James Reilly (Dublin North, Fine Gael)

I welcome the opportunity to speak on this important Bill, which provides for the dissolution of St. Luke's Hospital board and the transfer of its employees, assets and liabilities to the Health Service Executive. It is important to note that this Bill also provides for the amendment of the Health Acts 1947 and 1953 to discontinue the infectious diseases maintenance allowance, about which the Minister has informed us, and provides for technical amendments to the Health Nursing Home Act 1990, the Health Act 2009 and the Nursing Home Support Scheme Act 2009.

For more than 55 years, St. Luke's Hospital, in the Dublin suburb of Rathgar, has been caring for cancer patients from all over Ireland. Since its formal opening in May 1954, hundreds of thousands of patients and their families have been through its doors and experienced the excellent care that the hospital and its staff have provided at its unique site at Oakland.

I echo the Minister's praise for the board of St. Luke's Hospital and for the Friends of St. Luke's who have contributed so much and raised so many funds over the years. I would be very concerned that the wonderful ethos that exists in that hospital should continue into and infect our general oncology services. I must put it to the Minister that the HSE has not had that ethos at its centre. I shall refer to that later in terms of people's experiences. The progression of today's Bill reminds us of the many changes that have taken place in the provision of cancer care services since the publication of the Cancer Care Strategy in 2006.

This Bill reminds us of individuals such as Rebecca O'Malley and Susie Long who brought the failings of our cancer services to the nation's attention. The late, very brave Susie Long paid far too high a price for the dysfunctional system of our cancer services. The passing of this Bill also reminds us of the situation in Portlaoise where 97 women needed to be recalled after their ultrasounds were reviewed and were left waiting for contact until a sufficient "cohort" of files was reached. What on earth was meant by that? One still wonders but what I found repugnant about it, and what the people of this country found repugnant, was that a health service could form the view that it would deal with people when it felt it was appropriate, in terms of a magic number arbitrarily decided by somebody, as to when it would be worth its while to deal with women, some of whom transpired to have cancer.

When we think of that ethos we think of the north east where the people, having had 6,000 X-Rays and ultrasounds performed on 4,500 of the population, needed to have those re-examined because of a question mark over the competence of the individual who initially read them. Despite knowing in September 2007 there was a problem, this HSE system took no action until May 2008. Several people died. We do not know whether their demise was unavoidable in any event but to make a cold callous decision of that nature is something abhorrent to me, as a doctor and as an Irish citizen. Therefore, I hope our new cancer centres will absorb and embrace the excellent ethos of St. Luke's Hospital which always looked at patients from an holistic perspective, not look only to their radiological and oncological needs but also looked to their social needs and had the ability to provide them with an experience that would mimic the home as much as possible. That ethos is what makes St. Luke's so famous and such a success. Rarely have I heard patients complaining about St. Luke's. Unfortunately, the same cannot be said about the rest of our services.

The Minister alluded to colonoscopy and bowel cancer screening. These are to be welcomed. At the beginning of 2009, the Minister instructed the HSE to ensure that patients needing an urgent colonoscopy should not have to wait more than four weeks following referral from their general practitioner. More than a year later, high numbers of patients continue to wait excessive lengths of time for colonoscopies. The Irish Cancer Society recently reported there are 951 people waiting more than three months for a colonoscopy. This data was provided to the Irish Cancer Society by the National Treatment Purchase Fund. As the Minister well knows, the consequences of long waiting times for these tests can be fatal, as they were for the late and very brave Susie Long. We must sort this out or there will be more unnecessary deaths.

Last January, the Minister announced the roll-out of a colorectal cancer screening programme for people aged between 60 and 69. However, this programme will not commence until 2012, in selected hospitals. As the Minister knows, colorectal cancer is the second most commonly diagnosed cancer among men and women in Ireland, with approximately 2,200 new cases diagnosed every year and of which approximately 1,000 people die. Given the seriousness of the illness Fine Gael looks for an earlier roll-out of the programme and the immediate expansion of this programme to younger age groups. To wait until 2012 does not seem reasonable when this disease is such a major killer of Irish people, men and women alike.

I believe a real opportunity has been missed in regard to colonoscopy. Colonoscopy is a procedure that can be carried out safely in an outpatient setting. We all understand the need to provide more care in the primary care community setting rather than in hospitals, where appropriate. Therefore, the fact that only hospitals are applying for the additional colonoscopy capacity rather than primary care centres being encouraged to do so is a huge missed opportunity. There is no reason that these procedures could not be carried out in major primary care centres.

