned about the support they have given to cancer services, and, I hope, will continue to give because we need the efforts of all the volunteers in this area. I have been involved for several years with the breast cancer voluntary organisation Europa Donna and I am familiar with the work it has done to support individuals who have breast cancer. Really, a family can never have enough support if a member is going through cancer. The medics and the professionals will never be enough. It always will be about the support that one gets from family and one's wider network and from the volunteers who do such fantastic work with all of these illnesses and offer such brilliant support services. I hope the thousands of people who have given so much to St. Luke's will be able to continue to work for the benefit of cancer patients throughout the country. That is extremely important.

I suppose one of the major criticisms of the HSE has been the lack of the kind of ethos we have seen in St. Luke's. It is a significant challenge for us to turn the HSE, as the overarching supervisor of the health services, into the kind of body able to deliver the quality service that was available in St. Luke's.

I support the Bill. Will the Minister look at the amendment Deputy Reilly tabled? I acknowledge that to some degree the Minister has met his request that the lands would be maintained for health and allied services, and I welcome that. I congratulate and pay tribute to the enormous amount of work that all of those associated with St. Luke's have done over the many years that it has been providing such a tremendous service to Irish people who have had cancer. I hope their work will continue, albeit, perhaps, in a new place but also on the grounds of St. Luke's where the services will take a slightly different format than we have been used to.

I, too, welcome the Minister of State, Deputy Áine Brady, to the Chamber and thank her for her presentation. I am delighted to be associated with the Second Stage of this Bill.

I congratulate my colleague, Senator Fitzgerald. It was a pleasure to listen to her presentation.

She spoke from the heart with such knowledge. I can see she has a genuine compassion and concern for what is happening here today. That probably comes from all sides of the House, where everybody, whether one has had members of one's family or one's friends affected by cancer, knows somebody who has been through St. Luke's. Thankfully, I have never had anybody close to me there, but I have certainly had some good friends who have gone through, received very good treatment and come out the other end, and equally so, ones who did not come out the other end.

What is lovely about St. Luke's, everybody says, is the beautiful serenity, peacefulness and solace. The Minister of State mentioned it when she spoke about the grounds. It is a special place. Really, it is a little oasis tucked away in a busy part of Dublin called Rathgar.

Unfortunately, we are here today to see the winding up of St. Luke's Hospital. I say "unfortunately" with a little smile on my face because we are fortunate also in that our cancer control programme has reached such a level and we are now seeing the establishment of eight new specialist centres. I will always called them "specialist centres", rather than the term "centres of excellence" that is commonly used, because, as I have heard Deputy Áine Brady state previously, every centre that provides health care services is a centre of a excellence but these are specialist centres where there are multidisciplinary teams. I congratulate the former director of the entire cancer programme, Professor Tom Keane, and I wish his successor well in her new role.

No doubt before the national cancer programme was rolled out Ireland had one of the worst records in Europe. Sadly, we all know the sorry tales of the women who have been affected so badly by misdiagnosis of breast cancer, cervical cancer, ovarian cancer — all sorts of cancer. Not alone have women been misdiagnosed, but men have been misdiagnosed.

However, today is not a day to dwell on the national cancer control programme. It is a day for us to pay tribute to St. Luke's and the wonderful work it has done over 55 years. It was set up in 1954. I note Senator Mary White has just come in. Her husband, Pádraic, has been chair of the board for ten years. They always seemed to attract very good, hard-working, progressive caring-type minds to St. Luke's and they carry out their duty in a diligent and — again, I use the word — serene way. Things are done and nobody knows about them, but those who avail of the service certainly know about it. I come back again to speak about the wonderful caring staff. I am glad they will be redeployed and that they can carry on the significant work they have been doing over the years for cancer sufferers.

I was delighted to hear Deputy Áine Brady state that the building and the grounds will be almost ring-fenced and nothing will be done without the Minister's say. Naturally, one cannot leave it as a shrine but it seems to be a very special place. The board of St. Luke's to which I have briefly alluded certainly seems to be caring and hard-working. All boards are hard working, but it is difficult to get that special mix of people who really feel for what they are doing and how they do it. They certainly seem to have it on the board, and the staff are no different to their board.

What does one say about a charity like The Friends of St. Luke's Hospital? Some €26 million is an incredible amount of money to have raised. It is done by people who have had a member of their family suffer cancer or who have been sufferers themselves and have received and continue to receive wonderful treatment in St. Luke's Hospital. As voluntarism is a thing of the past, credit is due to those who have raised such a huge amount of money. Having done voluntary work for different groups and charities, I know what it is like to ask for money and hate doing it. However, it has to be done.

