Two Deputies raised the question of the conditions in St. Brendan's Hospital, Deputy O'Connell and Deputy Boland, and they will have ten minutes each and the Minister will have the remaining time to reply.
Adjournment Debate. - St. Brendan's (Dublin) Hospital.
Saint Brendan's Hospital, Grangegorman, as it was known, has conditions which would make every member of our society ashamed because we are treating poor helpless people in appalling conditions. No self-respecting government or parliament should tolerate them. Following a protest by junior non-consulting doctors who were repelled by the abnormal and appalling conditions in the hospital I visited the institution. Those doctors said it was rat-infested and unclean and there was no exaggeration on their part in the protest they made to the Minister for Health. I should like to state that they made a private protest to the Minister and did not wish to publicise it but the fact that their protest was treated with contempt and indifference prompted them to make the facts public.
The protest that they made is no exaggeration. I went on tour of the hospital and I will not easily forget what I saw. We are treating defenceless, helpless human beings in that hospital worse than we treat animals. When I visited the hospital there was a deliberate cover up, which I just realised when speaking to nurses working in the hospital. It transpired that I was only shown part of the hospital and not only that but there were places which were purposely cleaned only hours before I went there. I will give a description of one of the wards; one old lady was lying there with the paint falling on top of her as men were working in the ward. What I saw of the bathrooms and the toilets I could not describe adequately. Their condition was appalling. We are allowing this to take place in our society; poor defenceless people who are not able to speak out for themselves are living in conditions more reminiscent of the seventeenth or eighteenth century than today. The men and women sitting there in those depressing wards, depressed and lonely, could not but deteriorate in the conditions which I saw there.
What I am asking for is immediate action to improve the conditions of these most defenceless people in our society. Over and over again conditions in psychiatric hospitals have been exposed. I have attempted to expose them on many occasions. Indeed, I first exposed the conditions in St. Ita's Hospital in Portrane where I saw 96 in one ward. There were two open toilets for the use of those 96 women. Every attempt was made to cover up on that at the time and conditions are still bad there. But my visit to St. Brendan's was most depressing. When junior doctors or anyone else try to expose such conditions the Minister should in all honesty and, having regard to his position, personally visit the hospital to see for himself the conditions existing there. It would not be wrong for him to visit the hospital. He should not ignore the problem and he should not lay the blame for it on anyone but the Department of Health which should provide the money. The Minister may say he gave £200,000 or twice that, but the situation is that conditions could not be worse there. There are dirty, filthy kitchens that have not been painted or even cleaned in years. I saw a wild bird come in through the window, flying around the kitchen and its droppings all over the food. Not only did I see it but newspaper men saw it. I saw baths that one would not see discarded in fields used for patients. They are human beings. They need help. If they have to live in mental hospitals let them do so in a degree of comfort and privacy which they do not have at present.
It would not be right to condemn the conditions of a hospital without offering some constructive suggestions. I feel that the situation at St. Brendan's, if we are to be realistic about it, could be remedied at no cost whatsoever to the Exchequer. There are 87 acres up there at St. Brendan's. Thirty-seven acres of that could be sold immediately for housebuilding purposes. It is centre city development land and it could easily be disposed of. There is no doubt that at £20,000 an acre it would fetch £7 million. So that we have immediately £7 milmillion and I understand that £10 million, spent over the next five years, would bring about very comfortable conditions for these patients. I do not think that is a lot to ask over and above the normal maintenance costs of this hospital.
I recognise that there was a recession; I recognise that the money was not available for normal maintenance. But we are not talking about normal maintenance; we are talking about the appalling conditions that have existed for 30 years there. I have exposed it on previous occasions. I tried, through our medical newspaper, to highlight the position there so that doctors would join in this protest. There are consultant psychiatrists working there who are precluded from highlighting the conditions there by the terms of their employment. There is a statement just issued by the medical union to the effect that the consultants, under a clause of their contract, are not allowed to expose or refer to the conditions in the hospital in which they work. So we have people working in these conditions and I must say I have never seen such dedicated people as the nurses and doctors I have seen working in these conditions. I do not know how they keep their sanity working there. It is the most depressing place I have ever had the displeasure of being in and patients there could not but deteriorate in conditions such as exist there today.
