Deputy O'Hanlon has been given permission to raise on the Adjournment of the House the future of Beaumont Hospital. He has 20 minutes.
Adjournment Debate. - Beaumont (Dublin) Hospital.
I do not intend to use my 20 minutes. There has been great concern for a number of reasons about what exactly is happening as regards the future of Beaumont Hospital. First the Minister reversed a decision of his predecessor's to allow the building of a private hospital on the site. The only reason the Minister gave was that he would not allow public funds to be used for such a project. Consultants who were anxious to build a private hospital on location were prepared either to buy the site or to lease the site to build a hospital out of their own resources.
The advantage of having a private hospital on location should be obvious. It would mean that the consultants would be on the hospital campus for a longer period during the day, and that would be in the interests of public patients in the hospital. If the consultants are not prepared to use private facilities in the public hospital and if they have not their private clinic and patients wish to avail of private medicine, as is their right, if a consultant has a patient in, say, St. Michael's Dún Laoghaire, or in Rathgar, and the consultant has to travel back to an emergency to a public patient in the public hospital, this will cause a problem for that public patient. For example, if a public patient should have surgery this morning and some emergency should arise this afternoon about 4 o'clock and the consultant happened to be operating in the nursing home in Rathgar, the consultant would have to try to get back through very busy traffic to that patient. That would not be in the patient's interests. There is no logical reason why a private hospital should not be allowed there, and certainly it would not cost the Exchequer any money.
Equally serious is the decision of the Minister to reverse a decision not alone of his predecessor's but of his own. He told me in this House in answer to a parliamentary question that the building of a nurses' home would commence at the end of last year. Since then the Minister has stated that he does not intend to proceed with the building of a nurses' home. A very serious view has been taken of this, particularly by the nurses and the matrons of the hospitals that will be moving out to Beaumont, that is Jervis Street and the Richmond. The Minister was quoted as saying that secretaries in his office have no accommodation provided for them in the city, but that misses the point of the nurses' home. Nurses going into training, particularly in the first year, work very irregular hours. They work night shifts. It is a 24-hour job and some of them will be working right through every hour of the day and will have to travel to and from the hospital at irregular hours. This can pose a difficulty for young nurses. Much comment has been made recently about the fact that nursing can be a stressful occupation. Teenagers come in to training school, and seeing illness at first hand and persons moribund, dying from serious disease, can be stressful for them. In the Beaumont area the fact that there will not be a nurses' home will mean that nurses will have to go into digs or flats. It would be much more in their interests if they were together because of the stressful nature of their occupation and because they have to travel to and from work at such irregular hours. The Minister has also decided not to proceed with a doctors' residence. It would be very important that accommodation would be provided for the doctors who would be on duty at any time, particularly night duty.
The Minister was quoted in the Irish Independent on 1 December 1984 as saying that £16 million was wasted for the hospital. Will the Minister tell us in the House how he sees that money as having been wasted? It appears that Beaumont is a very necessary hospital. It will have 730 beds and will be replacing Jervis Street and the Richmond Hospital which in terms of structural building have outlived their usefulness. Jervis Street has 312 beds and the Richmond has 387 beds.
There is concern at the delay in the hospital opening and about the fact that the Minister will not allow the consultants to have their private clinic which would be in the interest of all patients, particularly public patients. There is concern that there is to be no nurses' home and no doctors' residence. I would like the Minister to let us know the up-to-date position, when he sees the hospital opening, what facilities he intends to provide for these people and if he is aware of the problems that will be created in terms of no private nursing home and no nurses' home.
I would like to put on record in this House that I regard the commissioning of Beaumont Hospital as a vital element in the provision of a modern acute general hospital service for the population of Dublin. I am determined that I will open the hospital in July 1985. I am equally determined that in the event of it not being opened I will not be held responsible, and I propose to make that clear to the House. Beaumont will be one of six major general hospitals in Dublin which together will provide a comprehensive hospital service for the area.
A question has arisen in relation to the construction of the hospital. The building is now being completed and I have been prepared to make the necessary resources available in the past two years for the equipping of the hospital to enable it to be opened in July 1985. However, difficulties have arisen with the medical consultant staff in the first instance regarding the provision of facilities for private practice in Beaumont Hospital. I want to go very briefly into the background of all this. As far back as July 1984 the chairmen of Beaumont, Jervis Street and St. Laurence's were informed by letter that I was prepared to permit private patients to be treated within the confines of the public hospital ready and available at both inpatient and outpatient level. As far as inpatient services were concerned I indicated that I would be prepared to consider proposals from the Beaumont Hospital Board regarding the level of allocation of private and semi-private beds in the hospital. The letter from the Department approved by me stated further that any designation of any such beds within the hospital for the use of all such facilities would be subject to the approval of the Minister of the day. Similarly I indicated I would be prepared to consider the board's proposals for the use of consulting rooms in respect of private patients on a refund basis for any administrative costs involved.
