Dáil Éireann debate -
Wednesday, 14 Feb 1968

Vol. 232 No. 7

Adjournment Debate. - St. Kevin's Hospital, Dublin.

Mr. Ryan

Though I regarded the Minister's reply to my question as unsatisfactory, evasive and impertinent, I would have restrained myself from raising the matter on the Adjournment, were it not for the fact that when, in the course of supplementary questions, I continued to press the Minister to give approval for the extension to the pathology laboratory in St. Kevin's Hospital, the Minister said, as reported at column 436 of the Dáil Debates for 6th February last, that if I continued along that line of country; "I will not give my approval to it at any stage". On behalf of every Member of Dáil Éireann, I particularly object to any Minister saying that because a Deputy is pressing for something which he strongly believes in, the Minister will not give approval. It may well be that the Minister, on reflection, might regret having said that, and if he expresses that regret here tonight, I will be only too willing to accept it. It is something that should not have been said. It represents a denial of the rights of Deputies to press matters in which they believe; it is something which the Minister in a democratic State should not give voice to, no matter what he might think is the provocation.

The Minister, in the course of replies he gave to further supplementaries, appeared to suggest that Dublin Health Authority were seeking something inefficient and unnecessary in seeking for sanction for the authority's proposal to extend the pathology laboratory department in St. Kevin's Hospital. I had asked the Minister in my question:

why he has not yet sanctioned proposals for extending the pathology laboratory department in Saint Kevin's Hospital, Dublin; if he is aware that because of lack of accommodation in the laboratory research equipment cannot be used and is stored elsewhere; if he will give the reasons for the delay; and how soon sanction will be granted.

One would think from the Minister's reply that there was something novel, something casual, something reckless, in what the authority were proposing. Later on in the course of further replies to supplementary questions, the Minister spoke about doing "something here, there and everywhere, higgledly-piggledly, throughout the hospitals in Dublin". Later he spoke of "muddled thinking" about the whole hospital service in Dublin.

It is necessary, therefore, to put on record the history of the urgent appeals made by Dublin Health Authority to the Minister for the extension of the pathology department accommodation in St. Kevin's Hospital. The Department were approached about the matter four years ago. In a letter dated 18th June, 1964, the Department conveyed the Minister's approval to the provision of a new central pathological laboratory in St. Kevin's, and a couple of months later, on 9th September, a further letter from the Department of Health advised the health authority that the Minister would give a grant equal to two-thirds of the approved cost of the project, including equipment. In the same letter of 9th September, 1964, the authority were requested to give the planning of a new laboratory a high degree of priority as soon as a senior pathologist was appointed.

The senior pathologist was appointed with effect from 1st August, 1965, and immediately the necessary discussions took place and the planning was put into effect with the help of the architect, in consultation with the senior pathologist, the medical superintendent and the engineering and administrative staff. Drawings were prepared and submitted to the Department of Health on 8th December, 1966. Nobody can reasonably say that there was any undue haste on the part of the health authority. Rather was every care taken in the preparation of the plans. Every proper assessment was made of the needs of Dublin Health Authority and of the Dublin region in the preparation of the plans sent to the Department of Health on 8th December, 1966.

That was two years after the health authority had been told by the Minister for Health that "a high degree of priority" should be given to the provision of the necessary laboratory accommodation in St. Kevin's. More than two years passed by after the note of urgency was spoken by the Minister for Health. Ever since, the health authority, having completed their plans and made the necessary arrangements in discharge of what the Minister considered to be necessary, have received no co-operation from the Department. Indeed we were told by the Minister, when I raised the matter in the Dáil last week, that the Minister will not give a decision for some months until he gets a report from the consultative council on the general hospital services in Dublin.

The health authority's visiting committee, in the course of a visit to St. Kevin's Hospital on 21st August last, were very concerned to note the position there and I shall quote from the report of the visiting committee:

The Medical Superintendent outlined difficulties under which this Laboratory Department was operating due to lack of adequate accommodation; he referred to the extent to which the Laboratory Department had already encroached on hospital space on the first and second floors of Hospital 7, and to the fact that further accommodation was now being sought by the Biochemistry Section in connection with research work concerning inborn errors of metabolism in mentally handicapped children and the siting of additional equipment which had been presented to the Authority by the Medical Research Council. It was stated that outline plans for additional accommodation had been with the Department of Health since December last and that, despite repeated requests, sanction to the proposal had not yet been received. Accompanied by Dr. P. Moore, Biochemist, and Mr. John Duffy, Chief Technician, an inspection of the Haematology and Histology Departments was made in Hospital 7 and of the Biochemistry and Bacteriological Departments in the annexe at Rialto.

During our inspection in Hospital 7 we noted the extent to which ward and ancillary accommodation had been taken over for haematology and histology and the problems which were being caused in endeavouring to accommodate additional equipment and staff in this area of the hospital. There was further evidence of overcrowding and unsatisfactory accommodation for staff and equipment in the annexe at Rialto.

An Ceann Comhairle

The quotations are rather lengthy, if the Deputy does not mind my pointing it out.

