Lucinda Creighton (Dublin South East, Fine Gael)

I am pleased to have an opportunity to speak on this important Bill but I am disappointed that the Minister is not present for the debate. It would be fitting that the Minister would see fit to appear in the House to take this legislation given its important and far-reaching ramifications for the health service in the future. It is important it is noted that the Minister did not see fit to come to the House.

The purpose of this Bill is the dissolution of the board of St. Luke's hospital and the transfer of staff in the hospital and the hospital's assets and liabilities to the HSE. I take the opportunity to express some degree of concern at that development. It is well-recorded that politicians and the public have almost lost all confidence in the Health Service Executive. It is difficult to have confidence in that body.

The original concept of the HSE was a good one. The aspirations of the Minister and the Government in establishing it were well-intentioned but the objective of eliminating bureaucracy and the parochial element associated with the old-style, traditional health boards was not achieved. What replaced the traditional health boards is essentially an ever-expanding and pretty frightening monster, namely, the HSE.

What we have been left with is a complete absence of the streamlining of services. We have an inaccessible, a confusing and an often frightening system which people shudder at the thought of interacting or interfacing with. We have some very old and well-known problems with over-staffing, excessive administration and with an absence, or at least a very severe shortage, of front line services. These problems are acute and are growing by the day. There is no clarity about the division of workload within the HSE. There is a hugely demoralised workforce within the health service.

From my experience of the HSE, the delivery of health services is getting worse. I say that with a heavy heart because it is essential to provide a quality service in which people can have confidence. However, that has not been my experience. To call it a fiasco is a serious understatement but the fiasco about which we heard in recent days in regard to the ultrasound which went wrong in Our Lady of Lourdes Hospital in Drogheda is simply symptomatic of deep and ingrained problems in the health service. I know that from my experience of dealing with constituents and from the experience of my family members. My uncle contracted MRSA in a hospital in Louth and died as a result. My father contracted MRSA in another public hospital in a different part of the country and was severely debilitated as a result. I am not unique in that there are few people and few families who have not been touched by the ongoing problems throughout our health care system, if one could call it that.

It is time the Minister stood up and was counted in terms of tackling the bureaucracy and the systemic problems in the HSE. I would be the first to acknowledge that the Minister set out with good intentions, with an agenda to reform the health service and that she did so in good faith. She is a politician for whom I have a huge degree of respect and she is a competent and capable politician. It was her intention to try to effect and drive change within the health service but she soon realised that would not be possible for a variety of reasons. They include the intransigent work practices within the health service and, more crucially from the Minister's point of view, the resistance from back bench Government Deputies who will protect the status quo at all costs and resist any sight or sign of change or meaningful reform within the health service. It is not the case that the Minister lacks the drive or intent to effect change and achieve reforms, but rather that she is constrained by the main Government party, which has been in power for too long and does not want, or have any enthusiasm for reform or change. That is a sad situation, the legacy of which, unfortunately, we will have to live with for many years to come as it will take years to solve the endemic problems within the HSE.

In contrast to the HSE, St. Luke's Hospital, otherwise known as "The Haven in Rathgar", is a beacon, a shining light, in the administrative labyrinth that is the health services here. Since 1954, when it was formally established, St. Luke's has provided the best quality of care for its patients and the best possible services to cancer patients from all over the country. Every family has been touched in some way by St. Luke's Hospital. Virtually every family has had some family member or friend attend St. Luke's at some point. Yet, St. Luke's is to cease operation in 2014. It is all very well to point to expert reports, expert opinion and the most cutting edge of medical advice, but it is difficult to explain to even the most intelligent human beings why the Government wants to dismantle one of the few public hospitals that functions and does its job with aplomb and replace it with a subsumed and submerged cancer service that will be provided via St. James's Hospital. The latter does not rank as one of the top hospitals in terms of hygiene, services available or its ethos and environment.

St. Luke's has been consistently rated as one of the top, one, two or three hospitals in the country on ratemyhospital.ie. Its rating is not scientific but it matters because it is the view of patients. They take the trouble to go on-line, complete surveys and judge the service they have received. It is the patients and their family members who have selected St. Luke's and held it up as a beacon in the HSE health service quagmire.

