Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)

Tá sé thar am go mbeimid ag déanamh plé ceart ar ceist ríthábhachtach na hailse, sa chás seo i gcomhthéacs Ospidéal St. Luke's, atá lonnaithe i Ráth Garbh sa chathair seo. Thar na blianta, d'aithnigh éinne a fhreastal ar othar a bhí san ospidéal le haghaidh obráid, nó aon ghnáthamh eile bainteach leis an ailse, gur áit speisialta a bhí ann. Tá na céadta míle othair imithe tríd St. Luke's ón lá gur oscail sé, breis is 56 bliain ó shin. Tháinig a lán dóibh amach ar an taobh eile ina lán-bheatha, ach níor éirigh le go leor dóibh teacht tríd an chóir leighis a cuireadh orthu san ospidéal.

Tá na banaltraí, na dochtúirí agus an foireann iomlán i St. Luke's speisialta freisin. Déanann siad i bhfad níos mó ná gur chóir dóibh, i mbealach amháin, agus iad ag déileáil leis na hothair. Tá siad sásta gach rud gur féidir leo a dhéanamh chun cuidiú leis na hothair atá faoina chúram. Is áit speisialta í St. Luke's freisin mar gheall ar an suíomh deas ciúin ata aici. Nuair atá daoine buartha faoin ailse atá tar éis iad a bhualadh, tá sé tábhachtach go mbíonn an ciúnas sin acu i suíomh atá leagtha amach chun a thuairimí a tharraingt chucu féin. Bíonn buairt ar daoine a bhíonn an "C mór" acu agus ar a mhuintir.

Is trua go bhfaigheann i bhfad Éireann an iomarca daoine bás de thairbhe ailse sa tír seo. Dá bhrí sin, aontaím leis an Rialtas go bhfuil gá ann radiation oncology a chur ar fáil lasmuigh de Bhaile Átha Cliath. Ní dhéanfaidh mé aon troid i leith an cinneadh sin. Dar ndóigh, tiocfaidh mé ar ais chuig na fadhbanna móra leis an bplean. Sa deireadh thiar thall, ní chóir go mbeadh gach rud lonnaithe i St. Luke's nó in aon ospidéal eile. Is fíor sin ó thaobh radiation oncology, paediatrics agus gach gné eile de chóras leighis na tíre seo.

Labhair mé faoi St. Luke's agus an suíomh atá ann. I gcomparáid le ospidéil eile, tá an ciúnas sin ann. Níl sé chomh ghnóthach sin go bhfuil gach rud ag tarlú ar luas ró-thapaidh. Measaim go bhfuil cinneadh mícheart déanta ag an Rialtas sa chás seo. Ní chóir dúinn glacadh leis an mBille seo, os rud é gur céim siar atá i gceist.

I have a problem with parts of the national plan for radiation oncology not because of the four centres and two satellite centres that have been identified, but because none of them is north of a line between Dublin and Galway and that still has not been properly addressed. There are ways to address it and they should have been announced before we dealt with this legislation. An all-Ireland approach to health services would also have helped to address this with greater co-operation between the HSE and the health services in the Six Counties. That would help to address some of the problems in counties Mayo, Sligo and Donegal and north Leitrim, which will not be properly served by the plan as it stands.

I cannot understand the logic of decisions the Government and the HSE have taken in recent years to close hospitals which are known the length and breadth of the island for the services and treatment they have provided and in which the State has invested significant sums in the recent past to upgrade facilities. For example, there was quite a financial investment in St. Luke's Hospital in recent years to upgrade it and make it, as was announced by Ministers at the time, a world class treatment centre that would stand out above others. That was true in 1996 when major investments were allocated to upgrade the hospital and in 1997 when St. Anne's Hospital was closed and its services to transferred to the St. Luke's site. It was also true as recently as 2008 when two new and two replacement linear accelerators were installed, increasing the hospital's radiotherapy treatment capacity. The investments have been made and while I am not critical of them, I am critical of the fact that they will be undone at a time we can ill afford it.

St. Luke's Hospital is located in Rathgar, Dublin. It is renowned among patients and their families for the beauty of its grounds and I do not see the logic of concentrating all its services in centres of excellence. Why not make this hospital a centre of excellence, as was proposed in the past? In 1996 when the Government invested in it St. Luke's was to be made a centre of excellence. Obviously there is a requirement for additional moneys to be invested in St. Luke's. There is a requirement for additional moneys to be invested in the satellite centres and in order for treatment to be made available in the community, and I have no complaint about that.

However, there is no logic in abandoning a hospital in which so much public money has been invested to date, and leaving it without a proper future. I am not aware of what the future plans are for St. Luke's.

This type of half thought out planning has also been the approach taken by the HSE to paediatric care in Ireland. Our Lady's Children's Hospital, Crumlin is in my constituency. There is another paediatric hospital in Tallaght, formerly Harcourt Street Hospital, and in Temple Street there is another. There is an enormous need for investment in paediatrics in Ireland and I am not disputing the logic that there should be one centre of excellence. Nor am I disputing the fact that there should be a centre of excellence for oncology services. I am, however, disputing the need for new build in all cases so that everything is moved into a centralised location, especially in paediatrics, without any plan as to what is to happen to the existing hospitals.

