Áine Brady (Kildare North, Fianna Fail)

I am pleased to have the opportunity to introduce the Bill, which has several purposes, to the House. Its main purpose is to give further effect to the Government's cancer control strategy and, in particular, the development of radiation oncology services under the national plan for radiation oncology. The plan will result in the expansion of public radiation oncology services, integrated with surgical and medical oncology. It includes the integration of St. Luke's Hospital, Rathgar, into the HSE's national cancer control programme. Accordingly, this Bill dissolves the board of St. Luke's hospital and transfers the hospital and its staff to the HSE.

The Health (Miscellaneous Provisions) Act 2009 provided for the integration of the national cancer screening service into the national cancer control programme. Cancer screening is an intrinsic component of cancer control and integrating it into the cancer programme ensured that services and resources were coordinated in the fight against cancer. Similarly, the provision of radiation oncology services is an intrinsic component of cancer treatment. This Bill makes provision for the integration of St Luke's into the HSE's cancer programme along the same lines as last year's legislation for the cancer screening service. The legislation also provides for the discontinuance of the infectious diseases maintenance allowance, which was introduced in 1947. Nobody is currently in receipt of this allowance and financial and other supports are provided to such persons under a number of other schemes.

The Bill contains a number of minor technical amendments. First, it makes technical amendments to the Nursing Homes Support Scheme Act 2009 and the Health (Nursing Homes) Act 1990 to assist in the interpretation of these Acts. Second, it makes a technical amendment to the Health Act 2007 which relates to decisions taken under section 55 of that Act. Third, it makes textual amendments to the Medical Practitioners Act 2007 to correct typographical errors. I propose to give an overview of the main policy areas of the Bill and then to set out its provisions in more detail.

The HSE's national cancer control programme, NCCP, was established and approved by Government in 2007 to give effect to the national cancer control strategy 2006. The strategy set out the future framework for delivery of cancer treatment in Ireland. It also endorsed the national plan for radiation oncology which had been approved by Government in 2005. Implementation of the programme involves the transfer of diagnostic, surgical and radiation oncology services to designated centres each with a critical mass of expertise, sufficient throughput of cases and a high concentration of multidisciplinary specialist skills. This approach is supported by international evidence, which demonstrates that the concentration of cancer services in large volumes in specialist centres produces superior outcomes.

The reorganisation of breast cancer diagnosis and surgery into the eight cancer centres has been the most high profile aspect of the work of the cancer programme to date. This has been a significant and challenging task and its completion late last year marked a major milestone for the cancer programme.

Considerable progress has also been made on other cancer services. One important development is the establishment of rapid access diagnostic clinics for lung and prostate cancer patients in each of the eight centres. These clinics will speed up access to diagnosis and multidisciplinary decision-making for patients whose symptoms are indicative of these cancers. So far, we have six lung clinics and five prostate clinics and the remainder are due to be established this year.

Good progress is also being made on the reorganisation of surgical services for pancreatic and rectal cancer patients. There will be one national centre for pancreatic cancer surgery, at St. Vincent's Hospital in Dublin, while rectal cancer surgery will be carried out in each of the eight centres. The community oncology programme is a more low profile aspect of the cancer programme's work but an extremely important one. The major focus of this programme is on creating capacity and knowledge among health professionals in the community to promote best practice in cancer control. These initiatives are all part of the overall implementation of the cancer control strategy.

Demand for cancer services, including radiation oncology, will continue to increase in the coming years as the population ages. The report of the expert group, Report on the Development of Radiation Oncology Services in Ireland, in 2003, the Hollywood report, recommended the development of a clinical network of large centres. The national plan for radiation oncology services was approved by the Government in 2005 and, as I said, endorsed in the 2006 cancer control strategy. Its aim is to provide new or additional radiation oncology facilities in four cancer centres: St. James's Hospital, Beaumont Hospital, Cork University Hospital and University Hospital Galway. There will also be satellite facilities at two other cancer centres, the Mid Western Regional Hospital, Limerick and Waterford Regional Hospital.

With regard to the north west, it is Government policy to promote a cross-Border solution in the provision of radiotherapy services. The Minister has offered to contribute to the capital cost of the proposed new radiotherapy centre at Altnagelvin Hospital in Derry. A final decision by the Northern Ireland Health Minister, Mr. Michael McGimpsey, on this proposal is expected in the near future.