I refer to the reason given for the closure of St. Luke's Hospital. Professor Tom Keane, rightly, has found that the hospital cannot be a stand-alone unit and that its facilities must be transferred to the specialist centre in St. James's Hospital. The wonderful radiotherapy unit will cease to operate in 2014, when the other two units will come into play at St. James's and Beaumont hospitals. I echo the sentiments expressed by Senator Fitzgerald that there is a concern that the date of 2014 will be extended to 2015. I do not see a real problem with this because St. Luke's Hospial will continue to provide a first-class service. I agree the specialist units and multidisciplinary teams are the way to go. Ireland had to come into the real world. As the Minister said yesterday in the House on a completely different matter, we have men and women in the medical world at the height of their careers who are leading the country and its 4.5 million people towards the best global level of health care and that we will be able to hold our heads up. However, there have been hiccups, which we will not deny. With the centres in place, it is to be hoped Ireland will move on and that patients who present with cancers will be treated appropriately. It is to be hoped also that fewer will present because there will be better screening programmes.

I will speak about a parochial matter. I reiterate that I have always supported the moving of smaller units to specialist units and have not changed my position. I supported the transfer of breast cancer services from my own hospital in Sligo. However, I was surprised to find that one of my colleagues had discovered under freedom of information legislation that the service in Galway might not have been ready for the transfer. I have been informed by the cancer support group, Cancer Ireland, that the transition has been made and things are working out well.

I wish those involved in St. Luke's Hospital well in the transition. I congratulate the hospital for the wonderful service it has given the nation in the past 55 years. I thank, in particular, its wonderful, dedicated staff, its wonderful board and the incredible Friends of St. Luke's Hospital which, with the staff and the board, has helped patients to come out the other end. This is wonderful to see, but it is equally important to acknowledge the wonderful comfort and solace St. Luke's Hospital provides for those who will not be fortunate to come out the other end. I know from talking to a person who had a family member in the hospital that it was the most wonderful place for the person concerned to end their days and find solace.

I wish the Bill well and look forward to the debate on the remaining Stages. It is lovely to see everyone singing from the same hymn sheet on legislation. I congratulate the Department for dealing with the matter so sensitively and the Minister of State for presenting the Bill.

I am delighted to welcome the Minister of State. I support the Bill, but I have a few questions to ask about it.

My colleagues and I have received an amount of correspondence on the following issue. I am aware there has been a delay in timelines in moving from the site. The move was due to take place in 2011. The date was extended first to 2014 and now to 2015. There will always be factors influencing the roll-out of any closure or change of use. I am aware that patients will be treated in St. James's Hospital and Beaumont Hospital. There will be an impact because of the closure of 65 beds in Beaumont Hospital and the moratorium on staff recruitment.

I recently received an e-mail from a lovely woman:

Saving St Lukes is more than the building and the lands but it is retaining the hospital as it is and even adding to what it can do, rather than winding it down. Currently patients attending St Lukes receive more than the standard care and develop what can only be called a close relationship with both the team they deal with and indeed all the staff who work in St Lukes, as opposed to attending for similar facilities in other more mainstream hospitals where patients feel they are on a conveyor belt and indeed keel over if a staff member knows their name without looking at a file!

Surely, you have to agree, that in these darkened days patients need and deserve the light into their lives that the staff and facilities in St Lukes bring to them.

I urge you on behalf of these, and future patients, to vote against the Bill.

I can accept the concepts expressed in that e-mail. St. Luke's Hospital has been caring for cancer patients for more than 50 years. Its website notes that it is truly "A Haven in Rathgar" for the thousands of patients from all over Ireland treated there each year. A history of the hospital, with this title, was published in December 2007. A family member of mine was treated there and was treated very well. I am aware that when it comes to the treatment of patients, the building in which they are treated can have a big psychological effect on their ability to recover. Sometimes not enough attention is paid to the holistic aspects of cancer treatment. Patients employ different ways of dealing with their diagnosis. It is the case that their personal circumstances can be helped by the way they are nursed. The mission statement of St. Luke's Hospital is linked with its surroundings; the hospital is an oasis when it seems there is chaos everywhere else in the health service.

