Chris Andrews (Dublin South East, Fianna Fail)
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A Cheann Comhairle, I thank you for the opportunity to speak on an issue of great importance both for the implementation of the national health strategy and for the provision of health care services in the constituency of Dublin South-East. First, I would like to focus on the facilities provided in St. Luke's Hospital in Rathgar. As residents and patients alike know, plans have been under way since July 2005 to transfer the oncology services of St. Luke's Hospital to a centre of excellence in St. James's Hospital. This decision was taken by the Minister based on the report, The Development of Radiation Oncology Services in Ireland.

The decision was designed to ensure that radiation oncology is integrated with all other aspects of cancer care including surgery and medical oncology. What this means in plain language is that cancer patients will receive all the treatment they need under the one roof, experts will be available in the one location, and all available technology and services will be on site. It is known as multidisciplinary care and it makes sense. It is in line with international best practice and it has been proven that patients have a 20% higher chance of survival if they are treated in specialist centres. Patient survival is the objective of health care strategy and I therefore welcome the initiative.

Members of the board of St. Luke's Hospital have also fully committed to supporting this decision. They recognise that it is in line with international best practice and is designed to ensure optimal outcomes for patients. They are fully behind it. They have also ensured that the expertise and ethos of St. Luke's will be at the heart of the new arrangement in St. James's Hospital.

However, two major points need further consideration in this debate. First, there is a chronic shortage of step-down facilities in Dublin South-East and second, the site of St. Luke's is a unique place for respite and palliative care. It provides a calm and tranquil setting in which to recuperate and undergo serious health treatment. This should not be ignored. Anybody who has been there will know there is a special quality about St. Luke's.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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Exactly.

Chris Andrews (Dublin South East, Fianna Fail)
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While we can sit in offices and work in laboratories and come up with the best ways to implement policy and assign treatment centres, we must also acknowledge the human aspect and the more subtle qualities of such a place. We must respect that there is a tradition of palliative care on this site and that enormous work has been done through the years by people who wish to continue providing care on this site. There has been investment in new radiotherapy treatment units or linear accelerators which will increase the treatment capacity of the hospital by up to 25%. It may seem odd that new services are being provided in a centre whose cancer services are to be transferred. However, the reason for this is to ensure the quality of service to cancer patients during the years that it will take to complete the transfer. I welcome the investment of almost €13 million in coming years, which shows a commitment to cancer care and shows foresight.

I understand no decisions have been made regarding the future of the St. Luke's site. However, this is simply not good enough. Residents, patients and doctors cannot hang in the balance without knowing their fate. They deserve assurance that this site with its long tradition of providing health care will remain in the hands of the HSE and will become a step-down facility that will continue to serve the community. If people like Kay Bradbury and the many community groups had not fought the case for the Meath Hospital, it would not be the successful health facility it is today.

The Minister recently said that St Luke's Hospital would be used in the best interests of the health services. The Minister must make a clear statement that this hospital will not be sold to private developers. I urge the Minister not to engage in any coyness and end the uncertainty by confirming that the St. Luke's site will provide step down facilities which are chronically needed. I do not want to be fobbed off with an ambiguous answer.

Fergus O'Dowd (Louth, Fine Gael)
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Hear, hear.

Chris Andrews (Dublin South East, Fianna Fail)
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I support the transfer of cancer services. There is a chronic shortage of step down facilities in south Dublin. We need to plan for the future. We need to end uncertainty over St. Luke's and not leave it go on for years.

Máire Hoctor (Tipperary North, Fianna Fail)
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I am speaking on behalf of the Minister, Deputy Harney, who is unavailable. I thank the Deputy for raising this issue, which provides an opportunity to reaffirm the Government's commitment to services for older people. The development of such services is a high priority. This is reflected in the funding committed to services for older people in the 2006 and 2007 budgets. In 2006, the Government funded the largest ever expansion in services for older people with a full year cost of €150 million. In budget 2007, a full year package of €255 million has been allocated for services for older people. This gives a total of more than €400 million added to services for older people over two years. Government policy on older people is to support people to live in dignity and independence in their own homes and communities for as long as possible and, where this is not possible, to support access to quality long-term residential care. This policy approach is renewed and developed in the latest partnership agreement, Towards 2016.

While the main emphasis will continue to be on providing supports that help older people to remain in their own home for as long as possible, additional long-stay residential places will be required in the coming years to meet the needs of an ageing population. Last year, the HSE, in conjunction with Prospectus, undertook a needs assessment of bed capacity requirements in the areas of long-stay, dementia specific and respite care beds. This report was submitted to the Department of Health and Children in September 2006. While the report indicates a small national surplus of long-stay beds, it also notes that this surplus masks the uneven distribution of beds between and within regions. In particular, HSE Dublin north east and HSE south have an immediate requirement for additional beds.

As part of the overall investment package for the development of services for older people, the Department and the HSE have prioritised the delivery of additional public continuing care beds through the development of community nursing units in large urban centres in both Dublin and Cork together with the expansion and the development of additional facilities across all regions. The Department is in discussions with the HSE regarding the delivery of this additional capacity. I understand the HSE has plans to provide additional step down-long stay facilities in the south Dublin area. Locations are being identified in the context of the 2008 capital plan.

The transfer of services from St. Luke's Hospital to new facilities at St. James's Hospital is not due to take place for a number of years. In the meantime, two additional linear accelerators will be commissioned at St. Luke's in early 2008 and two replacement linear accelerators will be commissioned later in 2008. These will provide much needed interim capacity pending the roll-out of the national plan for radiation oncology. No decisions have been taken on the future use of the site and facilities at St. Luke's. However, the Minister intends to ensure these resources are utilised in the best interest of the health services.