Mr. Ryan

I appreciate that, but it is a more satisfactory way of doing so because I am quoting from a report of the people who made the inspection and I want to put it on the record.

An Ceann Comhairle

It is unusual on the Adjournment to have such lengthy quotations.

Mr. Ryan

If I may not quote I can only paraphrase the report of the committee which carried out the inspections. I now point out that there is a staff of 20 professional and technical people in the laboratory building and, as can well be imagined, there is a large amount of expensive equipment, including incubators, centrifuges, water-baths, flame-photometers, a number of precision instruments, and the like. All of this staff and all this extensive and expensive machinery is housed in a little over 2,000 square feet.

In other words, these skilled people have only 100 square feet per man, not only in which to operate but also to house their equipment. It is really short of a miracle that in these slum conditions a quarter of a million examinations are conducted annually. That is the sorry situation as the health authority has to put up with it.

In addition to that, there are two other pieces of urgently needed equipment which are not in use because there is no accommodation for them, including the equipment which came to Dublin Health Authority by reason of the support of the Medical Research Council and the Hospitals Commission with the approval of the Minister and other equipment for the biochemistry department which is on order and cannot be accepted until there is accommodation for it.

The Minister said some arrangements were being made to house this equipment but Dáil Éireann should be made aware that the equipment will have to be temporarily housed in a building which was scheduled for demolition because of its decayed condition. Here, because of the Minister's delay, we will have to house very technical expensive equipment in a building which is only fit for demolition. In the experience of our engineering staff this can only be done as a temporary expedient.

The health authority at a general meeting discussed the committee's report on the 7th September and following that, the Minister received a further appeal from the health authority for sanction for these plans. Again on 19th October the health authority expressed strong criticism of the continuing delay which in turn was conveyed to the Minister. At its latest meeting in January this year the Visiting Committee was appalled to find out that notwithstanding its repeated requests, and particularly with regard to the urgency of the representations made last year, no progress had been made.

I have spoken of the terrible conditions in which we are forcing the laboratory staff to work. I think we must also concern ourselves with the interference with other services in the hospital as a result of the necessity to use accommodation for the hospital laboratory which ought to be available for other purposes. At the moment there is an extremely urgent need to provide additional accommodation for patients and staff. St. Kevin's Hospital has a waiting list of up to 120 patients who cannot be taken in and many are awaiting accommodation because some of the laboratory equipment and staff are lodged in part of the hospital that ought to be available for patients.

In particular, we urgently require accommodation for children in the adolescent and pre-adolescent age groups. There is also an urgent need to provide accommodation in St. Kevin's particularly as it is a teaching hospital, for surgical cases. At the end of this long queue there are the unfortunate members of the staff who have to tolerate miserable conditions which are less than fit for them and would not be tolerated anywhere else.

Dublin Health Authority is also up against the problem of recruiting senior consultant staff. It is reasonable that senior consultants should have adequate accommodation and we are aware that there are people who would otherwise be available but are not willing to come to the health authority because of the slum conditions imposed on them in St. Kevin's.

We were told by the Minister that the conditions in St. Kevin's were far superior to the laboratories in most of the voluntary hospitals. We do not know whether this is true or not, but I am prepared to accept it if the Minister says so. But, if that is so, it highlights the deplorable conditions in which laboratory work is being done in this city. We must remember that the local authority hospital is different from the voluntary hospital. Voluntary hospitals, particularly teaching hospitals, will have facilities available to them in the medical schools. Such facilities are not available in the local authority hospitals which must be self-sufficient.

Because of the compelling need for laboratory accommodation in St. Kevin's, we say, and I speak with the unanimous support of all the members of Dublin Health Authority, that the necessity for the sanction of the Minister for Health for a new laboratory in St. Kevin's is a matter of such great urgency that it cannot await the report of the Consultative Council on the general hospital services in Dublin. We cannot imagine any recommendation from that Council which will have any bearing on the laboratory accommodation in this mighty hospital of St. Kevin's.

We ought to return to the situation as referred to by the Minister's Department in 1964, that this extension to the laboratory in St. Kevin's is a matter of urgent consideration and ought to receive priority. I think that on reflection the Minister might appreciate the urgency and give this sanction. All the other laboratory accommodation which Dublin Health Authority have is needed. None of it is superfluous and what is required in St. Kevin's is small compared with the benefit which would flow to the hospital and the community in general.

If the Minister now sees the need for giving permission, I trust he will agree with me that if I considered it to be an urgent matter it was part of my duty to press it. I was consciously obliged to do it, and he might now see his way to withdraw his unfortunate remark that in no circumstances would he give his approval if he was pressed by me in this House.

Minister for Health (Mr. S. Flanagan)

There are two separate issues involved here. One is the role St. Kevin's will play in the future, and the other is the particular matter of the use or otherwise of a particular piece of research equipment. I do not have to remind the House, or Deputy Ryan, Chairman of Dublin Health Authority, of my goodwill towards St. Kevin's. It was with reluctance that I postponed a decision in regard to this matter of the extension of the laboratory facilities in the hospital.

