Health (Miscellaneous Provisions) Bill 2010: Committee Stage

Apologies have been received from Deputies O'Connor and Neville. It is proposed that we sit until 2 p.m. but I am hoping members will not require that much time to deal with the business before us, but we are in their hands. A briefing note on the amendments has been circulated to members for their information.

Sections 1 to 5, inclusive, agreed to.
SECTION 6

Amendment No. 1 is in the name of Deputy O'Sullivan who has not yet joined us.

In her absence, may I speak to the amendment?

Yes. I ask the Deputy to move the amendment.

I move amendment No. 1:

In page 4, subsection (5), lines 29 to 31, to delete all words from and including "may" in line 29 down to and including "section" in line 31 and substitute the following:

"may not dispose of any land (including buildings) vested in it by this section and must continue to use the land (including buildings) vested in it by this section for medical purposes related to the treatment of cancer in public patients in a manner and form determined by the Executive with the consent of the Minister".

Deputy O'Sullivan has arrived. I have moved the amendment for her. She might like to address it.

Has the committee reached that point already?

Apologies, Chairman.

That is fine. The Deputy can take her time.

Did members go through the preceding sections?

The amendment seeks to ensure St. Luke's Hospital will be retained for public use, particularly in the provision of cancer treatment services. We all spoke in the Dáil Chamber on Second Stage on the services provided in the hospital and the ethos of the hospital and mentioned that it was a haven of calm in the Rathgar area of Dublin. The amendment seeks to ensure it will be retained for the purposes for which it has been used. The Minister has indicated that it will form part of the oncology services network in Dublin and that it will provide radiological services. I have tabled the amendment to ensure that will be the case. People throughout the country have highlighted the importance of the hospital in how it assists patients in their recovery, not simply in the medical treatment they receive but also in the atmosphere to be found there which is unique and something we do not want to lose in the health service.

We have been given a commitment that St. Luke's Hospital will form part of the network up to 2014, but what are the Minister's intentions for the hospital post-2014? Under the cancer programme, we have a system of centres affiliated to larger so-called centres of excellence. For example, Limerick Regional Hospital and Waterford Regional Hospital are directly connected with centres of excellence. There is also a proposal that a satellite centre in County Donegal will be linked with a larger centre. St. Luke's Hospital could play a similar role as part of a larger Dublin network controlled by experts. The purpose of the amendment is to ensure the service the hospital has provided for patients in Dublin and throughout the country and its unique atmosphere, to which many have attested, will be maintained. I urge the Minister to consider the amendment favourably.

Pending the outcome of our deliberations on the amendment, I give notice, on behalf of the Fine Gael Party, that a further amendment will be tabled on this matter on Report Stage. I echo the words of Deputy O'Sullivan and reiterate comments I made in the Dáil Chamber. The ethos of St. Luke's Hospital is remarkable and the outstanding service it has provided is held in the highest esteem in the health service, notwithstanding the many problems experienced in the health system in recent years. The spirit of the amendment is to ensure the ethos of the hospital will not be lost and that there will be some level of certainty about its future after 2014. I respectfully suggest there be no change in the use of the hospital without the matter being first discussed at this committee. If a review of services takes place in 2014, the relevant Minister should place it before the committee for its consideration.

I reiterate the points madevis-à-vis the role of St. Luke’s Hospital as a safe haven. In so doing I am mindful of a recurring theme in the Health Service Executive, namely, its practice of removing services today with a promise of nirvana tomorrow. Unfortunately, tomorrow never comes. Following the passing of this legislation, responsibility for the management of St. Luke’s Hospital will transfer to the Health Service Executive. All of us are concerned to ensure appropriate and necessary services will be retained at the hospital. Notwithstanding the development of new services, notably radiological oncology services, at St. James’s Hospital and Beaumont Hospital, the Minister has indicated to the committee previously that the number of cancer cases is expected to double in the next 20 years. It is, therefore, highly likely that we will require the retention of the services provided in St. Luke’s Hospital.

St. Luke's Hospital provides a unique environment which will remain important in the treatment of cancer. Cancer care is very much about the whole patient. It is not solely about white cell counts and the radiation dosage but also about providing patients with sociological and psychological support in facilities such as St. Luke's Hospital.

On Monday I visited Lifford, Ballyshannon and Stranorlar in County Donegal where people were concerned about cancer services and were looking forward to the provision of a radiation oncology service locally. Until such time, many in counties Cavan, Monaghan and Kildare, among others, will continue to depend on the facilities provided in St. Luke's Hospital.

