Deputy Carter has given notice that he wishes to raise the subject matter of Questions Nos. 55 to 61, on 22nd March on the Adjournment.
Adjournment Debate. - Longford County Hospital.
On Tuesday last I raised the subject matter of a hospital for Longford in Questions Nos. 55 to 61 on the Order Paper. This matter arose because of the widespread anxiety of Longford people regarding a hospital. In directing these queries to the Minister, it was sought to establish what proposals the Minister had in mind after 30 years, and whether a hospital would be provided for Longford or not. It is now clear from his condensed reply that the Minister has nothing of a positive kind to offer Longford. In the first paragraph of his reply, it was indicated that as late as 1958 we would have a hospital. Would the Minister now indicate what standard of service is provided in the Mullingar unit which was mentioned in connection with Longford? If one takes the Minister's reply paragraph by paragraph, one can see at a glance the position.
In the first paragraph, the Minister admits, as I have said earlier, that it was contemplated in 1958 that Longford would have a unit, that his predecessor was disposed to provide a grant for such a hospital as soon as the economic position improved. In the second paragraph of the Minister's reply, he sets out to outline the complexity of a modern hospital. It is further stated in the reply that a physician, an anaesthetist, a pathologist and a radiologist are required amongst the personnel of a modern hospital. It would be relevant to inquire, for the purpose of the record, how many county units number such specialists on their staff? The third paragraph says that it would be unrealistic to meet the needs of Longford. It is to be wondered if it would be unrealistic to have a surgical unit to deal, for example, with high risk maternity cases, where two lives depend on immediate attention. It should be appreciated that such cases cannot be moved very far and numerous examples could be given in support of the need for service for this type of case, not to mention abdominal cases where heavy haemhorrage would be present and again where the patient could not be moved.
This brings one to accidents. It was well said by a traveller recently, who visualised Longford without a hospital, that if you wanted to commit suicide you could do it on the Battery Road. Take, for example, the case of brain injuries or arterial bleeding. Where could such cases be deal with, with any hope of saving life? In this category could be included serious poisoning cases of which we had a few recently and which were successfully dealt with by the county surgeon. Last, but not least, there are elective surgery cases, such as hernia, stomach disorders and certain types of diseases of extremities, of which it should be said that we have roughly a backlog of five years' work. Where would we gain entry for our patients?
The Minister referred to the deputation which he received in October last and stated that his views were set out in a letter to the council on 2nd March last. It took five months for his office to arrive at the adjective "possible" Those views were again re-asserted in his reply to my question on the 22nd instant. This prompted me to probe the matter further and the net result of that probe was that the Minister has nothing to offer Longford except to rely on the adjective "possible" that we should close our unit on the grounds of danger as soon as possible, which, to my mind, conveys precisely nothing. "Possible" means "that can or maybe, exist or happen, be done, a possibility".
What hope then does the Minister hold out for Longford? It is said that to travel hopefully is better than to arrive. It is apparent that we are not even travelling hopefully in this case. We are not in agreement on this matter and we never will be on such a vague basis. Where would we get temporary accommodation on such a basis? Nowhere. Would we be so mad, therefore, as to act on the Minister's proposition? For the first time in years, we have leadership in our hospitals. Why therefore, ask us to surrender our position? My reply to this request is never. In support of this contention, it is opportune to ask the Minister the date on which he reversed the decision of his predecessor that a new county hospital would be provided for Longford, which intelligence was conveyed to the local health authority as late as 1958. It will be noted here that a sum of £35,000 was spent on laying down a mains system to service the proposed unit.
Secondly, will the Minister state the date of the most recent visit of his architectural and other advisers to Longford County Hospital and the advice on which he bases his assumption that the present unit represents a risk to patients treated therein, and will copies of any such recent reports be laid on the Table of the House?