I recently attended a seminar in the Coombe Women's Hospital. I arrived very early in the morning. As I worked as a midwife in a hospital for many years, I am very conscious of how people from outside view what is seen as normal by those working in a hospital and how they deal with people. The environment of a hospital is very familiar to those who work in it. They are familiar with directional signs and instructions such as the red arrow pointing to the maternity ward, the green arrow pointing to the X-ray department and the blue line pointing somewhere else. They try to make it easy for people, but it can only be descsribed as chaotic for those trying to identify the different roles played by staff in a hospital. For instance, I was never comfortable looking at name tags because I always thought I should know the individuals concerned. As I was involved in politics, everyone thought I should know them when, in fact, I was the worst person in the world for remembering people's names.

Has the Minister of State engaged with the Friends of St. Luke's Hospital and the board of St. Luke's Hospital? Have they made proposals? I know this is departing somewhat from the topic. It was sad to read Ms Orla Tinsley inThe Irish Times and to hear her on “Liveline” discussing how the cystic fibrosis unit has not gone ahead and what this means for those in her situation, where being isolated is a major factor in preventing cross-infection, which has catastrophic effects on their health. For people who have illnesses and whose immune system is bombarded by treatment such as chemotherapy and radiotherapy, isolation is an important aspect of treatment. There is nothing like a natural setting where fresh air is part of it. My general nursing training was at Waterford Regional Hospital. All of the wards were laid out as sanatoriums because the building used to be a sanatorium. Every ward had four beds and full double doors on to a veranda. When I worked in the orthopaedic unit and we had fine young lads in with broken legs because of their antics, we used to put them in the sun on the veranda. We did not have information on putting people in the sun and letting them get fried but we did not do that, we used to do it for only a few hours. It is important to have a good diet, fresh air, a calm environment, good music, good therapists and people with the best interests of patients and their outcomes at the top of the agenda. I agree with specialist centres but sometimes people need to have a moment to give someone some time. Surroundings are particularly important and the idea of an isolated garden, waterfalls and music or art therapy within the footprint of a modern hospital means that St. Luke’s Hospital, Rathgar, is a gem. These factors are so important to people.

An earlier contribution referred to fundraising and the €26 million raised by Friends of St. Luke's Hospital. I compliment those who raise funds. I have never passed a fundraising container for St. Luke's. This was the case before I ever had a personal need for it. St. Luke's Hospital is synonymous with excellent care. One of the issues concerns the future of the site. People would like to know the site is enshrined so that the Minister has the final say, with this taking into account the views of relatives.

I refer to the rollout of colorectal screening. I looked at the national cancer registry and saw that between 2005 and 2007, an annual average of more than 27,000 new cancers were registered. The most common was prostate cancer, with 2,462 cases. We spoke briefly about the heartsafe programme and people taking responsibility for their health. All men over 40 years of age should have their PSA checked. This is a blood test to detect prostate cancer. We have a regular NCT for cars and people should have the same for themselves. This should include screening programmes such as BreastCheck. Breast cancer is the second most common at 2,335 cases and colorectal accounted for 2,156 cases. Lung cancer accounted for 1,118 cases, which is a major amount even though it is reducing because people have more of an idea of the risk factors associated with smoking. The risk of developing cancer is 6.6 per 1,000. Early screening, detection and prevention is key in respect of how we treat and manage people. We are talking about a facility that gave the very best care to people with cancer.

I refer to the new radiation technology at St. Luke's Hospital, which will improve survival and quality of life for cancer patients. This was the first public hospital in Ireland to make the most advanced technology available to patients. This provided great comfort for those who were treated and will continue to be treated at St Luke's Hospital until the timeline for relocation has been finalised. If the answers about the future use of this site can be clearly indicated, people will be happy with the outcome. I thank the Minister of State for her attention.

I welcome the Minister of State. Her speech was comprehensive and to the point. I acknowledge the quality of speeches today. It is an honour to speak in such a debate. There have been some responsible and heartfelt points made by Members. I note I am following a number of lady speakers. Every Member who spoke heretofore has been a lady. This demonstrates the caring nature of women and the need for women in politics. This debate is about an older facility, into which great love, care and attention has gone. This caring facility has thrived because of the major community effort people put into it. The reality is that the old infirmary building is no longer up to the task of providing top-level facilities needed in the modern era in rolling forward the national cancer programme, which everyone in the House is behind.