I want to make perfectly clear that when I spoke about development on a higgledy-piggledy basis in Dublin, I must not be taken as referring to Dublin Health Authority hospitals exclusively. On the contrary, it is not even principally the Dublin Health Authority hospitals to which I was referring but to the over-all development of the hospital services in the city. This is something which I regard as of very high priority and it is because I regard it as so important for the development of the hospital services in the country, not merely Dublin, but in the country generally, that I set up the consultative body which I asked to report to me in what I said at the time was a record period of from four to six months. From what I hear the body are working very hard and hope to be able to report to me within the stipulated time.

The nub of the issue here was made quite plain by Deputy Ryan towards the end of his speech. The question is whether the matter is so urgent that the decision could not be postponed until the report is available or could bear the delay of say three months. In my opinion, taking everything into account, it would be better to postpone it for that short period. As I understand the situation, out of one and a quarter million tests——

Mr. Ryan

A quarter million was what I said: it is big enough.

Mr. S. Flanagan

Out of a quarter million tests carried out, only 5,000 have to be farmed out elsewhere and a certain number of tests would, in any case, have to be farmed out to UCC or the College of Surgeons. I do appreciate that in the meantime and partly because of the vast growth in the number of these tests and their variety, the staff at St. Kevin's are at the moment working under difficulty. I thoroughly appreciate that but I think it is worthwhile to wait for two or three months to get the report from the consultative body. I have my own ideas in regard to the role St. Kevin's should play in the future development of our hospital services but I hesitate to impose my view and make a decision on the matter when I have a distinguished body of consultants who will advise me in a very short time and who, I hope, will make clear to me what they regard as the future role of St. Kevin's in hospital development generally.

I want to make it clear that if the consultative body's recommendation in regard to the role of St. Kevin's happens to coincide with my own view, I shall make a decision immediately, one way or another, because it is possible that the proposals of the health authority may have to be amended one way or another. If the body take a certain view, the proposals, even as they stand, may not be adequate because the role of the hospital may be improved rather than disimproved. It is in the light of that and with all those considerations in mind that I, while appreciating the fact that the staff are labouring under certain difficulty at the present time, think it best that the decision should await the general recommendations of the consultative body.

It is implicit in what I said that I was not making any serious attempt to deny Deputy Ryan's right to raise matters which he said affect his conscience and are concerned with the discharge of his responsibilities as a Deputy. I was trying to do no such thing: I was trying to prevent him from raising further irrelevant questions by saying to him: "If you do not keep quiet, I will not sanction the thing at all." I think the import of that should have been perfectly clear to the Deputy and I feel it was perfectly clear to the House. One thing about politics is that you are never supposed to make a joke——

Mr. Ryan

I did not regard it as funny.

Mr. S. Flanagan

Then the Deputy must have been in a cranky humour at the time. The Deputy knows very well that even in the short time since I was appointed, various developments in regard to St. Kevin's have been approved and the necessary authority issued for the payment of grants from Hospital Trust funds and so on. If Deputy Ryan were to try to suggest that I was in any way antagonistic to St. Kevin's I think nobody would believe him.

With regard to the research equipment which I believe is used by the paediatrician and a biochemist in connection with the study which Deputy Ryan mentioned, I think it right to point out that this refers to the mentally handicapped and therefore does not concern any of the patients in St. Kevin's itself. That is not to say that the use of the equipment is not desirable: of course it is, and I quite readily appreciate that it would be far better if you had a more suitable place in which this equipment could be used than a temporary shed which will have to be demolished in time. It is relevant to point out that this is work which is being done for the good of mentally handicapped and towards research into the causes of the malady but does not concern in any way the patients who are the responsibility of Dublin Health Authority in St. Kevin's Hospital.

Mr. Ryan

I do not want to interrupt the Minister but is he aware that there is a clinic for mentally handicapped children at St. Kevin's?

Mr. S. Flanagan

It affects all mentally handicapped children. It was implied in what the Deputy said that this research equipment was intended for the use and benefit of the patients of St. Kevin's——

Mr. Ryan

Some of them.

Mr. S. Flanagan

Only very marginally, some, so that so far as the patients are concerned, I do not think any real loss is involved.

The only other thing I want to say is that I do not for a moment suggest that the proposals of the health authority in regard to extensions either here or elsewhere are casual or reckless. What I would say and repeat is that, primarily from a medical point of view and secondarily, from an economic point of view, it is most undesirable that we should press ahead with casual improvement of hospitals here and there, without having regard to over-all development plans and in the belief that it is better to await the report on what those over-all development plans should be, including all hospitals as well as St. Kevin's, I made the decision to postpone final consideration of the health authority's proposals for another two or three months. I realise that while the staff may be slightly discommoded in the process in the meantime the situation would be clearer to all of us, and I think we shall be able to go forward then and proceed with goodwill to the implementation of those parts of the proposals which are designed to give us an over-all better hospital service in the country.

The Dáil adjourned at 11 p.m. until 10.30 a.m. on Thursday, 15th February, 1968.