Members may not be aware that radiation only takes a few moments to complete. Patients commencing a course of treatment are usually relatively strong but become debilitated and weak by the fourth or fifth week of treatment, at which point travel is no longer an option. For years St. Luke's Hospital has offered patients who need to minimise travel an opportunity to stay locally. I fully support the amendment and, depending on the outcome, will table a further amendment on Report Stage.

While I do not have a problem with the spirit of the amendment, I have a difficulty with its practical application from the point of view of the Minister and Health Service Executive. Deputy Reilly referred to care for the whole patient. I have always held the view that as many services as possible should be provided under one roof. The treatment of cancer in a single hospital is not as good for patients as being treated in a general hospital in which patients have access to a range of other services that they frequently and regrettably need.

I am not in favour of tying the hands of the Minister or the HSE by an amendment of this nature. I would like St. Luke's Hospital to continue to provide services if this option is practical, appropriate and delivers value for money. Detailed work needs to be done and a judgment must be made as to whether it would be in the best interests of the health service to maintain the hospital. I certainly do not have a difficulty with acute cancer services transferring elsewhere.

As I am not a member of the committee, I am grateful to the Chairman for his indulgence in permitting me to speak in favour of the amendment. In my Second Stage contribution to the Bill I accepted that a significant body of expert opinion supported the view that it was necessary to make surgical treatment available in conjunction with oncology treatment. I do not have sufficient expertise to dispute this view.

I have worked with the Friends of St. Luke's Hospital, visited the hospital on many occasions and become familiar with a broad range of people from my constituency of Dublin South-East and other parts of the country who have used its services. Deputy Reilly referred to people from counties Donegal, Cavan and Monaghan. Many generations of families from around the country have benefited from the extraordinary care provided by St. Luke's Hospital. The amendment reflects the desire and determination of people the length and breadth of the country who have been touched by cancer and benefited from the wonderful care available to preserve the hospital for cancer treatment and care services. This may entail making palliative care or after care services available on the site.

As I argued on Second Stage, the Department and specifically the Minister must provide a clear expression of intent with regard to the future of St. Luke's Hospital. I am aware that the decision on the hospital is a legacy of the Minister's predecessor in the Department, the current Minister for Foreign Affairs, Deputy Martin. Both Ministers stated on numerous occasions in the Dáil Chamber that they are committed to retaining the ethos of the hospital and the high standards of care provided. While I appreciate and welcome this commitment, we have never received a clear statement on what it will mean in practice and what are the Minister's intentions for the hospital. Having debated the Bill for some weeks, I ask her to avail of this opportunity to set out a vision for the hospital and how it can best play a part in continuing to deliver high quality care services for cancer patients. I would welcome a commitment from her to retain the building which was, I understand, designated a protected structure recently for the benefit of cancer patients long into the future.

Deputy O'Hanlon referred to the need to ensure value for money and long-term benefits under the ultimate cancer care strategy as set out by the Department of Health and Children and the Health Service Executive. While that is important, it would be a pity if value for money was the only objective. It is not simply a question of value for money, it is also a question of retaining a high standard of care for people who are ill and require a certain level of care. In that regard, St. Luke's Hospital is ahead of the rest. It is not a scientific assessment, but if one looks atratemyhospital.ie, it is rated by patients above virtually every other hospital in the country. Ultimately, patients are the barometer, as they are the ones who benefit from the high standard of care available in St. Luke’s Hospital.

I very much support the amendment. If it is not acceptable to the Minister, perhaps she might consider Deputy Reilly's amendment on Report Stage. It is important that a clear commitment is made to retain St. Luke's Hospital for the benefit of cancer patients in the future.

It is important to recap on why we are where we are on this issue. In 2003 the Government published its radiation oncology plan which strongly recommended that radiation services should be integrated with surgical and oncology services. That is why we are doing this. Subsequent to the plan, an international evaluation took place of all of the facilities in the country, including St. Luke's Hospital. All hospitals were evaluated according to five criteria. I will be happy to let the Deputies opposite have a copy of the evaluation. St. Luke's Hospital had a score of 46.7 as against 85 for St. James's Hospital.

There is virtually unanimous support among the experts for the cancer control programme. I am aware of only one expert who does not support it. It is seen to be delivering for patients. Central to the strategy is the integration of treatment services in a multidisciplinary unit environment. That is why the service will be provided in Dublin at Beaumont and St. James's hospitals. The facility in St. James's Hospital will be available later this year an in Beaumont Hospital next year. We are spending more than €58 million.