Health care should not be considered from the point of buildings alone. Health care is about people, not about buildings. When we talk about St. Luke's, I hope we are not talking about the closure of St. Luke's. Not only is there a building, there is an ethos and years of history. People have put great effort into what St. Luke's is today and it is essential that every effort is made to ensure those who put in the effort are accommodated and facilitated in terms of their knowledge and the work they have done so that they become part of the new service in so far as possible.

We have a major problem here, with cancer increasing by 41% between 1994 and 2015. We spoke about sunbeds recently. When we have such debates, it is important not to talk only about cancer care but also about cancer prevention. Good and all as St. Luke's, St. James's Hospital and the new national cancer programme are, we do not want our people getting cancer. We want to minimise the risk of cancer. It is possible to propose measures that minimise these risks.

The population is projected to increase to 4.3 million by 2015 even though there is a certain amount of emigration. We must upgrade our facilities and ensure the HSE is as efficient as we can make it. Any Government will contend with this problem, whether the HSE or another structure is governing health care. It is important to have an efficient and caring system.

My fear regarding this issue is that this Bill pertains to a system that was based to a great extent on caring and that worked with facilities that were neither the most modern nor the most up-to-date. Although the intention is to move to a highly technical process using very good facilities, we may be losing something in terms of caring. Caring should never be lost from the health services because it is the way in which so many people get better. I refer to how people who may not feel cared for but who understand they are getting the best medicines would have an ability to recover much faster. I believe Senator Fitzgerald used the word "holistic" and while many people do not understand the word, holistic health is highly important. As for people being in the right frame of mind, many studies have backed up the importance of mental and emotional linkages to good physical health.

Radiation therapy itself is an important treatment that is used in cancer management by 50% to 60% of patients and is successful. It is used in the clinical management of a limited number of non-malignant medical conditions and two major types of radiation therapy exist, namely, external beam and brachytherapy. I acknowledge that between 1960 and the 1990s, many centres were undeveloped. However, the work of Professor Keane has been mentioned and there has been a huge initiative on the part of the Government, the body politic and the HSE to improve cancer care services.

I refer to the reason there has been such an increase in the rate of cancer, which is a matter that must be examined constantly. In some cases, it is because people, who are living longer, now live long enough to get cancer. At the same time however, one must consider both the environment and environmental health, as well as what actually is causing cancer. As I stated, holistic health pertains to all aspects of health and not simply to treating illness when it has developed. It is not about allowing or even encouraging people to live unhealthy lifestyles and then trying to patch them up when unfortunately they become ill. It should be about living as healthy a lifestyle as possible in order that one avoids the diseases in the first place.

I welcome the Minister of State. St. Luke's Hospital, Rathgar, which has cared for patients for more than 50 years, has a reputation for excellence of treatment and devoted care of patients that is exceptional. The Bill before Members provides for the dissolution of the board, which then will become the responsibility of the HSE and specifically of the national cancer control programme. It is important to note that St. Luke's will continue to provide specialist radiotherapy and related services at Rathgar for the next four to five years until the planned facilities at St. James's and Beaumont hospitals come on-stream fully.

I welcome the significant provision in the Bill that the final decision on the long-term use of the beautiful and tranquil site will lie with the Minister and that the intention is to retain it for health purposes. I strongly advocate its use for support services for cancer patients in the future. I am aware that the board of the hospital and the Friends of St. Luke's Hospital will present a proposal on these lines to the Minister in the near future.

I pay tribute to the board, management and staff of St. Luke's. They and their predecessors can be proud of the service and ethos they built up over the years. All those staff will continue to contribute their expertise and service either at St. Luke's or at the other patients' centres in Dublin in the future. I also wish to acknowledge the passionate commitment of Mr. Joe Guilfoyle from County Waterford and the commitment of the patient support group led by him. In addition, I commend the work of the Friends of St. Luke's Hospital in mobilising funds and support for the hospital in every parish in Ireland. I acknowledge the role of the current chairman, Peter Byers, and his predecessor, David O'Halloran. It is fitting that the new radiation oncology network in Dublin involving St. James's and Beaumont hospitals is called the St. Luke's radiation oncology network.

Finally, I wish to put on record that my husband, Padraic White, was the chairman of the board of St. Luke's for the past ten years and I commend him on his dedication and his belief in the ethos and staff of St. Luke's, who provided an oasis for those with cancer in Ireland.

Cuirim fáilte roimh an Aire Stáit. Despite the comments by a previous speaker to the effect that it was great to have cross-party support on some legislation, that Member was misguided because my party and I completely reject this legislation.

