Barry Andrews (Dún Laoghaire, Fianna Fail)

I thank all the Senators for their contributions. This Bill is obviously a matter of serious concern to them. One thing which came across strongly from the comments was the strong ethos of care. Some of the phrases used were that it is "a gem", "an oasis" and that St. Luke's has provided a wonderful service to people over the years. The challenge for the HSE is to ensure the service is replicated in St. James's and Beaumont, a challenge which will not be lightly taken. However, it will be taken by the HSE and will be done in conjunction with the Friends of St. Luke's to ensure that St. Luke's radiation network will be of the first order and will try to bring the fantastic service that is provided by its staff to the services provided by St. James's and Beaumont over the next five years.

Senator Fitzgerald said something which was repeated a number of times, namely, that we all support the national cancer control programme which carries with it consequences. Perhaps when people support the generality of it at the beginning one does not anticipate what it will mean, something we all experience from time to time. If we are serious about the cancer control programme and the recommendations made by clinicians, in other words, that we would have co-located radiotherapy services, medical, oncology and surgical services for better outcomes for patients, and buy into that, it will have uncomfortable consequences which we may not have anticipated at the time.

They are the recommendations we have had from clinicians. Far from the fear described by Senator Norris that this was some kind of accounting exercise and would save the Exchequer money, the truth is that all the staff are being transferred in a similar manner to the transfer of undertakings, therefore there is no saving. The land cannot be sold or used for any purpose other than the provision of health services and social care services, therefore there is no possibility of realising any savings through the sale of land. In addition, under the national cancer control programme 12 linear accelerators will be available for the provision of radiation oncology in the two new hospitals described in the St. Luke's radiation network which will begin in late 2010 and early 2011. There will be a 50% expansion in capacity. It is impossible to describe this as an effort to realise money or create savings for the Exchequer. It is clearly informed by clinical advice from 2003. Demographics may have changed since then but we are dealing with an expansion in capacity and retention of the existing staff.

On Senator Fitzgerald's reference to Ms Coburn who spoke on radio today and wrote to a number of Senators, on behalf of the Department of Health and Children I wish to offer our sympathies to her and her extended family. It was obviously an extremely unpleasant experience and she had the courage to share it. We all learn from these things. The hospital has apologised to her and her family for the distress which was caused to her. I wish to bring to the attention of Senators that a new oncology assessment unit will open at Galway University Hospital in the middle of August. It should provide direct access for cancer patients and so will provide appropriate, timely treatment for cancer patients who are referred to it by their consultants. It is correct that there are specific protocols for cancer patients who present at accident and emergency departments. What happened to Ms Coburn's sister was not appropriate and the hospital put its hands up. The consultant Dr. David O'Keeffe referred to that this morning on radio when he explained some details of the case.

Senator Norris referred to an equivalence regarding cystic fibrosis but the truth is that there is a different danger of cross-infection for patients with cystic fibrosis because they can catch infections from each other and have to be kept in separate rooms. While cancer wards are quite acceptable, cystic fibrosis ones are not. There is no equivalence between the two.

Although it is a minor point, the phrase "centres of excellence" is a slight misnomer as they are referred to as "designated cancer centres". The phrase "centres of excellence" tends to suggest that other centres are not excellent or of the highest standard, and that is not acceptable. We want to ensure the highest standards are in place, and also that designated cancer centres can provide the highest possible level of care. Many Senators have personal experience of St. Luke's.

I am not sure if it is any consolation and I am making my comments from a personal point of view, but Crumlin Children's Hospital is the only paediatric oncology service in the country. Parents never hesitate to bring their children there from all corners of Ireland. It is the only place one can receive the service and one has to go the whole way through the hospital to get to the oncology unit. Everybody talks about it in the warmest possible terms.

There is always a fear of change. I do not mean to diminish, qualify or classify it as some kind of psychological frailty but this process will be carried out over five years. The Minister was clear that St. Luke's would not close before 2014 or early 2015 and that remains the case. There will be a transition period, as requested by Senator Cummins in his comments.

Some Senators were afraid that the hospital would be sold. An amendment was tabled by the Minister in the Dáil and section 6(5) now states that:

Subject to subsection (6), the Executive shall use the land vested in it by this section for the purposes of the delivery of health and personal social services within the meaning of the Health Act 2004.

The effect of the Labour Party amendment would be to go further than that and restrict it solely to cancer services. The Minister did not want to be overly prescriptive in the use because in certain circumstances palliative care could be provided to patients other than cancer patients. It may be a suitable use for the hospital. Nothing can change without the intervention of the Minister. It cannot be used for purposes other than health and personal social services.

The Fine Gael amendment refers to bringing the issue back to a committee. It is almost like a triple lock, whereby it has to go through the executive, the Government and committee. There is no precedence for that in an operational matter for the HSE. The amendment introduced by the Minister on Second Stage in the Dáil should address the concerns which were anticipated and encapsulate the amendment tabled by Fine Gael and the Labour Party. I hope I have addressed the majority of Senators' concerns.

Senator Healy Eames was correct in regard to quality of care but the outcomes are the crucial issue. She said her father is a difficult man, which I find hard to believe.