St. Luke's Hospital has a track record, reputation and an ethos because until relatively recently anyone who received radiation oncology services in this country received them in St. Luke's Hospital because there were no other facilities available. Now such facilities are available in Galway and Cork. There are also private sector facilities available. Traditionally, all such services were provided in St. Luke's Hospital. Therefore, there is a strong affinity between patients and their families with the hospital. We want to keep this. That is why the network is will be called the St. Luke's network. On 8 July I will engage with the Friends of St. Luke's Hospital who have a fantastic record in raising money for the hospital. They want to continue to raise money for cancer services.

It is clear that after 2014 there will not be radiation oncology services available on the site. The service will be integrated with the eight specialist centres. The services in Limerick and Waterford will be subsumed into the public system at that point or perhaps earlier. That is not only desirable from a treatment outcome point of view but also from the point of view of ensuring access to the range of experts we can put in place in both Limerick and Waterford. We will have two centres in Dublin and one in Galway and Waterford. The unit in Limerick will be a satellite unit of the centre in Galway, while the unit in Waterford will be a satellite unit of the centre in Cork.

It is clear that there are access issues for people living in County Donegal which is why we have been working with the authorities in Northern Ireland. We have agreed to provide capital to meet the cost of building the new facility at Altnagelvin. Three weeks ago I had further discussions with the Minister, Mr. McGimpsey MLA, on the project which has received strong support among patients and patient advocacy groups in County Donegal.

As I have said on many occasions, the site will be kept for public health purposes. When the Deputies opposite talk about cancer and palliative care services, the latter service is not just provided for cancer patients, it also involves other patients. If we were to say it was for cancer patients only, it would rule out that option.

The board of the hospital has commissioned a prospectus and a report on the best use of the facility. That report is imminent. I repeat the commitment, once again, that the building will be used for public health purposes. It might be used to provide a combination of palliative care services, including for non-cancer patients who require palliative support, and perhaps long-term care services. Until we receive the report and engage with the various parties involved, I do not wish to be prescriptive in legislation. I assure members that there is no intention to use the site for anything other than health care services. I will be more than happy to come back to the committee when we receive the report to discuss the contents. The facility will not be used for anything other than public health services, whether it be palliative care or support services for cancer patients receiving treatment in one of the big centres, or long-term care services. I give a commitment to members that it will not be used for any other purpose.

I know there is concern. Fears were raised that the hospital would be used for all kinds of odd things. It is difficult to secure land close to the centre of Dublin for public health services. Given that we have a site at St. Luke's Hospital, we need to keep it. As Deputy Reilly acknowledged, there will be a growing demand for additional services for patients and the facility will have to be used for that purpose.

While I accept the good faith of the Minister in maintaining the site for health services, she will not be Minister forever——

One never knows, the Deputy might be the Minister herself. There could be a choice to be made between any of the three Opposition Members present.

There is a view that, despite the verbal commitments given by the Minister, we need to pin this down and ensure the site will be maintained for public health services. The wording of the amendment has been chosen deliberately. The reference is "for medical purposes related to the treatment of cancer". This would not preclude other forms of treatment such as palliative care being provided for other patients.

To return to a point I made about satellite centres, I come from Limerick. Originally it was not meant to be included in the provision of centres of excellence, nor was Waterford, but because people in the two regions felt so strongly about the issue, campaigned and raised money in order to ensure radiation oncology and other services would be available in these areas we succeeded in having them included in the provision of satellite centres connected with the centres in Galway and Cork. Sometimes the impression is given that if one tries to vary the cancer programme in some way, one is somehow or other against it. I strongly refute that argument. All parties have strongly supported the concept of ensuring we have so-called centres of excellence and that we provide the best possible services to ensure the best possible outcomes for cancer patients, but that does not mean everything must be done in specific centres. That is proved by the fact that we will have satellite centres in Limerick and Waterford connected with the centres in Cork and Galway and a satellite centre in County Donegal connected with the centre in Derry. There is no principled reason it should be seen as a betrayal of the cancer programme that we should seek to keep St. Luke's Hospital as part of the St. James's Hospital or Beaumont Hospital network in Dublin. There are many examples to show how this approach works very well in other parts of the world, where there is a highly respected centre of excellence with a highly regarded team but also a satellite centre connected clinically with the larger centre.

I am convinced by those who say the atmosphere in St. Luke's Hospital contributes to the recovery of patients because it is calm and family-friendly. It is not a busy, acute hospital campus. The Minister must review the matter to ensure the qualities people have been able to enjoy in St. Luke's Hospital in the treatment of their loved ones are maintained within the service. The wisdom of clinicians is sometimes seen as the be-all and end-all. However, there are questions on how the marking scores were arrived at, particularly when St. Luke's Hospital scored so low considering how so many claim it is a wonderful place for those recovering from an illness. Some €15 million was spent on four new linear accelerators recently.