Ar mo bhealach isteach go dtí an tSeanaid casadh beirt as mo cheantar féin, as paróiste Ghaoth Dobhair orm, sa halla. Is comharsa béal dorais é duine acu agus níl siúl fada idir an duine eile agus mé féin. Tá aithne mhaith agam orthu agus tá aithne mhaith ag ár dteaghlaigh ar a chéile. Dúradh liom go raibh siad istigh anseo inniu de shiocair an Bhille seo atá ag dul tríd Tithe an Oireachtais. Dúirt siad liom go bhfuil siad féin amuigh i St. Luke's anois le sé nó seacht seachtaine anuas, go bhfuil ailse orthu agus go bhfuil siad ag fáil seirbhíse den chéad scoth ó St. Lukes. Níl siadsan ag iarraidh go ndúnfar an tseirbhís seo i 2014 mar atá beartaithe ag an Rialtas a dhéanamh. Leis an reachtaíocht seo, fágann an Rialtas an doras oscailte fá choinne sin. Chuir an méid a dúirt siad liom ina luí ormsa cé chomh tábhachtach agus atá an seirbhís i St. Lukes. Tá dlúthcheangal idir muintir Dhún na nGall agus ospidéal St. Luke's. Beidh mise ag cur in éadan an Bhille seo. Níor cheart dúinn, nuair atá seirbhísí maithe ann agus ospidéal againn atá ag cur ar fáil seirbhísí den chéad scoth, a bheith ag dúnadh na seirbhísí sin. Ba cheart dúinn a bheith ag cur leo agus ag tabhairt tacaíochta dóibh.

As I was walking into the Chamber to give my Second Stage speech, I met two gentlemen from my parish who are friends of mine and my family for many years. One is a next door neighbour and the other is from the same townland. They told me they were present to express their concerns regarding the passage of this Bill through the Seanad. They mentioned that both of them were availing of the services at St. Luke's and are undergoing treatment there at present. The decision of patients of St. Luke's Hospital to come into Leinster House today demonstrates their affinity and grá for that hospital. They had nothing but praise for the service provided there. This Bill provides for the discontinuation of such services for cancer patients and as such constitutes an attack upon the sick. Therefore, my support and that of my party will not be forthcoming.

The Bill principally deals with the discontinuation of services at St. Luke's Hospital for cancer. As previously noted, more than 180,000 people have signed a petition to the Dáil and Seanad appealing to Members as representatives and as the jury in this case to vote against this cruel and drastic legislation. This Bill is little more than an attack on the sick. One hears hear much about the Government's plans regarding centres of excellence. However, although St. Luke's has been a centre of excellence for many years, the Government, in a cynical and cruel move, wishes to close it in the future. Similar scenarios have arisen in my native county, in which two community hospitals, one of which also is a nursing home, are under threat of immediate closure by the HSE and the Government. That is simply one example of what the Government is doing to health services.

As I noted earlier, many people from County Donegal have a strong affinity with St. Luke's and either have been treated there or have had loved ones treated there. No one to whom I have had the chance to talk has had anything but praise for the services that were made available to them while in St. Luke's. I make this point in respect of people from my parish who must travel for four and a half hours to get to St. Luke's and who understand the services that are available there. However, they also understand that County Donegal and the north west have been completely left out of the radiation oncology plan proposed by the Minister for Health and Children and the HSE in which it is proposed that no centre of excellence will be situated north of a line from Dublin to Galway. That is nothing short of a scandal and the decision must be revisited.

Health care services across the State are in crisis. The HSE has been exposed many times as being grossly incompetent and unfit to run a health service. The Government tries to hide behind it, but central to the HSE's failure is the disastrous health policy of the Government.

The experience of St. Luke's Hospital is replicated around the country. The Government wishes to downgrade or close hospitals. It is following a policy of over-centralisation and the privatisation of services. This policy rewards the private health care sector with land on public hospital sites and tax breaks to develop private for-profit hospitals. At the same time the Government wishes to close long-standing, tried and trusted facilities such as those provided in St. Luke's Hospital. Across the country cancer patients have been denied life-saving opportunities because successive Governments have failed to provide the radiation oncology facilities required. The Government has had ample time and the benefit of a booming economy to plan and budget for the provision of radiotherapy centres across the country. The State could and should have taken the lead and provided these centres as public facilities open to all on the basis of need alone. Instead the Government committed itself to entering public private partnerships to deliver them.