The implementation of the national plan for radiation oncology services is under the governance of the cancer control programme. Construction of new facilities at St. James's and Beaumont hospitals will be completed at the end of this year. When these new facilities come on stream, they will increase radiotherapy capacity significantly. We will have 12 linear accelerators in the public system in the eastern region, compared with eight currently in operation at St. Luke's Hospital. The two new facilities at Beaumont and St. James's hospitals will come together with the facilities at St. Luke's Hospital to form the St. Luke's radiation oncology network. The new facilities will be under the governance of the cancer programme, not the individual hospitals. To facilitate the establishment of the St. Luke's network, the former director of the national cancer control programme, Professor Tom Keane, advised that there be a single governance model and that, therefore, St. Luke's Hospital should also come under the governance of the cancer programme. St. Luke's Hospital was established by statutory instrument in 1999 as a voluntary hospital under the Health (Corporate Bodies) Act 1961. It already receives all its operational funding from the HSE.

Providing for the effective delivery of radiation oncology services as a fully integrated component of the cancer control programme is the main purpose of the Bill. Accordingly, it provides for the dissolution of the board of St. Luke's Hospital and the transfer of its staff and facilities to the HSE. This means that all staff of the new network will be employees of the HSE, not any individual hospital. This will facilitate the transfer of employees between locations, subject, of course, to the usual industrial relations arrangements. It will allow for a single referral facility, a single management structure and shared support services across all three sites. Additional development funding and 54 posts have been provided for the cancer control programme this year for the new centres. In addition, some staff and resources will transfer from St. Luke's Hospital to the new centres in the second half of this year.

In 2014, when the national plan for radiation oncology services is completed and further capacity has been developed at St. James's and Beaumont hospitals, all remaining staff and resources will transfer from St. Luke's Hospital to St. James's or Beaumont Hospital and radiotherapy services will no longer be provided at St. Luke's Hospital. From 2014, therefore, all publicly funded radiotherapy services in Ireland will be provided as part of an integrated multidisciplinary service involving surgical, medical and radiation oncology services. This is in keeping with the recommendations made in the Hollywood report.

As many will be aware, there are organisations which are very closely associated with St. Luke's Hospital but which are at the same time separate entities. They are not encompassed within the legislation, nor should they be. The Department of Health and Children has liaised closely with the board of St. Luke's Hospial on the future of these organisations - the St. Luke's Institute of Cancer Research and the St. Luke's Cancer Research Fund. The focus of both entities is on cancer research and the continued development of expertise and knowledge and there is widespread agreement that this should continue into the future. The Minister understands the board of St. Luke's Hospital is taking the necessary steps to ensure these organisations continue to have legally sound structures following the enactment of this legislation. She very much welcomes this.

The Minister is also very aware of the significant work done by the Friends of St. Luke's Hospital for many years. To date, it raised more than €26 million in funds for various projects within the hospital. It has been a major force in fund-raising for radiation oncology services during the years and the Minister understands those involved wish to ensure the great goodwill and support for St. Luke's Hospital in the community can continue to benefit cancer patients into the future. This is also to be welcomed.

Another key policy area of the Bill is the reallocation of certain functions from the health sector to the Department of Social Protection. The Government decided some time ago that to increase the effectiveness of the health service generally, it was important that the service concentrated fully on addressing its core health objectives. Accordingly, it was considered there could be scope to transfer certain functions from the health service and locate them more appropriately within other Departments. The subsequent Core Functions of the Health Service Report in 2006 found that there were a number of schemes which were seen more as offering income supports than personal social services.

A number of implementation groups were set up to carry out the transfer of functions. One of these, the interdepartmental implementation group on non-supplementary welfare allowance payments, was given specific responsibility to examine the transfer of responsibility of income supports to the Department of Social Protection. A total of 25,000 domiciliary care allowance cases transferred from the HSE to the Department of Social Protection in 2009. In this context, the infectious diseases maintenance allowance, IDMA, was examined by the group. The IDMA was originally introduced in 1947 for a specified list of diseases, including tuberculosis.

In a situation where policy is moving towards mainstreaming supports for people with a disability, the sustainability of a separate income support payment for a prescribed set of diseases must be questioned. The group found that the key objectives of the IDMA were met by other allowances, in particular, disability allowance and supplementary welfare allowance. The incidence of the specified infectious diseases has been steadily declining and the number in receipt of the allowance in 2009 was very small - fewer than 20. The group, therefore, decided to ask the HSE to examine the small number in receipt of the IDMA with a view to establishing their eligibility and suitability for transfer to an appropriate equivalent Department of Social Protection income support. The HSE completed its examination of the small number of recipients in 2009. It found that some were no longer eligible for the allowance and that others were suitable for transfer to an appropriate Department of Social Protection payment. It should be noted that the weekly payment rates for IDMA, disability allowance and the supplementary welfare allowance were the same and, therefore, those who transferred to a new payment were not disadvantaged. The HSE has informed the Department that no one is currently in receipt of the infectious diseases maintenance allowance and that there are no applications or appeals in hand. Therefore, it has been decided to remove the infectious diseases maintenance allowance from statute by repealing section 44 of the Health Act 1947 and section 36(2) of the Health Act 1953.