I am not asking for the closure of the hospital. All I am asking is that the Minister go and visit it. There could be some simple changes carried out. Parts of that hospital need to be closed immediately because they prove a serious fire hazard. Indeed, the top floor of one building there is a fire hazard because the elderly people there could not negotiate the narrow stairways to get out in the event of a fire and I understand from talking to some nurses there that there was a fire and it was a miracle that people were saved. I am saying that parts of that hospital should be closed immediately. There are many hospitals around the city that could take in the geriatric cases that are at present in St. Brendan's. Some of the hospitals that could take these patients are Cherry Orchard, Clonskeagh Hospital and Kilcroney. We should mobilise these places to take some of these patients urgently, especially the geriatric patients who should not be in St. Brendan's in the first place. I am asking that these hospitals be asked to provide the beds for these patients and that parts of St. Brendan's be closed immediately.
The chief psychiatrist of the Eastern Health Board maintains that proper services could be rendered, that proper physical comforts for the patients could be provided and also that parts of this hospital should be closed down immediately. This should be done. What the non-consultant hospital doctors ask for are simple things like cleaning the place, providing proper heating for the patients and providing proper sanitary facilities. They refer to the fact that it is extremely dirty, that it is overcrowded and lacks any adequate sanitary facilities.
I have read the report of the programme manager who confirms the fact that the heating is inadequate, that conditions there are bad. He says that despite the fact that the physical conditions in the hospital are bad it is rendering a tolerable service. This is not good enough for these people. I am asking the Minister to visit it to see for himself the appalling conditions there because no words of mine could describe them. The Minister should make the necessary money available immediately by disposing of the land as I have suggested. He should consult with the Eastern Health Board so that they could provide beds in Clonskeagh Fever Hospital, in Cherry Orchard and places like Kilcroney and so enable the relevant parts of St. Brendan's Hospital to be closed.
The publicity about St. Brendan's has helped to some extent to bring home to the general public the reality behind the public relations facade which the Minister for Health has been engaging upon since his assumption of office. The fact that the non-consultant hospital doctors in the hospital took the most unusual step for anyone engaged in the medical profession of publicly releasing their complaints is indicative of the condition of part of the hospital. Those doctors are to be congratulated for what they did. There was no onus on them. They were doctors working for the health board as many pople had done before them and yet they took it upon themselves to make public the facts as they saw them. They deserve credit for what they did and I am not at all prepared to subscribe to the point of view that they caused unnecessary ripples or that they did not go through the proper channels.
They wrote to the Minister about this matter and received a reply from him on 19 October. They replied by letter dated 27 October complaining about specific items and areas and said that if the Minister refused to go to the hospital and if those items and areas were still without attention they intended making this correspondence public. They did not do that for a further fortnight when the Minister had time to act if he wished. He apparently did nothing more and the correspondence was published. The option afforded was not accepted. The invitation to visit the hospital was not accepted and consequently the people who feel annoyed should not be.
The doctors complained about the level of cleanliness in wards of the hospital. During my recent visit I found that walls and parts of wards of that hospital were dirty. Everybody there agreed that the walls were dirty. I do not believe it is acceptable to have walls in public places as dirty as the walls of that hospital are. I accept that the patients, because of their particular handicap, might not be the easiest patients to mind but nevertheless the level of cleanliness in some of the wards which is not the fault of the staff is unjustifiable.
There are a number of wards in the hospital which have been renovated and I was impressed by the services provided in those wards when one bears in mind the age of this building. They represent substantial improvements since I last visited the hospital some years ago. The conditions in the wards which have not been renovated can only be described as dickensian and deplorable. If the toilets and service kitchens attached to some of the wards in St. Brendan's were attached to restaurants and hotels those places would be closed down by the Minister's officials and the owners would be prosecuted. If the officers of the court saw such toilets attached to restaurants they would impose the maximum penalty.
This is not an overnight situation. It is a very old building which would cost a very large sum of money to renovate. We are talking about a vast programme which the Eastern Health Board are trying to have implemented to improve areas of this hospital over a five year period and to close down parts of it. I was amazed when the Minister first reacted to the criticism in an interview on the Friday to hear him say that it was part of his policy to completely close down this hospital. That was the first I heard that it was Government policy to completely close down this hospital.
I announced it in January.
I never heard of any policy to close down St. Brendan's.
That does not mean I did not announce it. I said it in January 1978.
The Minister will get his ten minutes. He seems anxious to speak now but he was not anxious earlier tonight for some strange reason. The policy of the Eastern Health Board was to close down a considerable area of this hospital and to retain part of it in conjunction with some specialist buildings such as the community care centre for a particular area of Dublin.