Thirdly, how many complaints has the Minister received over, say, a period of ten or 15 years from patients treated in our hospitals? Fourthly, will the Minister state the number of county hospitals where there are pathologists, the other specialities mentioned, together with full laboratory facilities? Fifthly, what hospitals in the Minister's opinion would provide 40 surgical beds for Longford patients? Sixthly, is the Minister aware of the fact that Longford and Leitrim, between the two areas, have a population of 52,000? Incidentally, as was mentioned in my letter, South Leitrim is bereft of surgery. We find that Offaly, with a population of 51,500 and Westmeath, with 52,500, not to mention Limerick city with 50,500 and Tipperary North Riding with 53,500, all have county units. It is therefore unrealistic and unwise, in my view, to suggest the closure of our hospital.
I submit that I have done enough to show the danger of acting on the Minister's advice, and it is to be hoped that a further deputation will hear a more positive proposal from the Minister in the future. Lastly, when my questions were answered on 22nd instant, I was absent on Government business. The unctuous Deputy Dillon took advantage of my absence to point out the malpractice of Fianna Fáil Deputies in putting down questions and then not being present to ask them. I must confess Deputy Dillon is a very garrulous backbencher. He is a backbencher, of course, not by his own wish but due to an earthquake in Fine Gael which moved him to where he is now.
(Interruptions.)
Deputy Dillon is a backbencher by his own wish and by nobody else's wish. In the course of his remarks, Deputy Carter said it would be mad to accept the Minister's proposals. I am in complete agreement with Deputy Carter's remarks and endorse them entirely. It would be a disgrace and a retrograde step to close Longford Hospital at present. As Deputy Carter stated, the Minister has nothing to offer Longford except the word "possible". He used a dictionary to define its meaning—I do not know whether it was the Oxford Dictionary that used to be used—but he says it means "to exist or happen". That is strictly in line with Fianna Fáil policy at the present time and, in fact, all the time.
Longford needs a hospital in Longford town to treat its own patients. We have been told by the Minister that the patients can be transferred to other hospitals. Hospitals in Leitrim, Galway, Roscommon and Mullingar have been mentioned. It has already been pointed out in a fine letter to the Irish Times and other papers by Deputy Carter that those hospitals are not in a position to cater for Longford patients at present. As far as Westmeath is concerned, the hospital there has been bursting at the seams for the past five or six years. We have been appealing to the Government for an extra 100 beds. There is no room in Mullingar to take the patients from Longford. Now that the Fianna Fáil axe has fallen on the Garda Band, the FCA, education, housing and hospitalisation, there does not seem to be a chance——
The Deputy should keep to the question.
——of enlarging Mullingar Hospital to take the patients from Longford. A suggestion has been made as regards surgeons. We have been told a surgeon will not stay in Longford at present. I do not see any reason why we could not have two surgeons in Mullingar. It would be much more convenient for a doctor to step into his car and travel at 50 or 60 miles per hour down to Longford hospital than to bring——
No, thank you. You have a smaller unit than we have. We will have no truck with you whatever.
At present you do not seem to want to have any truck with your own Minister.
We will not have any truck with you.
Deputy Carter has already spoken and time is running out.
I believe there could be two surgeons there. One could work in Longford. It would be much better for him to go to Longford than to bring patients from such places as Aughnacliffe and Lanesboro up to Mullingar. Last week the Minister stated it was the intention to close the hospital at once. He should take into consideration the high rates the ratepayers in Longford have to pay at present. The cost for patients in outside institutions in Dublin is as high as £25 per week. I doubt if in present circumstances the ratepayers of Longford would be able to bear that burden.
Another thing, we all know from a humanitarian point of view that people like to visit their relatives in hospital. Longford is more or less in the centre of the county. It is a reasonable distance from such places as Aughnacliffe, Granard, Lanesboro, Killashee and Ballinalee. The people have very little trouble because in 15 minutes or half an hour they can get to the hospital to see their relatives. If the patients are transferred to Mullingar, Roscommon or Leitrim, they may have to travel 50 to 60 miles. That is unfair and unjust to those unfortunate people.
