by Enid O'Dowd
We need this capacity as our general capacity in the health service is creaking at the seams. I raised earlier the fact that 52 beds have been closed in Beaumont, which is one of the proposed centres. We were told today that 60 beds are to be closed in the Mater, a surgical ward closed in Cavan, beds were closed in Portlaoise and Roscommon and there has been a major bed closure in Portiuncula. The bottom line is that patients cannot access the service; it does not just come down to numbers and figures.
I was informed today by a colleague of a female patient in her 40s who attended a Dublin hospital in December last year. She was kept in the accident and emergency department for two days, having been advised that she needed to be admitted to the hospital because of a serious heart arrhythmia, which is an irregular heartbeat. That predisposes her to ventricular fibrillation and cardiac arrest.
After 48 hours in the accident and emergency department, she was informed there was no bed and she could not be admitted. She was sent home on medication and advised she would get an early appointment. That early appointment is for 13 August this year. The lady is experiencing symptoms and has been back and forth to her GP and the accident and emergency department. This is no way to treat people. The woman continues to be at risk and may need a surgical procedure, which is why she was to be admitted. This illustrates a broken health service that is not working or delivering.
The excellence in the service provided at St. Luke’s is about staff attitude to the patient and people in general, seeing the patient as a person rather than a number at the bottom of a page. I hope that ethos will be taken up by broader HSE services but this will not be possible if the capacity does not exist.
I mentioned the north-east region earlier. Hospitals such as the Mater and Beaumont, along with Cavan, have been affected and the facility in Monaghan is gone. Services are being shoehorned through Drogheda to the Dublin hospitals which cannot cope. They do not have enough beds but we cannot reduce emergency admissions by 33,000 when we do not have the facilities in the community to prevent those emergencies from developing. We will probably see more emergencies developing as people wait longer for elective surgery without getting it. A problem which may be treatable in an elective planned fashion could become an emergency, and everybody in the House knows that when there is emergency surgery, the chances of an optimum outcome are reduced when compared to planned surgery.
I would appreciate if the Minister could arrange for a briefing on progress of the wider radiation oncology plan. It is important that we know what progress has been made, when it will be completed, how much it will cost and what the funding will be, etc. I recently read that 79 posts in the cancer control service earmarked for the development of planned radiation oncology services can only be filled if a similar number of posts of equivalent salary value are suppressed elsewhere. Will the Minister assure us the suppressed posts will not be from the front line? We would appreciate clarity on this important matter.
I will finish by commending the fantastic work done in St. Luke’s Hospital. I also commend the Friends of St. Luke’s Hospital, who have raised so much funding and been at the sharp end of leading the way in radiation oncology. I would have no problem with supporting the Bill, but I warn that we must protect the ethos that made St. Luke’s Hospital so successful.
Deputy Jan O’Sullivan (Lab): It is with a sense of sadness that we discuss the change of the role St. Luke’s Hospital in Dublin, which has been caring for cancer patients from all over Ireland for more than 50 years. I understand it was founded by the then Cancer Association of Ireland in 1954. No family in Ireland has not had some experience of the care provided by St. Luke’s Hospital. My family experienced it, since my father attended the hospital. His care was excellent. When people discuss the hospital, they are referring to its atmosphere and air of tranquility more than anything else. There is a sense that someone is cared for as a human being as opposed to as a number going through the system. Families were involved in everything. I was reading through some of the documentation that we got from the library in preparation for this Bill and I came across quotes from people who were involved in the Friends of St. Luke’s Hospital and various other protests. They talk about that ethos as being part of what St. Luke’s Hospital represents in the minds of the Irish population. My mother used to get a letter twice a year from a lady whose husband was in St. Luke’s at the same time as my father. They maintained that friendship and contact for many years afterwards. That is a snapshot of the way in which St. Luke’s cared for people and for the families of people who were in there because they had cancer. That is the ethos that all of us in this House and the people of Ireland want to see preserved. We are right to be sceptical that this might not happen in the future plans for the hospital.
We understand that times move on and that we have to use resources well. In spite of what the Minister might say sometimes, we all supported the cancer strategy. We had one doubt about it, which was the fact that there was no centre north of a line between Galway and Dublin. By and large, the Government got the kind of support from the Opposition on the cancer strategy that I feel would not have happened if it came from the other side of the House. It must be acknowledged that we all want better outcomes for patients, which is why we largely supported the ethos of the national cancer strategy. This move today is a part of that, and St. Luke’s will be part of a wider network of care for patients who have cancer in that part of the Dublin region.
We will now have four main centres, plus two ancillary centres in Waterford and Limerick. We all hope that will produce better outcomes for cancer patients, because the statistics are quite stark. The National Cancer Registry statistics show that between 2005 and 2007, an annual average of 27,023 new cancers was registered. Apart from non-melanoma skin cancer, the most common cancers were prostate cancer at 2,462 cases, breast cancer at 2,335 cases, colorectal cancer at 2,156 cases and lung cancer at 1,118 cases. The risk of developing cancer was roughly 6.6 per 1,000 persons per year over the two year period in question. Our wish is that those statistics be addressed primarily through screening, early detection and prevention.