The decision on St. Luke's Hospital was made at the same time it was decided there would be no centres in Waterford, Limerick and County Donegal. Variations have since been made to the plan. St. Luke's Hospital should be considered in the same context.

There is a genuine concern that after 2014 the site will be sold. It is an extremely valuable site located in an up-market part of Dublin. While its value may be somewhat reduced because of the current economic climate, there is a fair chance it will be valuable again by 2014. While I do not doubt the Minister's word, a verbal commitment on the future of the site is not enough. Something stronger is needed.

The original plan to which the Minister referred has been varied since 2003. The quality of cancer care provided in St. Luke's Hospital during the years cannot be easily measured or quantified. Many claim the atmosphere it provided had a strong bearing on people's recovery from illness. These factors need to be considered.

While I do not doubt the Minister's commitment, clarity is needed. As time passes, Governments change. I will table an amendment on Report Stage to have any review of services or new plans for St. Luke's Hospital brought before the committee by the Minister. This would allow members to have their say and act on the basis of full information. I agree with the Minister on the fantastic work done for the institution by the Friends of St. Luke's Hospital.

I am happy to agree to Deputy Reilly's suggestion.

The plan on cancer care has not been varied. It was adopted by the Government in 2005 and provided for a facility in Limerick and Waterford. They are different from St. Luke's Hospital in that they are both cancer centres. The plan does not include provision for a stand-alone radiation facility.

A facility will not be located in County Donegal but at Altnagelvin Area Hospital in Northern Ireland. Currently, there is only a radiation oncology facility in Northern Ireland at Belfast City Hospital. For capacity reasons, the Northern Ireland authorities will provide a facility at Altnagelvin Area Hospital which will open in 2015. As this facility will suit patients in County Donegal, we are anxious to avail of the service, about which the Northern Ireland authorities are happy. We will contribute to the capital cost of the investment and also procure services paid for on the number per patients treated each year. This has received much support from the clinical community in County Donegal and patients' advocacy groups.

The scoring was not done by me but by the Royal College of Radiologists in London, the US National Institute of Health and the European Society for Therapeutic Radiology and Oncology, world experts in this field. While I do not know how they came to their conclusions, the advice is it is better to integrate radiation oncology services with surgical services rather than having stand-alone facilities.

What has happened in Limerick and Waterford in the meantime is that private facilities have opened. The question for the State is should it procure services for public patients. No one wants to see facilities available just for one group of patients. The facility run by the Mater Hospital in Limerick will be subsumed into the public system in Limerick and there will be a facility built at Waterford Regional Hospital.

I will be happy to reflect on the concerns raised about the use of the St. Luke's Hospital site for public health facilities before Report Stage. There should not be disagreement between us, as we are all at one on this matter. It is not my intention that the site should be used for any purpose other than the provision of public health services.

That is welcome. My point about services in Limerick and Waterford is that originally there was no intention to provide radiation oncology facilities there.

The Government's decision was made in 2005 and the plan included facilities in Waterford and Limerick.

Yes, but only because people in Limerick and Waterford fought to have these facilities provided.

In 2003 the advice was that we should build the backbone of the main service before dealing with satellite facilities. Later this year the St. James's Hospital facility will come on stream, followed next year by the facility at Beaumont Hospital. The clinicians working at these facilities will be the same.

If there had not been campaigns in Waterford and Limerick, I have no doubt these services which were originally set up as private facilities would not be part of the system.

I welcome the Minister's commitment to consider the concerns expressed about the hospital site before Report Stage. However, I want to press the amendment because we need to put down a marker that a statutory commitment should be made that the site will be retained for public health use.

It is important to note that even if something is incorporated into law, it can still be changed.

Amendment put.
The Committee divided: Tá, 6; Níl, 8.

  • Connaughton, Paul.
  • Creighton, Lucinda.
  • Naughten, Denis.
  • O’Sullivan, Jan.
  • Reilly, James.
  • Wall, Jack.

Níl

  • Aylward, Bobby.
  • Byrne, Thomas.
  • Conlon, Margaret.
  • Flynn, Beverley.
  • Harney, Mary.
  • McGrath, Mattie.
  • Ó Fearghaíl, Seán.
  • O’Hanlon, Rory.
Amendment declared lost.
Section 6 agreed to.
Sections 7 to 17, inclusive, agreed to.
Title agreed to.
Bill reported without amendments.