I believe the ratepayers and people of Longford are entitled to a hospital in Longford town in the county of Longford. It gives me great pleasure to agree heartily with Deputy Carter. For once, I am in entire agreement with him. It is a new inter-Party.
First, I have listened with a great deal of sympathy to the arguments put forward by Deputies Carter and L'Estrange in favour of the provision of a new county hospital in Longford. It is only right and proper that local representatives should campaign vigorously for what they consider to be in the best interests of the local community they represent. As Minister for Health, however, I must approach problems in an endeavour to provide a properly co-ordinated and high quality health service for the country generally, and because of the need to deploy our limited resources in a rational way, a well-planned approach must be adopted, even though this may sometimes appear to clash with local interests. I can assure the House that my decision in this case was not easily reached. Deputy Carter criticised me for taking five months from the time I met the deputation. Instead of warranting criticism, that indicates that it got a tremendous amount of consideration.
The problems of the Longford area have had my attention and that of my officials for a considerable time and the various factors for and against a number of alternative solutions were minutely examined. In drawing up the proposals which have been subjected to such eloquent criticism to-night, I want to make it plain that my overriding concern as Minister for Health was to ensure that the best interests of patients in the Longford area would be served by my decision. The patient came first in my consideration and I believe that the decision at which I have arrived, with the advice of my officials, is a wise and proper one.
I should like to say, in passing, that according to the statistics—and this is rather curious in view of what the Deputies say — half of all Longford persons requiring medical and surgical care now go outside the county. I wonder why. It is also interesting to note, notwithstanding the type of injuries which Deputy Carter described, that up to very recently an Indian lady surgeon had the post as county surgeon and she resigned; there is now a surgeon there temporarily, and the only other medical staff there are a temporary house surgeon and a parttime anaesthetist.
It may be on account of the Indian woman that they are leaving the county.
A Deputy
That is most unfair.
That can be read into the Minister's remark.
Mr. O'Malley
I am not casting aspersions on that lady. I understand she was very efficient. However, one of the things to bear in mind is that it is very difficult to get first-class staff or competent staff in small units. Anyone who is conversant with this problem, anyone who goes to the trouble of discussing it with surgeons in any part of the country, will agree that the trend nowadays is towards concentration in bigger centres. It is, therefore, in the best interests of the people of Longford that first-class medical facilities are made available to them. I am satisfied that such care cannot satisfactorily be provided nowadays in small, isolated county hospitals.
For the information of the House, I think it would be helpful if I were to refer briefly to the background of these proposals as it appears to me. It is over 30 years since the project was first mooted, but, although it then received ministerial approval, there were difficulties in securing a suitable site and progress was held up until 1939; then the emergency conditions of 1939-1945 intervened. Subsequently the project advanced to tender stage, but economic difficulties forced its postponement. During all this time developments were taking place in the sphere of the hospital, which were tending to make it a more and more complex and costly organisation.
Within the last decade, the continued advances of medical science have had the effect of fundamentally altering the concept of a modern hospital service. A complete service may require many specialised components. Medical opinion regards it as highly desirable in the interests of the patients that a general medical and surgical hospital should have readily available to it as wide a range as possible of medical skills. Obviously the establishment and operation of a service of this type is a complicated and costly undertaking and is one which it is feasible to provide only in a limited number of centres. Every small town in Ireland would like its own hospital. That is human nature. I have no prejudice against Longford or any other town. I am only doing my job and I have got the best medical advice. I am not under any illusions about the political implications of such a decision, that it would be unpopular, and as a politician, besides being Minister for Health, I have to take cognisance of these things. However, the overriding consideration as far as I am concerned is the patient.
I should like to point out that elsewhere, in keeping with this concept, large hospitals of several hundred beds are being established on a regional rather than a local basis. Deputy Carter referred to the population of Limerick and other such places. In Limerick we have a regional hospital.
It is a glorified county hospital.