When I visited the hospital I saw toilets attached to wards where there were incontinent patients who had to be changed sometimes twice a night but there were no sluice rooms attached to those wards. The soiled bed linen had to be sluiced in the single bath that was available in the washroom attached to those wards and the patients were washed in the bath afterwards. Those are the facilities which are available to the staff there.
The complaints made about rat and mice infestation were highlighted but I got no evidence from anybody of rat infestation. There is mice infestation which I understand is a problem in many public buildings. None of the people I spoke to were prepared to say that there were rats in the hospital.
With regard to the complaint about a lack of bedside lockers and no place for patients' clothes, I saw bathrooms with baths on one side and racks of patients' clothes along the other side because there was nowhere else to hang them. That is the type of facilities being complained about. It is a long time since I was a member of the Dublin Health Authority and heard of the proposal to have this hospital phased out. I am afraid some of the senior medical staff, who also had administrative responsibility, will have to take some of the blame for the criticism in regard to this hospital. There was a tendency to flit about like butterflies from one aspect to the other of the mental services that did not help in having an orderly development. Certain areas were sometimes concentrated on and sometimes ignored. The fear now is that if this hospital is improved money may be diverted from the community care programme but that should not be the case. In order that the community care programme may be a comprehensive programme it must be arranged with a certain amount of institutional care in the mental handicap services. There has been a tendency to concentrate on one aspect or another of the services to the detriment of others. This has been because of the policy of certain senior administrative people in that hospital. This needs looking into.
The Eastern Health Board proposal to improve this hospital over five years should not be shortened to a two or three year phased programme. There are certain wards in the hospital which should be closed down immediately. St. Brendan's is not unique. There are other hospitals in the Dublin area, notably part of St. Ita's, where the temporary buildings built 90 years ago are still being filled with patients. There are psychiatric hospitals in some parts of the country that have unsanitary and unhygienic conditions because of the age of the buildings. The hospital services generally could best be served now by conducting a public inquiry into the level of facilities provided in public hospitals but especially in the psychiatric hospitals.
The conditions in St. Brendan's hospital and others which have not been highlighted are a testimonial of shame which society should bear because it has not wanted to know about the mentally handicapped. We must all ensure that the matters raised by those junior hospital doctors are not brushed to one side, that public money is set aside in the health budget for services for the mentally handicapped and that an inquiry be held into the conditions of St. Brendan's hospital.
Who is mental?
If the Minister visited this hospital he would see many people there who are mentally handicapped. He would be better off doing a quick job for them than the publicity jogging he has being doing for the last few weeks. We will continue to press for a public inquiry until it is held.
The first thing I want to point out is that since I assumed office neither of the Deputies who have spoken ever mentioned St. Brendan's Hospital in the House or put down a Parliamentary Question about it. With regard to my going to visit St. Brendan's Hospital, I am endeavouring to do so. It would have been very difficult for me to do that in the last couple of weeks because there was such a scramble of politicians seeking to get up there to get in on the act that I would have found it very difficult to get there.
My association with St. Brendan's Hospital is very clear. I want, first of all, to indicate to Deputy Boland that in January 1978 in connection with the capital allocation for 1978 I made it quite clear that it was my policy to close down St. Brendan's and for that purpose I was this year allocating in the capital allocation the first amount of money for that purpose. If Deputy Boland was not aware of that being the policy which was being implemented then I suggest the fault is his and not mine. Secondly, in regard to St. Brendan's, because in 1976 there were savage cutbacks by the National Coalition Government, when not one penny was spent on that hospital or any other mental hospital. I made special provision in 1978 for St. Brendan's Hospital. I provided £200,000 for some minor works. I also made available to the Eastern Health Board a special sum of £360,000 for the type of works which are badly needed in St. Brendan's.
The overall policy in relation to St. Brendan's is to close it down and in pursuance of that policy the number of patients has been steadily reduced. Throughout the city the programme of providing hostels for community mental care is being pursued steadily and the situation is that the only possible ultimate solution is to close St. Brendan's. This policy is being pursued by me as Minister for Health.
