asked the Minister for Health if he will make a comprehensive statement on the dispute between the Southern Health Board and his Department over hospital services in Mallow; and if he will state why he rejected the Southern Health Board's proposal for a general hospital in that area.
Ceisteanna—Questions. Oral Answers. - Mallow Hospital Services.
6.
As the reply is in the form of a rather lengthy statement, I propose, with your permission, a Cheann Comhairle, to circulate it with the Official Report.
The following is the statement:
In November, 1967, the then Minister for Health appointed a consultative council to examine the position in regard to general hospital in-patient and out-patient services in the country and to report in outline on the future organisation, extent and location of these services taking all relevant matters into consideration. The council submitted its report to the Minister in June, 1968. The following is an extract from that report in regard to Mallow Hospital:
Mallow County Hospital is a 98 bed hospital in a modern building providing a general medical, surgical and maternity service, and staffed at consultant level by one surgeon and one physician. This hospital is 23 miles from Cork and is serving an area from which access to Cork is easy. The area north of it, around Rathluric, is convenient to Limerick. We recommend that the role of this hospital be changed to that of a Community Health Centre and that its acute hospital functions be transferred to Cork and Limerick hospital centres as appropriate.
Arising out of this report a campaign developed in North Cork to prevent a change in the function of Mallow County Hospital. Strong representations were made to the Minister from many public bodies and voluntary organisations and a public petition asked the Minister to disregard the recommendations in the consultative council's report and to consider instead an expanded role for Mallow County Hospital in the future hospital services in County Cork. It was pointed out in reply that the implementation of the consultative council's report did not necessarily involve a lowering of the status of Mallow Hospital. In fact one of the main features of the new hospital services would be a close association with the major centre in Cork. Various specialists from Cork would visit Mallow regularly to provide a wide range of out-patient services at consultant level. The effect of the proposed changes was explained by the Minister at a meeting with interested groups at Mallow early in June, 1969. In the course of the discussion the Minister conveyed that it was not the intention to transfer surgery to Cork until the proposed Cork Regional Hospital was built. This was a major 600 bed development and it would transform the hospital position in the Cork area. The reaction at the meeting was not, however, favourable to the Minister's outline of the proposals.
In May, 1971, two developments occurred which affected the hospital position in the Mallow area. Firstly, the permanent county surgeon, Mallow, successfully competed for an appointment in Tralee which he subsequently accepted. Secondly, the proprietors of St. Patrick's Hospital at Mount Alvernia near Mallow—a modern hospital with 60 beds—offered to sell the hospital to the Southern Health Board. In November, 1971, the chief executive officer recommended to the board that he negotiate for the purchase of the hospital or alternatively for an agreement by which the order of runs would on agreed terms continue to run it on behalf of the board. He recommended that the hospital with some extensions and part of the land be used as a centre to accommodate psychiatric long stay patients from the North Cork area thereby helping to make further substantial permanent reduction in the number of long stay patients in the large complex of buildings at Our Lady's Hospital in Cork. He also recommended a change of function for Mallow County Hospital involving the transfer of surgery to the Cork city hospitals.
The general institutional care committee of the Southern Health Board considered the recommendations at meetings extending over a protracted period. The chief executive officer submitted a comprehensive report on the 18th November, 1971, and at a meeting held on the 1st December, 1971, the committee decided to recommend to the board that Mallow County Hospital and Mount Alvernia Hospital be integrated and upgraded. On the 6th December the Southern Health Board approved of this recommendation and sought the approval of the Minister to the proposal.
The following reply was sent to this proposal on the 16th February, 1972:
A Chara,
I am directed by the Minister for Health to refer to Mr. Long's letter of the 8th December last and enclosures regarding the decision of the Southern Health Board to adopt, subject to the Minister's approval, the recommendation of the General Institutional Care Committee that Mallow Hospital and Mount Alvernia Hospital be "integrated and upgraded".
The Minister has considered carefully the information supplied by the Chief Executive Officer to the General Institutional Care Committee in his comprehensive report of the 18th November, 1971. In that report the Chief Executive Officer emphasised that the need to improve the psychiatric services is the outstanding priority in relation to institutional services in the Cork area. This applies with special emphasis to the extermely poor conditions in a great part of Our Lady's Hospital complex. The alleviation of these seriously sub-standard conditions urgently calls for a reduction in the number of patients being accommodated in that hospital. The Minister shares the concern expressed by the Chief Executive Officer about this situation and he accepts that steps to reduce overcrowding by transfer of patients would represent a major improvement and should be accorded a high degree of priority.