We must acknowledge the reality. We have to take account of expert opinion and advice. Between 2005 and 2007 more than 27,000 new cases of cancer were diagnosed every year. Our population has grown quite rapidly and, unfortunately, in tandem with that the number of cases of cancer patients presenting has increased dramatically. During the 1990s and the early years of this decade Ireland fell way behind in terms of dealing with the new developments and advancement in cancer treatment. We now rank as one of the worst countries in terms of having a national plan to deal with cancer care. That is the reason I welcome the national plan for radiation oncology. It is necessary and important that we do everything in our power to implement it. I recognise the Minister's commitment to that and her ambition to implement it and, in so far as it is possible, we all have a duty to respect that and to work with it. It is an ambitious plan, which I sincerely hope - I genuinely mean that - will deliver better and improved cancer treatment facilities and care for patients throughout the country. It is imperative that I acknowledge that the strategy has been devised by some of the top medical experts, some of the most eminent cancer specialists not only in Ireland but from further afield. I would not pretend to second guess these medical experts when it comes to identifying medical need. I also would not be so bold as to second guess them in terms of outlining the types of streamlined services that are required to tackle the shortfall in radiation oncology services here. It is important that we, as politicians, examine needs and the best possible strategy to tackle cancer on a national basis and in an integrated fashion. That is the onus on us and we cannot afford to be populist in that regard.

I also understand that radiation oncology must be integrated with other cancer treatments. Essentially, radiation must be integrated with surgical and medical oncology. In essence, that is not happening in St. Luke's. I understand this is the most pressing reason for the decision to relocate radiation services from St. Luke's and to bring them under auspices of St. James's Hospital.

In that context, it is important to remind the Minister of commitments made by her predecessor, the Minister, Deputy Martin, in 2003. He said:

... that the ethos and strengths of St. Luke's must remain as key drivers nationally. How best to ensure this happens will be a key objective of mine. In the meantime, I am fully committed to ensuring that the excellent standards of care at St. Luke's continue to be supported.

The Minister, Deputy Harney, in 2005 committed that "arrangements to ensure the continuity of St. Luke's expertise and ethos in the service" would be maintained. I am confused as to how exactly that ethos will be maintained within the precincts of St. James's Hospital. I have no confidence that the ethos and the quality and the level of care, to which people have become accustomed and have come to expect, in St. Luke's will be maintained or that the dignity afforded to cancer patients there will be carried through and replicated under the auspices of St. James's Hospital. I do not have any confidence that will happen. I would like some assurances on that. That is the reason I am disappointed the Minister, Deputy Harney, is not present. I want to hear from her and I hope in her reply to this debate on Second Stage she will address this issue because we have no clarity on it. I have been raising the issue of St. Luke's in this Chamber since I was elected to it and prior to that I raised it through engagement with patients and campaigners from and in support of St. Luke's.

Over and over we requested assurances and guarantees from the Department, the Minister and the HSE regarding how the level of care can be maintained and how people can have confidence in the HSE to deliver that level of care and they have not been provided. The aspiration was set out by the former Minister, Deputy Martin, followed by the current Minister. They both proclaimed they were committed to delivering and maintaining this ethos but they have outlined nowhere how it is expected that can or will be achieved.

St. Luke's Hospital is set in just over 18 acres of beautiful landscaped gardens in Rathgar. It was always the objective of the patrons of the hospital that it would be a place of refuge, peace and tranquility where people from different parts of the country and south Dublin who were battling for their lives could access the best medical care, compassionate care and be afforded the greatest dignity while undergoing hugely stressful radiation, chemotherapy and other treatments. That is the unique element of the hospital, which marks it out from all the other public hospitals in the State. It is something for which people have a deep affinity and that is why there is such outrage of the prospect of the hospital's closure. It is also why many people, including me, are concerned about the proposed closure.

There are strong medical arguments in favour of moving the hospital's services lock, stock and barrel to St. James's Hospital but it is conceivable that the special conditions available to patients in St. Luke's Hospital, including the peace, tranquility and solace, will be lost forever. These conditions have a healing power in their own right and that is not hocus-pocus. Strength of will and of mind is an essential element in healing. It is not simply about medical treatments; it is also about the psychological and we cannot afford to lose that element of the healing process as well.

While the oncology service may well have to be relocated to St. James's Hospital, there is a strong case for retaining St. Luke's Hospital for recovery, rehabilitation and respite care. The time has come, particularly in light of this legislation, for the Minister to outline her vision for the site in Rathgar and for the input of the hospital in the long-term provision of health services for the city of Dublin. I plead with her not only to maintain this unique hospital for the delivery of cancer care or some other form of care but to integrate and maintain it as an essential part of the health services in the city and the country.

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