asked the Minister for Health if he is aware of the widespread concern throughout the country concerning the proposed closure of so many hospitals foreshadowed in the Fitzgerald Report; and if he will allay public anxiety by making a statement on the matter indicating the Government's intention.
Ceisteanna—Questions. Oral Answers. - Fitzgerald Report.
9.
It is not correct to say that the Fitzgerald Report foreshadows "the proposed closure of so many hospitals". What it does is to suggest a change in the function to be assigned to certain of our hospitals.
The report sets out the principles which should govern the future development of the hospital services if we are to keep in step with modern advances in medical knowledge and techniques. One of the fundamental recommendations in the report is that the consuitant staffed acute hospital services should be reorganised into a smaller number of units to the extent necessary to justify the staffing, equipment and other facilities which are necessary in a first-class modern hospital service dealing with serious conditions.
As my predecessor as Minister for Health made clear on many occasions, he, and, indeed, the members of the Government, accepted the principles on which the Fitzgerald Report is based. Having studied the report, I welcome this opportunity to signify my firm conviction of the rightness of this decision. The practical implementation of the principles of the report requires further detailed examination in consultation with the various interests concerned and this is being done.
As regards the Deputy's reference to widespread concern and public anxiety, I am aware that in particular areas the Fitzgerald Report has evoked a very active response in the way of public discussion, the organising of petitions and so on. Public interest in developments affecting future services is, of course, to be applauded. It is important, however, to emphasise that the common object is to quote the concluding part of the terms of reference of the consultative council, "to secure, with due regard to the national resources, that the public is provided in the most effective way with the best possible services." I certainly subscribe to this. In my position as Minister for Health I am not going to permit a situation to arise whereby in a few years time I could be accused by Dáil Éireann of permitting a higher rate of mortality in respect of many illnesses which need not have come to pass had firm decisions been taken on this matter.
The Minister must surely be aware of the anxiety to which I refer. The closure of very many hospitals is foreshadowed. I put it to the Minister that the Fitzgerald Report specifically states that it is proposed to close all county hospitals in Tipperary. Furthermore, in respect of these hospitals doomed to extinction, which have been maintained at considerable cost by health authorities down through the years, there is particular concern about the possibility of having to transport dangerously ill patients upwards of 60 miles to the regional hospitals designated and will the Minister also have regard to the inability of freinds and relatives to visit patients at regular intervals because of the considerable distance involved? Will he at least give the House an assurance——
This is quite a long question.
——that the necessary money will still be forthcoming for the maintainance and upkeep of the existing institutions and that there will not be any deliberate lowering of standards, which will eventually bring about closure at any rate?
I have not seen anything in the report to suggest that county hospitals will be closed. The report is immensely complex and covers every aspect of medical and hospital services, including the curing of illnesses in which there are some 30 or 40 specialist forms of medical and surgical techniques, with their accompanying ancillary laboratory facilities, which are a very essential part of the whole. The report covers maternity and geriatric resources and in-patient diagnostic clinical services. It is a most complicated report. Quite obviously it could not be a perfect blueprint. No report could take into account all the relevant considerations. It will be my duty to consider what should be the short term, medium term and long-term action in regard to the report. Secondly, it will be necessary to secure the consent of the various hospital interests concerned. Thirdly, we shall have to evaluate the report in the light of our financial capacity.
Above all, we shall have to take into account all the observations already made by local authorities in regard to the proposed changes and the removal of acute medical and surgical cases from certain hospitals to certain centralised hospitals. I have to take into account all the representations I have received and those which I will receive in the future. It will naturally take me some time to do this. The House need not be worried that rapid decisions will be taken overnight. As I have said, I have got to take into account the observations of a highly reputable body of men who are thinking not only of today's medicine but of medicine as it will be ten years from now, when equipment and treatment will be even more specialised and when medical and surgical services will be even more specialised. I have got to consider how best to ensure recovery from sickness of the largest number of people and bear that in mind in relation to all the observations already made in regard to the preservation of the country hospitals in their present form. This is a gigantic task for any Minister and I am quite sure that when the whole matter is discussed later on in this House, Deputies will realise certain decisions have just got to be taken.
Will the Minister give the House an assurance that no hospital, at least in my constituency, will be closed or down-graded without the fullest consultation with the health authority? Is he not aware of the determination of all the members of that authority to resist to the utmost of our ability any such suggestion of closure or down-grading? The Minister is aware that the intention is to turn these hospitals into outpatients' clinics?
I have made the position very clear.
Will the Minister give the guarantee that he will do what his predecessor said, to wait 15 or 20 years before that section of the report is put into operation?
I do not think the Minister said that specifically. Neither myself not the previous Minister had sufficient time to study the implications of this report. There are certain reasonably short-term decisions which have to be taken; there are medium-term decisions and long-term decisions——
The Minister's predecessor said 15 to 20 years in regard to this particular section.
In the case of some of the hospitals that might be the case.
In all the hospitals.