Mary Harney (Dublin Mid West, Independent)

I wanted to be here earlier but I was taking the prescription charges legislation in the Seanad. When that debate concluded I came to the Dáil, although I do not mean to imply I have no confidence in the capacity of the Minister of State, Deputy Moloney, to address the issues arising. I wish to make some remarks for the record because I have grown weary of Opposition Deputies constantly saying they support the cancer control programme only to criticise specific parts of it.

Four years ago, 32 hospitals performed breast cancer surgery in Ireland. In one instance, a surgeon carried out a single procedure in a year. This was totally unsafe and it produced bad outcomes for patients and the health care system. We have changed these practices after asking a group of 23 people, of whom 19 were clinicians, from this country and abroad to investigate the best international practices which this country should follow in organising its cancer services. This group made recommendations which were endorsed by the Government. A group under Professor Hollywood was established specifically to examine radiation oncology. The report of the group recommended that radiation oncology should not stand alone from other cancer services. An evaluation was conducted of all the facilities, including St. Luke's. The evaluation committee, which comprised nominees from the National Institutes of Health in the United States, the European Society for Therapeutic Radiation and Oncology and a radiation oncology institute in the UK, gave the following scores: St. Luke's, 3,965; St. James's, 8,897; St. Vincent's, 8,497; and Tallaght, 7,484.

All hell would break loose in this House if I moved a facility that received a score of 8,000 to one with a score of 3,900. I would be rightly told, as I was during Private Members' business last night, that I did not put patients first. A motion has been put before the House which asks us to establish a new authority that would put patients first, yet every clinician who works solely in the public system favours this approach, as do the Irish Cancer Society, Europa Donna and every other patient advocacy organisation I have encountered.

I fully acknowledge that St. Luke's has a terrific reputation and I want to preserve its ethos. Until relatively recently radiation oncology could be administered only in St. Luke's. Members of all our families have been given a fantastic service at the hospital. Health care moves on, however, and developments in cancer care are revolutionary as well as evolutionary. We either go with the pace of change in order to achieve better outcomes for patients based on evidence or we stay fixed in time and deliver less. Neither I, as Minister for Health and Children, nor the Government is prepared to take the latter option.

I made the remarks to which Deputy Reilly referred in the context of a Bill which at the time lacked provision to maintain public health services at St. Luke's. I have now come forward with an amendment because my word was not trusted. Since this decision was made, I have stated it was never intended to use St. Luke's for any purpose other than public health because, God knows, we have relatively few facilities close to the centre of Dublin and its growing population. Instead of giving my commitment to discuss the issue in committee, I am writing it into the legislation. How much stronger could I be?

Do not pretend I am reneging on my word because I do not renege on the policies I make. We were required to put the cystic fibrosis unit at St. Vincent's to public tender but the company which came first was not in a position to make the tender bankable. I am confident that a successful tender will be found shortly. I do not choose who constructs these projects but I stand over the policies I make. I accept the cervical cancer vaccine was delayed for financial reasons but all the girls who were affected in that year are being covered. The programme was delayed but it was not reneged on and the Deputy needs to use his language carefully.

I know that patients have had a happy experience in St. Luke's and many of them are sad and, in some cases, emotional about what is happening. However, all the clinical expertise we could assemble, both from within this country and from abroad and including an expert of Professor Keane's global reputation in radiation oncology, supports what we are doing. I do not wish to ring fence the future use of the facility for cancer treatment because it could also serve palliative patients. Not all palliative patients are cancer patients. Perhaps it could incorporate a long-term care facility. Prospectus is producing a report for the Friends of St. Luke's Hospital and we will engage honestly with regard to the future use of the hospital. I had thought a guarantee that it will be used for public health services would be good enough for the Deputies opposite and I am sorry that is not the case.

The decisions taken by the Government were based on the best clinical expertise we could assemble from within this country and abroad. The three nominees from the aforementioned institutes, along with two doctors from Ireland, evaluated all the submissions and scored them accordingly. We may not like the scores but we must be prepared to accept them. For that reason, I am not in a position to reverse my decision or to maintain what is broadly known as a stand-alone radiation oncology facility at St. Luke's beyond 2014. As I want to maintain the hospital's ethos and name, the new unit at Beaumont or St. James's will be called the St. Luke facility. However, this issue is about more than just a name because we are focused on achieving the best outcomes and care for our cancer patients.

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