I welcome the fact that we pretty much have BreastCheck all over the country now, and we will have colorectal screening within a couple of years.
I support the calls by Deputy Reilly and Deputy Neville for the Minister to tell us that we are on schedule for the roll out of colorectal screening in accordance with the plans that have been outlined to us. There were 952 people waiting for more than three months for a colonoscopy in the most recent statistics. That is directly at variance with the specific plans of the Minister in respect of access. When she signed the most recent consultants’ contract, one of her aims was to ensure that there would be no difference in waiting times between public and private patients for colonoscopies. That is welcome and we remember the tragic story of Susie Long that was put into the public domain. At the beginning, she did not use her own name, but eventually she did. If she had been diagnosed earlier, she would have had a better prognosis for the outcome of her case.
While the Minister has said that there will be no difference between public and private patients in respect of waiting times, the reality is completely different. Private patients can go to private hospitals and clinics to have colonoscopies carried out and can then access the service sooner than public patients. That is the reality of the world in which live. Private patients make appointments every day and are seen within a short period of time.
We need a system of health care in this country where everybody is treated on the basis of need. We need it especially in respect of early diagnosis of killer diseases like cancer. There should be no difference between public and private patients in the diagnosis. If somebody needs a diagnosis, then he or she should get it. If there are symptoms of colorectal cancer, then the person should get in as quickly as possible to have a colonoscopy if that what the person’s GP considers to be the best option. It is not within the capacity of GPs to decide that o
ne person is urgent and another person is not urgent. If the GP sees symptoms, he or she will want that person to have the diagnosis.
I want to express my concern about the future of St. Luke’s Hospital and Deputy Quinn will continue in that vein because of his own experience of people who live near the hospital. We do not know anything about the future use of the site and we have not been given any undertaking on that use. We need to provide certainty that the site will be retained for health purposes. It is being transferred to the ownership of the HSE, as are the staff and the resources, but we need to know that the site will be retained for health purposes. There are many health needs in this city and across the country, and I would like the Minister to give us that kind of undertaking today.
Deputy Mary Harney: It will be retained for those purposes. I am awaiting their proposals.
Deputy Jan O’Sullivan (Lab): I thank the Minister. She said in her own contribution that she has engaged with the Friends of St. Luke’s and is waiting to hear from them. Maybe she can give us a clearer picture when she replies.
I have doubts and concerns because I am familiar with reconfiguration. It is happening in my own region. In spite of all the assurances given to us that there would be full resources available at the Mid-West Regional Hospital before services closed in Ennis and Nenagh, services have already closed in Ennis and Nenagh and further services will close in July but the critical care unit that was promised, the kind of resources needed by the accident and emergency department and the extra beds are not in Limerick yet. In fact, beds are being closed as they are being closed in other parts of the country. We were given all these undertakings that reconfiguration is good for everybody and that hospitals in the network could do more for patients. The hospitals in Ennis and Nenagh would get day beds and day wards and much more work would be carried out there, but that has not happened either. Therefore, I am extremely sceptical about promises in respect of the future use of health resources. It is an issue for other regions as well and people in those regions are beginning to experience what we have already experienced in the mid-west.
It is a huge issue in the north east and I am sure Deputy Ó Caoláin will address it when he contributes to the debate. We cannot trust the Government or the HSE to deliver what they undertake. That is the real problem, particularly so now because there is a shortage of resources. There are indiscriminate cuts across the board which do not take any account of their effects. The moratorium is crucifying many of the health services because key people are not being replaced.
Today, we heard that 60 beds are to be closed in the Mater Hospital. In Beaumont Hospital, 52 have already been closed with other bed closures throughout the country. More and more patients are not getting into hospitals because the beds are not there. People are clogged up in accident and emergency departments and on longer outpatient waiting lists. People in pain and distress are waiting to get access to the health services and that is a direct result of the closure of beds. The Minister cannot sit there and treat that as an abstract concept. These are real people with real suffering. I spoke with a man who recently sat on a hard chair for 15 hours in an accident and emergency department in Dublin with his sick wife. The real people of Ireland depend on the health service and most of them are public patients who do not have the opportunity to go into the more cushy surroundings of private hospitals. The Minister for Health and Children cannot stand over that and she needs to engage more in what is happening in the health services.
I pay tribute to everyone involved in St. Luke’s since 1954. I strongly reiterate the importance of retaining the premises for the use in health services and, more important, the ethos. It has been described as a haven in Rathgar and that is a very good description of what St. Luke’s has meant to many families in Ireland over the years. We need to ensure that type of thinking remains in the care of cancer patients. Unfortunately, in the life of a busy general hospital or tertiary hospital it is difficult to maintain that so it is important that the units are appropriately designed, laid out and structured and that there are garden and outdoor areas and the sense of calm and peace that patients need. I do not know how that can be achieved but it is the strong view of people who have experienced what happens in St. Luke’s that it should be retained for the families concerned.
