Ulick Burke (Galway East, Fine Gael)

I welcome the opportunity to contribute to this debate on the Health (Miscellaneous Provisions) Bill. I regret provision is being made to dissolve the board of St. Luke's Hospital. While we are told this will lead to improved access and outcomes for cancer patients in the new cancer treatment strategy, it has always been acknowledged St. Luke's staff, both clinical and non-clinical, provided excellent care to their patients. All patients who attended the hospital from around the country were always afforded the greatest care possible. My regret is the HSE will now include the hospital in a network of cancer care centres with the two Dublin centres of excellence located in Beaumont and St. James's hospitals.

While many of these centres of excellence have only started to operate recently, the experience so far has not been satisfactory. For example, in Galway's centre of excellence based at University College Hospital, Galway any claim we have better access and outcomes resulting in better cancer care would have to be examined thoroughly. One would get fantastic treatment if one got access to the services. However, the provision of extra staff and beds has not happened in Galway. Members from Sligo and Mayo have raised the problems their constituents have in gaining access to services at Galway as a result of this lack of provision. It is claimed the Irish scheme follows international best practice. If the Government believes it has established centres of excellence by putting a brand on a hospital, it should think again.

I know of a person who was diagnosed with cancer three years ago. He has had to repeatedly enter University College Hospital, Galway for treatment. Each time he must go through the accident and emergency department and give all his personal and medical details on each occasion. There is something wrong in a centre of excellence maintaining such a cumbersome delaying tactic. Neither is it acceptable that this person, suffering from cancer and who has been treated in the same hospital, must wait six hours in the accident and emergency department for attention. One must query any claim this is a centre of excellence. While the treatment and personnel are first class, the problem is getting access to the services. This is not isolated to Galway but is happening in the other centres of excellence across the country. That is what is taking place there and it is not an isolated incident. It takes place on a constant basis. The management must be restructured or the centre of excellence for cancer care must be streamlined in some way and focused directly on access rather than having to go through the accident and emergency department, which is unnecessary and creates repetition. If one queries why this procedure is necessary, one is informed in no uncertain terms that the routine in place applies and that is it. It is an obvious waste of time, manpower and effort and it is costly and painful for the patients who must wait and go through that torture.

The report indicated that on average some 23,000 people in Ireland suffer from cancer annually. They must be treated. We are informed that figure will double between now and 2020. We have identified only four centres of excellence and we are dismantling the other centres that were in place. It is unfair that established treatment centres in other parts of the country should be dismantled on a regional basis. Dismantling those centres and directing people to the major centres is unfortunate and represents short-term thinking. Let us consider the far end of Donegal or, as Deputy Deenihan remarked, County Kerry. Such geographical situations must be considered. We have broken up a network that could have been developed. Much of the trauma with regard to access at present would not exist had we continued on the existing basis. For this reason, I regret that St. Luke's is being brought into the network. It has been recognised by the Minister and the Department that the personnel relocated under the reconfiguration play a pivotal role in the continuation of services, which is important. The personnel in St. Luke's have a pivotal role in the new structures.

I refer to the centres of excellence to be established and how they should be defined. The term should not refer to a physical building, but should represent the people and personnel involved. In her identification of the centres of excellence, the Minister should have given consideration to the fact that the label should be earned, not simply applied. If people were in competition to earn that label, there would be a far better delivery of service to many patients throughout the country.

Any discussion of cancer and cancer centres must include a mention of Our Lady's Children's Hospital, Crumlin. I refer to the centre in Crumlin under the direction of Mr. Finn Breathnach. The Minister and the Government have repeatedly starved that centre of excellence. The term or classification "excellence" was earned by the centre because of its commitment to the treatment of children. Although Mr. Finn Breathnach and many of his colleagues have indicated the importance and potential of Crumlin as a children's hospital, all their experience and requests were ignored by the Minister when she reconfigured children's hospitals and under what she is proposing to do now. That was regrettable. I am aware of the service that has been provided from first-hand experience and from being involved in Crumlin hospital for six years. Thankfully, the outcome was 100%. I refer to the dedication of the staff there led by Mr. Finn Breathnach. It is a pity and regrettable for the many people who will have to attend there on an ongoing basis that he has retired. However, he continues his commitment to the treatment of children's cancer at the Robertstown centre. As he had done at all times in Crumlin, he continues to deliver the absolute dedication and care needed for the treatment of children with cancer.

Parents fundraised on a national basis to make good the deficit and to provide reasonable conditions in Crumlin hospital. This was ignored by successive Fianna Fáil Ministers with responsibility for health during the past ten or 20 years. The hospital received only a paltry subvention from Government, far short of what was necessary because the Government and the Ministers were aware that the parents had a commitment to that hospital and that they would raise funds. Many individuals including sporting individuals and others in society have given commitments to raise funds for that hospital. It is regrettable that we are demolishing what was and is a first class service and would continue to be were it allowed and supported by the Minister and the Government of the day.

Regarding the HSE moving in and taking over an institution or a hospital, the hospital nearest to me is the Portiuncula Hospital in Ballinasloe which has lost its cancer treatment facility. It was taken over some six or eight years ago. In the meantime, it has been stifled of funding and personnel because of Government policy. We are waiting for the appointment of two consultants at present. Senior medical people have referred to the dangers in the accident and emergency department in some hospitals such as Portiuncula hospital because of the lack of consultants. This is ironic given the controversy of recent days involving a mother who went to the centre of excellence in Galway and was misdiagnosed there. Eventually, following advice from a friend she was referred to the maternity services in Portiuncula. There, thankfully, her condition was confirmed and we are all aware of the outcome in this regard from the media reports of recent days.

When discussing centres of excellence we should consider the record of the very large centres. They have lost contact with patients. Patients are no longer individual people; they become numbers and statistics, which is regrettable. Report after report from the HSE refers to statistics. They do not refer to people as such or as patients or to their outcomes. Until a change comes about in the statistical delivery of health services and until we return to the idea that people and patients are important, the HSE is on a wrong course. Unfortunately and tragically, many cases will be affected by this approach.

Portiuncula Hospital in Ballinasloe has been starved of support by the Government and the HSE. I refer to one simple example of what is taking place. We are informed that, as of last month, the hospital must save €1 million each month. Even at this, the hospital will have a deficit at the end of the year.

I refer to a previous provision of the Minister. If one goes to a general practitioner, one pays him or her €50 while the statutory fee in a hospital is €100. The general practitioner might do nothing other than refer the patient to the hospital but the hospital will lose the €100 even though it does the work, which might be expensive.

It is important that anomaly is rectified. Hospitals, such as Portiuncula Hospital, are losing scarce resources because of this anomaly. We hear much about the out-of-hours service, including West Doc and all the other doc services. The same is happening there. A patient goes to the out-of-hours service but nothing is done there and the patient is referred to the hospital. Once the patient produces a receipt showing he or she paid the general practitioner, the hospital will lose out on the €100 statutory fee. Perhaps the Minister will look into that anomaly. If €50 is paid to the general practitioner, the other €50 should be paid to the hospital for the work it carries out.

Each year 23,000 patients seek cancer treatment and that figure will probably double. The strategy in place must be revised. We must reconsider the decision to close centres against the people's wishes. It is regrettable that we have taken a short term view which will have to be reassessed in the near future in order to cater for the numbers. The downgrading of the oncology section in Our Lady's Hospital for Sick Children in Crumlin, St. Luke's Hospital and the hospitals in Sligo and Mayo and elsewhere is short-sighted. If we are following this international model, which has been referred to, in regard to this reconfiguration, we are overlooking so many factors which are important for the delivery of a proper cancer service.

See this speech in context