In case some Deputy may suggest that I did not advert to this situation before it reached crisis level, I availed specifically of a recent dinner at which psychiatrists were present to draw attention to the position of long-term patients in mental hospitals throughout the country. I pointed out there were about 10,000 long-stay patients who were totally dependent on the particular mental hospital in which they were living and I said that too many of them were still living in drab, overcrowded conditions bereft of many things which most of us would consider essential to make life tolerable. I said that they were our fellow citizens with a right to a life of dignity and self-respect and that there was a moral obligation on us to do what we could as quickly as possible to improve their conditions and standards. That the conditions existing in some mental hospitals have not been improved long ago is a reflection of the lack of any great level of public concern about them. I said that Governments generally respond to public demand, particularly if it is articulated in a definite and sustained manner. What I said on that occasion is a little ironic. I said "Would that some of the marches that have taken place, the banners that have been waved, the drums beaten about, for instance, the role of the general hospitals had been undertaken to procure improvements in the district mental hospitals". I mention that to indicate to the House that I was not unaware, unsympathetic or insensitive to the conditions pertaining in many of our mental hospitals throughout the country and in particular to St. Brendan's.
Of course there are other mental hospitals throughout the country which are accommodated in old, unsuitable buildings also. I shall refer to just two of such hospitals which I visited recently: one was Our Lady's Hospital in Ennis and the other was the hospital in Mullingar. The buildings in question are old and no great amount of money has been spent on structural improvements. But it was a pleasure to go into those wards. They were clean, bright and cheerful and efforts were made at ward and hospital level to do something about the difficult, drab and unsatisfactory conditions. The staff, doctors and nurses, and the local health committees buy curtains, they provide flowers in the wards and they provide the little amenities that change a dull, drab, depressing ward into a tolerable living place.
St. Brendan's needs bigger things.
When Deputy Dr. Noel Browne was a doctor in St. Brendan's Hospital the wards there were a credit to any mental hospital anywhere in the world.
Is that why he was shifted?
I do not know anything about him being shifted but I am stating the position when he was there and I want to give him credit for it. He was able in St. Brendan's to transform a ward into a reasonable, tolerable and cheerful place.
That is why he was shifted.
I am not accepting that. I am just saying what can be done. I am saying what I saw in Our Lady's Hospital in Ennis and in Mullingar and what I am told was done by Deputy Dr. Browne when he was one of the staff in St. Brendan's. In respect of many of the matters mentioned in this debate, any reasonable person will admit that they are not something of national policy, and are not something for which the Minister for Health or his advisers are responsible. For instance, the cleaning in any health institution is surely a matter for the management of that institution——
It needs money.
I was not made aware by anybody since I assumed office, either in this House or outside, that more money was needed for St. Brendan's to clean it or to do any of the things about which Deputies are now complaining.
The Minister is aware now.
The doctors made the Minister aware of the situation in September.
Deputies should allow the Minister to continue without interruption.
When this matter was brought to my attention we moved immediately to have something done——
The Minister's reply does not seem to indicate that.
Through the health board and the programme manager we moved immediately to get some emergency action undertaken in regard to St. Brendan's. We did not wait for the matter to be raised in this House. I deplore the conditions in St. Brendan's but, unfortunately, they exist there and in other places also. There is an obligation on all of us to put them right as quickly as possible.
What will the Minister do?
Management of St. Brendan's is vested in the Eastern Health Board——
Will the Minister provide the money?
I have already provided money. I told the Deputy what I did in 1978 alone, in direct contrast to what was not done for years before.
It needs £2 million.
I have started on a programme that ultimately will close St. Brendan's, by providing the necessary level of community hospitals throughout the city. I provided a sum of £200,000 in 1978 alone——
A drop in the ocean.
The sum of £200,000 would do most of the things the Deputies have mentioned tonight.
It is not enough.
Nobody interrupted the Deputy when he was speaking. He must allow the Minister to continue his speech without interruption. He has only one minute left.
I do not think there is any point in our pursuing this matter any further.
Will the Minister give a special grant?
I have given a special grant.
Will the Minister give a special grant for 1979?
The Deputy should not cross-examine me. I gave special funds in 1978 to improve the matters that the Deputies raised this evening. I have discussed the situation again with the programme manager and with the other authorities responsible to see what can be done in 1979 to effect immediate and specific improvements in the hospital; but the ultimate solution is the policy I have initiated, namely, to pursue a steady programme of closing down St. Brendan's Hospital and dispersing the patients into community hospitals or to some alternative institutional care.
Will the Minister agree to come to St. Brendan's in six months' time with Deputy Boland and me to see what improvements have been carried out?
The Deputy will be there ahead of me.
Secondly, will the Minister give an undertaking that discriminatory action will not be taken against the doctors——
The Deputy may not continue.
The Dáil adjourned at 9 p.m. until 10:30 a.m on Wednesday, 22 November 1978.