Deputy Ruairí Quinn (Lab): I thank my colleague, Deputy Jan O’Sullivan, for allowing me to intervene in this debate. I have seldom spoken on health matters because, quite frankly, I know very little about the medical side of health and I would hate to have to deal with the complexity of the problems in our system. Therefore, I do not propose to try in any way to second guess those who have put much more effort and consideration into these matters.
I wish to offer some observations, from a personal point of view and from a constituency point of view. I will start with the HSE itself. I do not think any of us, certainly I did not, opposed the concept of the HSE at the time. However, I do not think any of those who vigorously proposed its establishment, including the former Minister for Health and Children, Deputy Micheál Martin, and the present Minister, would ever have believed it would become the unmanageable monster it now is. In the course of that transition from inefficient and various health boards to what became an integrated single unit, the credibility of our ability in efficiency terms to deliver an efficient health service, or the perception that — and frequently perception is more important than reality — is that it is a dysfunctional body.
The Minister proposes to implement the Hollywood report and, as she stated to me in reply to a question in March 2007:
It is my objective, and that of the Health Service Executive (HSE) and St. Luke’s Hospital to see the earliest delivery of the Government’s Plan for Radiation Oncology. I am determined that the HSE will deliver on this Plan in 2011 as originally scheduled. The HSE and my Department are considering options to speed up the pace of delivery. This is a challenging timetable and I will provide the HSE with the necessary support to deliver on it.
As regards the future use of the site and facilities at St. Luke’s Hospital, my objective is to ensure that these resources are utilised in the best interest of the health services. I will discuss this issue in due course with the HSE and the Hospital Board.
At the time, that reply sent shockwaves and fear across the cancer community I encountered who visited St. Luke’s on a regular basis and among many of the residents who live there. I never encountered a resident in the Rathgar area who was worried or upset by the excessive car parking that took place on occasion or gave out about it. I never encountered a resident who felt his or her privacy or the tranquility of a residential area was marred or disrupted by people walking manifestly sick and dying relatives because of the haven of calm, to use the phrase referred to by Deputy Jan O’Sullivan, that was Rathgar and that still is St. Luke’s.
Let me declare a personal interest. I am a graduate of cancer treatment and I can still remember, five years on, that extraordinary sense of total inner panic and fear that came right through me when my doctor said to me that one of the six samples tests which took place out in Tallaght was cancerous. The word “cancer” for my generation has the same resonance as “TB” for my parents’ generation. The health outcomes, as the Minister knows much better than I do as she has the statistics to hand, are wonderfully positive. It is not the TB of our generation; it is a curable disease. We know a great deal about what cures it but a framework and context in which those around one can be reassured is critically important.
I had my full total body assessment after I went to the consultant when he told me that the first task was to find out if there was any cancer anywhere else in my system. I went through a long process. Going to St. Luke’s was like going to a religious retreat. It was not like going to accident and emergency in St. James’s. It was not like trying to find a parking place in the vicinity of St. James’s and then negotiating something akin to a bazaar in Istanbul to get to the right place.
The best
architecture in the world will not transform St. James’s into a place which will provide the sort of calm which already exists in St. Luke’s. In her speech and in the overall report that has been produced, I understand the Minister is bringing the facilities that were offered by St. Luke’s to the National Oncology Centre. I am sure the medical treatment will be of the best possible quality. I consulted with some colleagues in my constituency who are medical professionals and they said from a medical point of view the recommendations are the best, but we do not know everything about medicine. Our present standing in the world does not mean we are the most knowledgeable or that future cohorts of population and expertise will not discover anything new or different.
We do not know what psychosomatic elements contribute to recovery from prostate cancer for some people and a failure to recover for others. In sports psychology the whole area of mind over matter is discernible and has been observed but given the limitations of science and knowledge it cannot be quantified. When I was a young athlete my coach gave me a book which described an incident in a garage in England. A man who was an athlete and had a young child had a Morris Minor up on a block. Something happened, the block shifted and the child was trapped under the car. The man let a roar out of him, bent down and lifted up the Morris Minor to save the child. When it was all over somebody asked him if he knew what he had just done. He said, “No, is my kid all right?”. The person said, “You have just lifted this car. Try and do it again”. Of course he could not.
There are aspects of the human condition, physiology and emotional drive that we know about but cannot yet measure. I am putting to the Minister that what we know but cannot measure is the healing calm that is St. Luke’s. I respectfully suggest, with the comfort of ignorance because I am not a medical scientist, that there are components of the campus in St. Luke’s that provide that healing calm. After the diagnosis in my case, which took place in St. Luke’s, I had regular treatment. I cycled up to St. Vincent’s on the Merrion Road at 8 a.m., got my 15 minutes of treatment and came in here on the bus or by bicycle. It was in July five years ago. I was the lucky one because I was not very sick as they got it very early.