Very few Members are unaffected by cancer. Withdrawing services from St. Luke's Hospital is little more than an attack on people who are suffering. This proposal made by the Government to close St. Luke's Hospital as a cancer centre by 2014 should be opposed by everyone who believes people have a right to decent health care. I will vote against the Bill and urge everyone who referred to the 180,000 people who had petitioned them to listen to their voices, including of those who have survived cancer and been treated in St. Luke's Hospital and who are pleading with us not to pass the legislation and to reject the Bill outright. I urge Senators to join me in doing so today.

I wish to share time with Senator Dearey.

I welcome the Minister of State, Deputy Áine Brady. As other colleagues have done, I pay tribute to all the staff in St. Luke's Hospital for their enormous work, dedication and commitment to patients which are not alone evident in the treatment outcomes for patients but also in the confidence, security and comfort with which they have been able to receive treatment. This can only have come about through the tremendous efforts made by staff in the hospital who have gone beyond the call of duty. I give credit also to those who have supported the hospital, who have raised funding, volunteered or given of their time in other ways. Their efforts have resulted in the provision of an outstandingly high standard of service.

I was struck by the level of concern expressed at talk of a change in St. Luke's Hospital when the Bill was published. There were concerns that this would signal the end of the hospital and the excellent service provided therein. That is a reflection of the high regard in which the hospital is held. It is also symptomatic of the degree of uncertainty in the face of change. It is important that we put the matter in context. This is about taking the next step forward in enhancing cancer services. I have great regard for Professor Tom Keane who has led the programme that has resulted in concrete and tangible achievements. In the years to come a greater number will survive cancer because of the steps that have been taken in the national cancer programme. The proposed developments in the Bill represent part of the next step to enhance the level of service and increase the capacity, effectiveness and efficiency of the service.

I welcome the two new radiotherapy centres at St. James's and Beaumont hospitals; the former will open at the end of this year and the latter early in 2011. What was especially important about them opening within that timeframe was that one of the concerns expressed was that perhaps services in St. Luke's Hospital might come to an end before the new centres were opened. That they are due to open by the end of this year and early next year and that services will continue in St. Luke's Hospital until 2014 is important in terms of service delivery. The centres in St. James's and Beaumont hospitals will be well served by taking the lead of St. Luke's Hospital in the delivery of services. It is important that under the Bill everyone will be brought under the umbrella of the same service in terms of co-ordination and inter-agency co-operation. In all of the reports, whether they relate to direct service provision or general health services, one of the deficits that is constantly identified is that there is not enough inter-agency co-ordination and co-operation. The Bill is a positive step forward in ensuring we tackle this aspect from the outset. I pay tribute to all involved and reassure people that this is a positive step forward. There will not be a discontinuation of services. The Bill is about increasing and enhancing the level of service, not diminishing it.

I thank Senator Corrigan for sharing time with me.

I have a particular interest in this issue. I do not like to drag my good wife into the debate, but she has worked in St. Luke's Hospital and the cancer centre in Belfast as a senior radiation therapist. As such, she has a particular insight into the issues involved. I asked her the other night whether patients from County Donegal being treated in the cancer centre in Belfast received enhanced treatment as compared to the excellent treatment they had received during the years in St. Luke's Hospital. She was in absolutely no doubt that the clinical setting was critical when it came to cancer treatment and that placing a cancer treatment centre in the heart of a large hospital, with all disciplines and specialisms on-site, would undoubtedly result in better outcomes for patients. To characterise the move as an attack on the sick is convenient sloganeering, but it is not factually correct. That comes from my own resident expert. I recognise the fantastic work done in St. Luke's Hospital and also the fact that better practices should be pursued.

I welcome the Minister of State, Deputy Áine Brady. I also welcome the advances made in cancer care in recent years. I fully support the concept of having eight centres of excellence, providing for enhanced services and with multidisciplinary teams in place. We must have these facilities; that is what the experts say. We have heard what Senator Dearey's wife said about multidisciplinary teams and the enhancement of services. We must have such centres and they must be staffed adequately. We must get them up and running to avoid the misdiagnoses that have occurred in many hospitals in recent years, which was an absolute scandal.

There is no question but that we are going down the right path by having centres of excellence but we should not close down facilities until similar ones are put in their place. This has been alluded to by Senator Feeney, who referred to Sligo. Facilities were closed down in Sligo before adequate facilities were put in place in Galway. That should not happen elsewhere. There should be an orderly closure of facilities only after their replacement has been provided. This is a fair suggestion.