I will now outline the principal features of the Bill. Part 1, comprising sections 1 to 4, inclusive, contains standard provisions dealing with the Short Title, commencement, definitions and expenses. Section 3 removes the Health Service Executive's duty to provide an infectious diseases maintenance allowance and also revokes the St. Luke's Hospital Board (Establishment) Order 1999. Parts of the legislation will come into operation by ministerial order and different provisions will be brought into operation at different times.

The specific provisions of the Bill that relate to St. Luke's Hospital are in Part 2, comprising sections 5 to 13, inclusive. Section 5 provides for the board of St. Luke's Hospital to be dissolved. Section 6 provides for the transfer of the land and other property of St. Luke's Hospital to the HSE. The Bill also includes a provision that the site may not be disposed of in any way without the permission of the Minister. Many will be familiar with the location of St. Luke's Hospital and its very attractive grounds. How this site may be used in future will be on many people's minds. The Minister understands that the Friends of St. Luke's Hospital and the board have been considering the future use of the hospital after 2014 and that they intend to submit their proposals to her in the very near future. The Minister stated during the Dáil debates on the Bill that she is committed to St. Luke's remaining within the public health service and that she will consult the Friends of St. Luke's Hospital, the Health Service Executive and other interested parties on how the site could best be used for the benefit of patients in the future. To provide further assurance, the Government introduced an amendment to the Bill on Report Stage in the Dáil which ensures that St. Luke's will continue to be used by the HSE for the delivery of health and personal social services.

Sections 7 to 9, inclusive, are standard provisions dealing with the transfer of rights and liabilities of the St. Luke's board to the HSE, the preservation of contracts and pending legal proceedings.

Section 10 deals with the transfer of St. Luke's staff to the HSE. Staff are being transferred to support the future provision of radiation oncology services within the network model. For staff, some of whom will transfer to other sites in the network at the end of this year and some of whom will remain at St. Luke's for a number of years to come, this provision provides certainty on their future conditions of employment. All current employees of St. Luke's at the date of transfer will become employees of the HSE on conditions and pay that are no less beneficial than those they have currently. All superannuation benefits and reckonable service transfer with the employees. Furthermore, the Bill provides that the pension liabilities of St. Luke's will now become the pension liabilities of the HSE. The Bill provides certainty, therefore, about the future for pensioners of St. Luke's also. These provisions are similar to those under which the national cancer screening service staff transferred to the HSE in April this year.

Sections 11 to 13, inclusive, are standard provisions dealing with the transfer of records and the preparation of a final report and final accounts of the St. Luke's board for submission to the Minister and the Oireachtas.

Part 3, sections 14 to 17, inclusive, deals with various miscellaneous technical and textual amendments. Section 14 updates the definition of "nursing home" in the Health (Nursing Homes) Act 1990 to reflect the new legal framework for the regulation of nursing homes, namely the Health Act 2007.

Section 15 is a technical amendment to the Health Act 2007 to enable a decision by the Chief Inspector of Social Services to take effect immediately in cases where the registered provider or applicant informs the chief inspector that he or she accepts the decision. Section 16 makes textual amendments to the Medical Practitioners Act 2007 to correct typographical errors.

Section 17 updates the definition of "proprietor" in the Nursing Homes Support Scheme Act 2009 to reflect the new legal framework for the regulation of nursing homes. It also amends the definitions of "allowable deduction" and "minimum retained income threshold" to ensure they take account of situations where both members of a couple enter long-term residential care.

The contribution of St. Luke's Hospital board and its staff to the provision of cancer services has been immense. The Minister acknowledges this contribution and thanks the board members, the management and staff for their commitment and dedication. It is also important to say that the board has provided great support and co-operation for the process of integration into the cancer programme.

The Minister looks forward to the ethos and sense of professionalism, which is so much a part of St. Luke's, contributing to the continued successful implementation of the cancer control programme and in particular the new St. Luke's radiation oncology network. I commend the Bill to the House.