I do not intend to embark on a long dissertation on the lack of progress in the roll-out of the primary care strategy which was announced in 2001 and has delivered so little to date. When we are planning new services we should look to where they can be provided most cost effectively and conveniently for patients. I believe this is the case with colonoscopy.

I will provide a context for where we stand. Demographically, we are heading for a great increase in the number of people aged over 85 years of age. By 2021 the numbers will more than double from the present figures, as will the age group between 74 and 84 and 65 to 74. If memory serves me correctly, today's figure is 510,000 people aged over 65 years. By 2021 this will have risen to more than 900,000. Unfortunately, there will be more cancers because, as people live longer they are more likely to develop the disease. We need early intervention because the country will go broke if we do not change the way we are delivering health care. As much as possible, this should be delivered through primary care which is cost effective and convenient for patients.

This morning I had the pleasure of launching a book by Joe Ahern and John Whelton, "Applying "Lean" to Healthcare", based on the Toyota manufacturers' new approach to creating efficiencies in their factories. It has been applied to health care in Ireland and abroad, and I have two examples. The metabolic lab in Temple Street hospital has, through reorganisation of people's work and where equipment was placed, reduced a 30-day turnaround to five days. That was without any new tests or modalities. As we are talking about cancer services, the oncology unit in St. James's Hospital used the lean approach and significantly improved patient satisfaction ratings, service to patients and efficiency. We will need more of that in future, along with close scrutiny of how we deliver care and the various players - front line and others - operate together in their work.

I am a fan of treating the patient at the lowest level of complexity that is timely and safe. To put this simply, we do not want to see nurses taking blood samples when phlebotomists should be doing it, GPs taking blood pressure readings when nurses could do it or consultants reading ECGs when GPs can do it. It is about appropriate services from appropriate clinicians. As the Minister knows, 800 pharmacists have been trained by the Royal College of Surgeons to deliver safe adult vaccines. Vaccination programmes in America and many other places are run on such a basis so there is a whole new role for other members of primary care teams.

There was an excellent programme in St. Mary's orthopaedic hospital in Cork, which is mooted to be closed with the physiotherapy unit to be shoehorned into a very small space in the South Infirmary. Its study, which replicated one in England, showed that the number of referrals to consultant surgeons could be reduced by 40% if patients were given appropriate physiotherapy and exercises. There are many ways to improve the way we deliver care and we must consider the matter. According to the VHI, the health bill will be €37 billion by 2021. Although I do not necessarily accept the figure, it sparks a necessary public debate nonetheless.

The main provision of this Bill is the dissolution of the board of St. Luke's Hospital. It is a statutory body funded by the HSE and is currently the largest provider of radiation oncology services in Ireland. The Minister has told us two new radiotherapy centres at St. James's Hospital and Beaumont will open at the end of 2010 under phase one of the national plan for radiation oncology. It is important to note that the full network of radiation oncology services as promised under the national network for radiation oncology was supposed to be rolled out by 2011 but, like so much else, this will not happen and the deadline has been extended to 2015.

In July 2005, the Government announced a decision to move the services at St. Luke's to the site of St. James's Hospital as part of the national radiotherapy network. Radiotherapy services will continue to be delivered at St. Luke's until at least 2014, when additional capacity is scheduled to come on stream under phase two of the national plan for radiation oncology. On this occasion, I congratulate the Minister on not doing away with the existing service before the new service comes on stream, as has happened in so many places like the mid-west and others.

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.

Another issue of particular interest to me and others, and which has been raised in the House recently, is the regulation and control of the use of sunbeds, which we know can cause skin cancer. We are back to trying to prevent rather than cure the disease. We know sunbeds are a real risk, particularly if there is exposure during childhood. Unless we act, more young people will be at risk of developing cancer through prolonged use of sunbeds. We know much education is needed to inform people of the dangers, as people want girls in particular to look well on days such as when they celebrate first holy communion. Children are being exposed unnecessarily and recklessly so we must legislate on the matter. We have a duty of care to our children.

Will the Minister indicate when the legislation on sunbed use will be introduced? She launched the strategy for cancer control in 2006 and this legislation was part of it. In the past number of years we have seen a rapid increase in the number of tanning centres and as people are not aware of the dangers we must take positive action.

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.

See this speech in context