Alan Shatter (Dublin South, Fine Gael)

I am greatly obliged to the Ceann Comhairle for this opportunity to contribute and I thank my colleague, Deputy Creed, for sharing his time with me.

I was anxious to briefly speak on this legislation because of the many people in my constituency of Dublin South, across south Dublin and from outside Dublin who have used the facilities in St. Luke's, who admire the medical care available there, who regard it as a centre of excellence in the area of radiotherapy, who greatly fear for the future in the context of the Government's intention to transfer the facilities and services provided by it to St. James's Hospital and who have fears, in the context of the future management of that hospital, not only about how matters will develop but also about its accessibility and the nature of relationships with patients. St. Luke's has truly been a centre of excellence in providing for many thousands of people going through the trauma of cancer care and oncological treatment. It has an ethos, to which many other speakers have made reference, whereby the patient is absolutely put first. Unlike the HSE dealing with people as if they are anonymous nuisances whose situations have to be addressed and who frequently seem to lose to sight of the humanity of the individuals and their health concerns, St. Luke's deals with people on a one to one basis. There is an ethos about the hospital and a support system within it not only for cancer patients but for their families. Accommodation arrangements are made of a nature that certainly are not currently available in St. James's Hospital and there is no indication that they will be available when the services are moved from St. Luke's. It is only right that we in this House reflect the concerns that are inherent in the Government's proposal. I am saying this from the position of someone who supports the concept of centres of excellence and believes that we must provide the best possible medical care of a specialist nature to patients not simply with regard to the area of cancer but also in other areas. However, in this context, we are talking about cancer patients.

In the context of St. Luke's in Rathgar, a major criticism is that surgery is not provided for there and that it cannot deliver the multidisciplinary care that many believe is necessary to ensure the best possible care for cancer patients. This is seen very much to be the Achilles' heel of St. Luke's. While the centralisation of technology and expertise is important when it comes to diagnosis and surgery, radiotherapy can be delivered in a community setting. In many countries that is the arrangement. St. Luke's is a centre of excellence in that regard. I have grave doubts about the wisdom of Government policy. I see no reason there cannot be a linkage between the preservation of St. Luke's and the expansion of services in St. James's to incorporate both of them into the one centre of excellence. This is something to which serious consideration should be given.

I have grave doubts about the Government's timeframe for its proposal. When it was first proposed that St. Luke's essentially be closed down and its services transferred to St. James's, I recall the date of 2011 was given for the move. The target date of 2011 then became 2012, and that target date has now become 2015. I am not clear at this stage what is the credible timeframe for the move and the financing of it. This is creating a level of uncertainty that is undesirable. However, what I am particularly concerned about, and I want to emphasise this point, is that St. Luke's - which currently has an independent board - a well-managed hospital albeit one that on occasion has a waiting list, is to be replaced by management provided by the HSE. I regularly talk in this House about the complete incapacity of the HSE to manage our child care services. Professor Drumm in the Irish Examiner this morning almost bewailed the fact, that, as chief executive of the HSE, he has had to deal with child care services. If I could say this within this Chamber, he has managed the child care services with unprecedented incompetence as a chief executive during his term of office and we are seeing the consequence of that in all of the revelations of the past 18 months. However, equally, despite all of the good work done by Professor Keane, and I acknowledge he has done good work, we have seen the extent to which there are endemic problems within the medical service managed by the HSE, namely, the failure to ensure proper patient care, to treat individuals, to acknowledge the stress individuals suffering serious ill health are under and to provide a response to them of a humane and rapid nature when required. I have huge reservations about the HSE taking over the management of St. Luke's, be it St. Luke's as it is currently positioned within Rathgar or the new St. Luke's to be in St. James's.

In terms of the level of patient care at a human level - I am not being critical of nurses or doctors in St. Luke's - in the context of the administration of the hospital in Rathgar, the manner in which the hospital interacts with patients and their families, the types of services it provides for them that go outside the medical area in providing the supports necessary to ensure that people avail of the medical care and that their family members understand the nature of the illness being suffered and the impact of treatment, I am concerned that when the HSE replaces the current board, there will be a deterioration in that area. The facilities in St. Luke's which has beautiful grounds - a tranquil setting where there is an opportunity for those undergoing treatment and their visiting families, particularly when the weather is good, to go for walks in the grounds - will not be available in the grounds of St. James's, which may be a hospital of excellence but is essentially turning into a huge hospital factory covering a broad range of areas. The types of facilities available to patients undergoing treatment in St. Luke's will not be available to such patients in St. James's. I do not understand why we cannot ensure that St. Luke's remains open as part of a centre of excellence interlinking with St. James's Hospital. That is something I would like to see happen and to be reconsidered. In the context of current economic catastrophe confronting this State and the financial dilemmas of where we will find money to spend on projects, previously deemed desirable, I suspect that, as a matter of practical economics, what is now being proposed may have to be reviewed. However, as a matter of ensuring medical excellence, there is no reason there cannot be the type of linkage between the two to which I have made reference.

It is important that if one is a cancer patient and requires radiological treatment that is available as rapidly as recommended by the consultant whose care one is under but there remains a problem in so far as there are those on radiation oncologists waiting lists in circumstances which are not acceptable. Such waiting lists are simply not acceptable in any civilised state not only because of the worry and anxiety it causes to patients, but because of the life and death implications of radiation treatment that is required being unnecessarily delayed. At the moment when that occurs and there are waiting lists, there are arrangements in place and, in recent times, a number of patients on waiting lists in St. Luke's Hospital have been referred on and been provided with the treatment they require.

My concern is that when this administration is taken over by the HSE these individuals whose care is catered for will simply become more HSE statistics on a list that someone in HSE central views as one among hundreds of people on waiting lists for a variety of reasons across the country. We must ensure that does not happen and that the best treatment possible in the quickest time it can be provided be made available to cancer patients who require the type of treatment that to date has been so excellently provided in St. Luke's Hospital, Rathgar.

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