Mary Harney (Dublin Mid West, Independent)

I move: "That the Bill be now read a Second Time."

I am pleased to have the opportunity to introduce to the House today the Second Stage of the Health (Miscellaneous Provisions) Bill 2010. The Bill has several purposes. 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.

Deputies will recall that 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 ensures that services and resources in the fight against cancer are co-ordinated. Similarly, the provision of radiation oncology services is an intrinsic component of cancer treatment. The Bill makes provision for the integration of St. Luke's Hospital into the HSE's cancer programme as in the case of last year's legislation for the cancer screening service.

The Health (Miscellaneous Provisions) Bill 2010 also provides for the discontinuance of the infectious diseases maintenance allowance originally introduced in 1947. Currently, no person is in receipt of this allowance and there are in place a number of other schemes through which financial and other supports are provided to such persons. Finally, 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 now 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 sets out the future framework for delivery of cancer treatment in Ireland. It also endorses 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 multi-disciplinary 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 re-organisation 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 a challenging task. Its completion late last year marked a major milestone for the cancer programme. HIQA's assessment of the symptomatic breast cancer services in February this year found that all the fundamentals are now in place in the eight centres to ensure safe, quality care for patients, which is very positive confirmation of the progress that has been made.

Considerable progress has also been made on services for other cancers. An important development is the establishment in each of the eight centres of rapid access diagnostic clinics for lung and prostate cancers. These clinics will speed up access to diagnosis and multi-disciplinary 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 re-organisation of surgical services for pancreatic and rectal cancer. 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 to create 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 2003 report of the expert group, known as the Hollywood report, recommended the development of a clinical network of large centres. The national plan for radiation oncology was approved by Government in 2005 and was, as I have already stated, endorsed in the 2006 cancer control strategy. Its aim is to provide new or additional radiation oncology facilities in four cancer centres, namely, St. James's Hospital, Beaumont Hospital, Cork University Hospital and University Hospital Galway. There will also be satellite facilities at the Mid-Western Regional Hospital, Limerick, and at Waterford Regional Hospital.

Implementation of the plan is under the governance of the cancer control programme and is well under way. Construction of new facilities at St. James's and Beaumont Hospitals will be completed this year. When the new facilities come on stream, they will increase radiotherapy capacity significantly. We will have 12 linear accelerators in the public system in the eastern area as compared to only eight now. St. Luke's Hospital, Rathgar, is the largest provider and the most specialist centre for radiotherapy in Ireland, with an international reputation. The two new facilities at Beaumont and St. James's will come together with 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.

To facilitate the establishment of the St. Luke's network, the then director of national cancer control programme, Professor Tom Keane, advised that there should 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 board was established by statutory instrument in 1999 as a voluntary hospital under the Health (Corporate Bodies) Act 1961. Providing for the effective delivery of radiation oncology services as a fully integrated component of the cancer control programme is the main purpose of this Bill. Accordingly, the Bill provides for the dissolution of the board of St. Luke's and the transfer of St. Luke's staff and facilities to the HSE.

This means that all staff of the new network will be employees of the HSE and not of any individual hospital. This will facilitate the transfer of employees between locations, subject of course to the usual industrial relations mechanisms. 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 to the cancer programme this year for the new centres. In addition to these, some staff and resources will transfer from St. Luke's to the new centres in the second half of this year.

In 2014, when the national plan for radiation oncology will have been completed and further capacity will have been developed at St James's and Beaumont, all remaining staff and resources will transfer from St. Luke's Hospital to St. James's Hospital or Beaumont Hospital and radiotherapy will no longer be provided at St. Luke's.

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