Radiation oncology and radiotherapy have been a burning issue in Waterford for many years. The Minister of State spoke of centres of excellence in Dublin, Cork and Galway and referred to the north west. In passing, she mentioned Waterford. Our debate pack on the Bill also glosses over Waterford. It states: "In addition, the Government has also decided that in the further development of services, consideration should be given to developing satellite centres at Waterford".

I presume the Government is fully committed to providing radiotherapy facilities in Waterford. The deadline for provision of a number of the centres seems to have been extended in several areas for some of the disciplines. I want the Minister of State to let me know today, or if not today fairly soon, the timeframe for provision of radiotherapy facilities in Waterford Regional Hospital in the south-east region. At present, we are lucky there is a private hospital, the Whitfield Clinic, providing radiotherapy for patients in the south east under an arrangement between it and the HSE. However, there is a commitment from the Government and I want to know the timeframe for the development of cancer services, especially radiotherapy services and the linear accelerators necessary at Waterford Regional Hospital.

St. Luke's Hospital has been a beacon of light for more than 50 years for those suffering from cancer. Its day of downgrading is a sad day. We have had representations on this from many people. I have known Mr. Joe Guilfoyle, chairman of the support group, for many years. People are angry and sorrowful to see the downgrading of such a wonderful hospital, bearing in mind the serenity and treatment it afforded to patients down through the years. I am glad the facility will remain open and that radiotherapy and other services will continue until 2014. Perhaps the Minster of State will clarify this.

St. Luke's Hospital has been a haven of care, security and tranquility for people who have suffered from cancer. Patients and their families love the hospital. I hear this daily. I welcome the announcement, which I hope is not just words, that the hospital and its grounds will be used for health services. It could be used as a step-down facility for those recovering from cancer. It could be used in many other ways. It should not be lost to the health system. I hope the words spoken will be honoured.

I am disappointed the deadline has been extended. All the deadlines have not been met in regard to the centres of excellence. I hope we can expedite the development of the eight regional cancer services and that they will be in place before we close down any other units.

I join Senator Cummins and others in expressing regret over the downgrading of St. Luke's Hospital. I acknowledge the work it has done and the care it has provided to thousands of patients who received treatment in the facility over the years. Its work was brought home to me a couple of years ago when the eight year old son of my cousin had cancer. He received his treatment in St. Luke's. It was very convenient for the family to be able to stay just around the corner from the hospital. Subsequently, little Luke Roche died of his illness but I know the care he and his family received in St. Luke's was remarkable. The family was very happy with the way he was treated.

I echo the comments of Senator Cummins on radiotherapy services for the south east. It is a long-running political issue in the region. The Government made commitments on the provision of public radiotherapy facilities for the region but it seems from the Minister of State's comments that they have drifted far down the list of priorities. Perhaps she will clarify her statements in her concluding remarks.

Part 3 deals with amendments to the nursing home legislation. This covers a contentious issue that has been discussed many times in the House in recent months. Supported care homes are being treated as nursing homes by HIQA in terms of the application of standards. Will the Minister of State, when concluding, state whether a change of legislation is required to ensure these homes, which are not nursing homes, will not be covered by the HIQA standards? This is because they were never intended to provide 24-hour nursing care for those living in them. They are just supported care homes, mostly for single people who want sheltered accommodation towards the end of their lives. Would a ministerial regulation be sufficient to ensure the supported care homes will not be in the same category as nursing homes according to HIQA standards.

There are six supported care homes in Kilkenny. We all acknowledge that standards are needed for them and for nursing homes, but they are not nursing homes. When people's requirements are such that they need nursing home care, they leave the supported care homes to go to the public facilities in Thomastown or Castlecomer, or the private facilities available throughout the county.

There is a section in the legislation that deals with nursing homes and changes to the definition of their proprietors. The Minister of State may be able to answer my questions. Yesterday she was present to speak on the unemployment motion. I have been asking the Leader for a long time to invite the Minister of State to the House to talk about this issue. It is through the efforts of a very well-known Kilkenny man, Dr. Peter Birch, who was Bishop of Ossory for several years, that much church property was handed over to local communities for the provision of supported care homes. Dr. Birch was very much ahead of his time. Supported care homes are not nursing homes and were never designed to be such, yet they are being penalised as if they were under the standards of HIQA. If applied, these standards will ultimately result in the homes' closure. That is why I seek a response on this issue.