Mr. O'Malley
It is a regional hospital which has been accepted as the most practicable method of placing the fullest possible range of hospital facilities at the disposal of the patients. It is true that an arrangement such as this would not be as convenient for patients and their relatives, as Deputy L'Estrange says, as if the hospital were built locally. I regard the medical interests of the patient as paramount and, if we are to ensure that the people get the best possible hospital service, it can in future only be provided in the way I have indicated.
These are the considerations I had to bear in mind in coming to a decision on the proposals that Longford should have its own county hospital. The arrangement involving the further development of Mullingar County Hospital which I suggested in my letter to Longford County Council on 2nd March is the most desirable and practicable one. Under this arrangement, the extension of the accommodation at Mullingar and the further augmentation of the specialist staff there will make available to the area as a whole, including Longford, facilities and a range of specialist skills of the highest order.
A lot of attention in this debate has been centred on the statement in my letter to the county council which dealt with the closure of the Longford Surgical Hospital. I am advised that because this hospital is very old and incapable of successful and economical reconstruction, lacks lifts, hampering the movement of patients, and in particular, because the facilities for surgery are most inadequate by modern standards, it should be closed as soon as possible. Deputies from the area who are members of the county council will be familiar with the difficulties which have arisen in the last few years in staffing the hospital.
Pending the provision of additional beds at Mullingar, interim arrangements should be made with the surrounding counties for the admission of patients from County Longford. We hear a great deal of talk about other hospitals being chock-a-block with patients. In Mullingar County Hospital, there are 43 medical beds available; the average daily occupancy is 37; there are 49 surgical beds, and the average daily occupancy is 39. In Roscommon, 39 medical beds; average daily occupancy, 24; 58 surgical beds, average daily occupancy, 54. In Tullamore County Hospital, there are 32 medical beds available, average daily occupancy, 21; 61 surgical beds, average daily occupancy, 38. In Cavan County Hospital, there are 50 medical beds, average daily occupancy, 42; 58 surgical beds, average daily occupancy, 41. In the Portiuncula Hospital, Ballinasloe, there are 185 medical and surgical beds, and the average daily occupancy is 151.
Those are surgical cases.
Mr. O'Malley
I have given the figures for surgical and medical beds in these different hospitals, and these statistics——
Prove nothing.
Mr. O'Malley
If any Deputy wishes to put down a question as to the accuracy of the figures I have read out, I shall be glad to deal with it. I am satisfied, as regards these hospitals I have mentioned, that with co-operation, it should be possible for them to meet the essential needs of Longford, bearing in mind that a proportion of the cases in the county normally gain admission to Dublin hospitals. I have not yet heard it explained why half of all the Longford persons requiring medical and surgical care go outside the county.
There was no surgeon.
Mr. O'Malley
The suggestion that there was no surgeon up to recently is completely incorrect. There was this lady there who resigned, and now there is another surgeon there.
Only a temporary surgeon.
Mr. O'Malley
There is no point in trying to bluff me.
It is not the Deputy who is bluffing as much as the Minister's officers.
Mr. O'Malley
It should be possible for these other hospitals to meet the essential needs of Longford, bearing in mind that a proportion of the cases in the county normally gain admission to Dublin hospitals, for which I did not read out statistics. I am still of the opinion that early closure of the hospital would be in the best interests of Longford patients. I have noted, however, remarks attributed to the acting surgeon to the effect that he would be prepared to carry on in the present building as an interim measure. This is professional opinion which merits the closest attention. I therefore propose to ask the county council to arrange for the submission to me of a report by the acting county surgeon on this whole matter. It may be possible to arrive at an arrangement which would enable a limited amount of surgery to be continued in the hospital for the time being, but I would regard it as an essential part of any such arrangements that general practitioners in the county would be enabled at their discretion to refer cases requiring surgical treatment to any suitable outside hospital.
I repeat that the decision I have come to has not been arrived at without the closest and most careful consideration. The patient has been our primary consideration and I believe that the decision arrived at by me is a wise and just one.
The Dáil adjourned at 11.5 a.m. until 10.30 a.m. on Wednesday, 30th March, 1966.