In my view, the only logical thing that can happen, given the current approach of the Minister for Health and Children and the Government as a whole to health services, is that those centres will be sold to private concerns. That question has not been answered here in terms of the site of Crumlin children's hospital. What is the future of that site? Only last month the hospital applied for planning permission to upgrade its ICU unit, despite the fact that it is going to be closed in four years time. There is absolutely no logic in continuously investing public money in upgrading facilities that will be closed within a few years. The same goes for St. Luke's. There is no logic in upgrading the facilities there if it is intended to close the hospital in a year or two.

I believe these hospitals should be upgraded and should not be closed. That is a question for the Minister of State to answer as regards the future plans for the site of St. Luke's once the national plan has been fully rolled out and the hospital transferred to St. James's or Beaumont by 2014.

We have a major problem in Ireland with cancer. The figures I was provided with show that there are some 23,000 patients annually, and this is expected to increase. As legislators we have to ensure that appropriate education is made available so that people can detect cancers early and avail of treatment locally. Of the 23,000 detected some 12,000 or 13,000 will require treatment annually. For all concerned, there is a logic to the fact that the treatment required should be made available at the nearest possible point to a centre of excellence. From a patient's viewpoint whatever services can be provided should be available as locally as possible. Everyone accepts that not all treatment can be provided on one's doorstep, and that there is a need for centres of excellence. However, the health services in Ireland have become more and more centralised over the years. Every small hospital around the country seems to be targeted for closure by the HSE, supposedly on efficiency grounds. However, I can guarantee that when a cost analysis is done in a year or two, it will show that the efficiencies which were meant to be achieved will be found wanting because people will be presenting at centres of excellence with problems that could have been addressed at an earlier stage, if the services were more locally available – or if they did not have to travel up and down to Dublin by taxi from as far afield as Donegal, for example.

I am opposed to this Bill, and I am asking that, even at this late stage, the Government thinks again about this and takes into account the financial constraints the country is under. I believe part of its policy objectives can be achieved by investing in St. Luke's. It would be cheaper to upgrade St. Luke's than to roll out all of the current plans.

I have visited a number of friends in the recent past who, sadly, have died, and who had undergone various radiation treatments. They were very proud of the work done in St. Luke's and praised its staff and the treatment they received. One of those treated at St. Luke's had previously been treated in St. James's for another ailment. He said that the difference in terms of his whole attitude to the problems he was facing, from being in a major general hospital to being treated in a dedicated small hospital, was immense, and it gave him some relief. Regrettably, he is not with us today.

Another friend who died recently, too, also was full of praise for the staff at St. Luke's. Now that staff is to be transferred by the HSE to wherever it decides. Hopefully, most of that staff will be able to stay together, because they have built up a good working relationship, regardless of whether they are transferred to St. James's, Beaumont or one of the four satellite centres so that the care and treatment they mete out to patients over and above their normal responsibilities will continue. I know this will be difficult, because I am aware of the problems experienced by staff from smaller hospitals when Tallaght General Hospital was set up. To this day there is a tendency among staff to identify colleagues as belonging to the Adelaide, Harcourt Street or the Meath. Sometimes it is difficulty for people to gel. That difficulty would be removed, however, if St. Luke's in its present form was maintained and expanded, while increasing and enhancing the services, as required.

I will not continue for much longer, apart from saying that every decision taken by the HSE of late seems to have been ill-conceived, and I cannot see how this one is any different. The HSE is running on a political platform to the effect that privatisation is good and should be facilitated. The Government has fully endorsed that platform and I believe it will be further endorsed in this case, because the plans probably will be carried out under a PPP. While I may be incorrect in this regard, I cannot envisage the Government changing its mind on its current approach to building an investment in the public health services, which is that it must have private investment. Public moneys should be spent on public hospitals and private moneys should be spent on private hospitals, if the latter are allowed at all. I am one of those who believe that Ireland should have a single tiered health service provided from the public purse and paid for by the public. It would be paid for by those who can properly afford it. This is the argument in respect of the need to change the taxation system. The taxes that are raised should be targeted specifically at public services such as hospitals and so on and public moneys should not be diverted from public services, as is the case at present under the National Treatment Purchase Fund.

I recently learned that €5 million, which would have kept open the St. Joseph's ward in Crumlin hospital, was diverted from public paediatric services to pay for private paediatric services. It is a living disgrace that a hospital cannot keep open its wards and operating theatre because the money is being diverted to private hospitals. Moreover, I believe the same is happening in respect of radiation oncology and that this is the plan for the grounds and buildings of St. Luke's Hospital once they have been transferred, if this Bill is passed, to St. James's and Beaumont hospitals.

I urge the Minister of State, even at this late stage, to reject this Bill and to go back to the drawing board. It is not a big drawing board and I believe this can be achieved on-site at St. Luke's Hospital.

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