I thank the Senators for their participation in this 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.

The Bill provides for the discontinuance of the infectious diseases maintenance allowance, originally introduced in 1947. It provides for technical amendments to the Nursing Home Support Scheme Act 2009 and the Health (Nursing Homes) Act 1990 to assist in their interpretation. It also makes a technical amendment to the Health Act 2007, which relates to decisions taken under section 55 of that Act. It makes textual amendments to the Medical Practitioners Act 2007 to correct typographical errors.

The incidence of cancer is continuing to rise, as figures from our national cancer registry show. We must have the necessary radiation oncology facilities to meet requirements to ensure the best possible outcomes for cancer patients are achieved. By the beginning of 2011 with the establishment of the St. Luke's network, radiation oncology services will be provided at St. Luke's Hospital, St. James's Hospital and Beaumont Hospital. The number of linear accelerators will increase from eight at St. Luke's Hospital to 12 in the network. High quality radiotherapy services will be delivered in an integrated fashion across the three Dublin sites by the network, which will report to the director of the national cancer control programme.

The new facilities at St. James's Hospital will open in 2010 and those at Beaumont Hospital will open in early 2011. St. Luke's Hospital will also continue to provide radiotherapy until at least 2014. Additional funding and staffing have been provided this year to the national cancer control programme to open the services at St. James's Hospital and Beaumont Hospital. Twelve beds will be available in both hospitals for radiotherapy patients. The new facilities will ensure sufficient capacity for patients until 2015, when additional facilities and capacity will be completed under phase 2 of the national plan for radiation oncology.

To answer Senators Cummins and Phelan, the Government is firmly committed to its decision under phase 2 for a radiotherapy centre in Waterford by 2015. The HSE pays for public patients in Waterford to be treated in the local private radiotherapy clinic in Whitfield.

The Hollywood report on the development of radiation oncology services noted that optimal treatment outcomes are achieved through the close co-ordination of radiation, surgical and medical oncology and palliative care services. Effective treatment for patients will often require these treatment modalities to be combined simultaneously 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. Therefore, it is 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 cancer centres under the cancer programme should result in the best outcomes for patients.

During the Bill's passage through the Dáil, people expressed concerns about the future use of St. Luke's Hospital and fears that the intention was to sell the site. This is not the case, as St. Luke's Hospital will continue to provide radiotherapy services until at least 2014. After that time, it is the Minister's intention to use the site for health care purposes yet to be determined. In answer to Senator Prendergast, the Minister has met the chair of the board a number of times. She will meet the Friends of St. Luke's on 8 July to hear that group's proposals on the hospital's future after 2014. Colorectal cancer screening will commence in early 2012 and the preparatory work is under way. Screening will be offered to all people aged between 60 and 69 years.

Despite the Minister's assurances on the future of St. Luke's Hospital, concerns are still appearing. Accordingly, the Minister introduced an amendment, which has since been accepted, to ensure the hospital will be used for health care purposes by the HSE, that is, health and personal social services in accordance with the Health Act 2004. The Minister was happy to table this amendment in a bid to bring certainty to her position as outlined and to respond to the concerns expressed.

The St. Luke's network model will provide a single clinical governance and management structure across the eastern region to deliver a service to patients in line with best international standards. This also means a significant increase in radiotherapy capacity in the public system in Dublin and the east, with 12 instead of eight linear accelerators. Further development under phase 2 of the national plan for radiation oncology will see capacity increase further to meet future needs.

On the Bill's enactment, staff at St. Luke's Hospital will become HSE staff and, therefore, will be able to work across the hospitals in the network under this governance structure. The network's establishment and the involvement of St. Luke's Hospital's staff in all three centres from the beginning will enable the new centres to reflect the successful patient-centric model that the hospital represents.

I might be handling the carers matter in the Seanad next week. If not, I would be delighted to meet Senator Phelan privately concerning the supported care home issue. I cannot answer him now.

I thank Senators for their contributions. The Minister looks forward to the remaining Stages, at which time the opinions tabled will be considered in detail. I commend the Bill to the House.

Question put.

The question has been put and Senator Doherty has called for a division of the House. However, as he is unable to provide a second teller, the division cannot proceed.

Question declared carried.

When is it proposed to take Committee Stage?

On Tuesday next, 6 July 2010.

Is that agreed? Agreed.

Committee Stage ordered for Tuesday, 6 July 2010.