As regards the undoubted need in the Cork area for extensive modern general hospital facilities, the position now is that the Regional Hospital project it at a point near to the start of construction. When this major hospital is available for the treatment of patients it will transform the situation in the area as regards the extent and range of the most modern facilities provided for acute hospital care. As it is anticipated that the construction work will require less than five years to complete, these new facilities should be available in a comparatively short time.
Taking these two considerations together it is clear to the Minister that the proposal of the Board in regard to the development of general hospital services in Mallow runs counter to the true priority needs for institutional care in the area on any reasonable overall view. The idea of acquiring Mount Alvernia hospital and associating it with the County Hospital, about three miles distant, to be worked as a single hospital complex presents obvious difficulties. Apart from this, there is the fundamental question as to whether the needs of the population to be served, now or in the foreseeable future, would justify the expansion of in-patient accommodation proposed. On that issue, as the Chief Executive Officer pointed out at the meeting of the Committee on 1st December, 1971, while the population of the North Cork health district was in the region of 70,000, the population actually being served by the County Hospital now was in the region of 40,000 to 50,000 about one-third of the admissions being from in and around the town of Mallow. It is quite clear from this assessment and from the actual experience of the demand on the two hospitals working separately that the proposed "merger" of the two hospital units would entail over-provision of expensive general hospital services for the effective population to be served.
With regard to the development of the psychiatric services, it is the Minister's unalterable policy to press on towards proper segregation of in-patients, acute patients, in particular the younger ones, on the one hand and long stay on the other. Such segregation is essential if effective therapy and rehabilitation is to be applied to those patients who can and should be restored to their place in the community in the shortest possible time. At this stage in the Cork situation the decentralisation of long stay patients so as to permit an improvement of the organisation of patient care at Our Lady's Hospital offers the most effective contribution. In these circumstances the Minister could only see his way to sanction the purchase of Mount Alverna Hospital if it were agreed that it would be used to accommodate psychiatric patients.
Bearing in mind the views of the Minister, the Board will no doubt wish to reconsider the proposals of the Chief Executive Officer and the alternative course to maintain the status quo until the Cork Regional Hospital is ready for occupation when undoubtedly the Board as of that date will be obliged to examine the position again in the light of the then prevailing conditions.
Mise, le meas,
(Sgd.) P.S. O'Muireadhaigh.
The Chief Executive Officer,
Southern Health Board,
County Hall,
Cork.
The Southern Health Board considered this reply on the 6th March, 1972, and resolved that the whole matter of the hospital services in Mallow be referred back to the Minister for further consideration. It was also decided that the Minister be requested to send to the Local Appointments Commissioners the particulars of office necessary to enable the commissioners to proceed with the appointment of a permanent surgeon at Mallow County Hospital.
On 28th March, 1972, a reply was sent as follows:
A Chara,
I am directed by the Minister for Health to refer to Mr. Long's letter of the 9th March regarding the board's proposals about the hospital services in Mallow.
I am to state that the Minister has given the most earnest consideration to this problem and, as he made clear in the course of the recent discussion in the Dáil on the Estimate for this Department, he could not possibly agree to the Board's proposals which would entail going in the reverse direction to the lines of development recommended in the report of the Consultative Council on the general hospital services.
In the circumstances the most the Minister feels able to do to meet the wishes of the Board is to agree to the making of a permanent appointment of a consultant surgeon in Mallow in replacement of Mr. Henley. This would enable the status quo to be maintained until the Cork Regional Hospital comes into operation.
The necessary documentation in connection with the replacement appointment has now been transmitted to the Local Appointments Commission so that they may proceed with advertisement of the post and the selection of a suitable candidate.
Mise, le meas,
(Sgd.) B.Oh. Iarfhlaithe.
The Chief Executive Officer,
Southern Health Board,
County Hall,
Cork.
On the 18th April, 1972, the Southern Health Board decided to accept the Minister's letter and agreed to proceed with the purchase of Mount Alvernia Hospital.
Is it a good statement?
It is a very complete statement. The Deputy or any other Member of the House can ask further questions arising from it if they so desire.