I made those proposals as far back as July 1984 but I am sorry to say that there was virtually no response for several months. Then the officials of the Department and myself had another meeting with the major medical cogwheel committee on 30 November last. Following that meeting I confirmed with the committee that I would be prepared to approve of a proposal from the Beaumont Hospital Board to designate as private or semi-private a total of 70 beds within the hospital, together with an appropriate number of beds in the specialised unit. I indicated also that I was prepared to construct within the design framework of the hospital an out-patient facility of approximately 20 consulting rooms and ancillary accommodation for use as private consulting rooms, subject to agreement for the appropriate payment by the consultants for the facility, the payment to be made to the board of the hospital. I have not yet received any firm response on that matter but I understand there is a meeting this evening of the consultants concerned. I hope that my proposals will be accepted and that it will be possible to proceed with arrangements for commissioning the hospital without further delay.
I wish to reply to the question of private hospitals being built on the campus of this hospital and the reply is that for as long as I am Minister for Health, that will not happen.
Why not?
It will not happen because Beaumont is a public facility paid for by the taxpayer. The land was bought by the Exchequer. The building was paid for out of the Exchequer. We are talking of £40 million and I have yet to put in another £5 million by way of equipment. The gross cost of the hospital will be £52.7 million of which I have allocated £5,500,000 this year. I make the point again that if that is not acceptable I will spend the money by accelerating the expenditure at Castlebar hospital. That can be done easily for a hospital that is in urgent need of upgrading and updating. Private beds can be on a variety of arrangements, for instance, floor by floor or in a separate unit and while I am prepared to spend £500,000 within a hospital of 650 beds by way of new expenditure I am not prepared to provide private consulting rooms. I am very critical of the hospital design. The Deputy's leader in his mad rush to have a hospital provided in his constituency chose a design identical with the Cork Regional Hospital which is a 1970 design of late 1960 vintage. It was built in the mid seventies and opened in 1978. In my humble view, in terms of cost effectiveness it is now highly expensive. The Deputy's leader could not act fast enough in respect of Beaumont. He took only six weeks to begin a £50 million project. However, we are landed with it now but it is a very good hospital and very well equipped. The money has been spent on it and I have spent a fair proportion of the £52.7 million in the past two years because I decided it would be in the best national interest to finish the hospital as quickly as possible. The Deputy's leader and former Minister for Health in his mad rush to be well in with everyone and with all sorts of consultants said to a private company, to the Jervis Street-Richmond Company Limited, which was formed by the joint medical staff association of Jervis Street and St. Laurence's Hospitals, that he would give them a lease on part of that land. He did not say he would give them the land for nothing. He was rather careful.
He was right. That was very wise.
I suggest that he was constrained by responsible public officials in his rush to have another private hospital built on the campus when there was no need for it.
That makes good sense.
I totally accept that it makes good sense that consultants should treat their private and public patients within the one framework but it does not make good sense to have within the complex of a hospital a separate structure by way of a private hospital and private consulting rooms.
Why not?
I am prepared to facilitate the consultants concerned within the hospital but not on a separate basis outside or on a separate basis in which there would be no rational control and which would not be in the general interest either of the consultants or of the patients who would attend the hospital. Therefore, for so long as I am Minister for Health I regard the matter as disposed of.
When one considers the Richmond Hospital which is owned by the Department of Health and also when one considers Jervis Street hospital which is a public voluntary hospital, one finds both in a dreadful condition with working conditions being appalling. The conditions for patients going there are equally bad. We are prepared to provide for the staff of those hospitals. There are private beds within the framework of the Richmond Hospital and there is a private nursing home within the framework of Jervis Street Hospital. Out of the total number of beds in Beaumont we are prepared to allow 70 private beds. I will not argue that the number has to be 80 because intensive care beds may have to be taken into account. In respect of people availing of those private beds and who are VHI subscribers, the money will go to the board of the hospital. That is how such matters will be dealt with in Cavan. It is what happens in our other hospitals.
We turn then to the question of residential accommodation. The internal accommodation for on-call doctors and on-call nurses in Jervis Street is rubbish. The accommodation in the Richmond is dreadful. In the case of Beaumont we are talking about a hospital that will cost about £25 million to run between mid-1985 and mid-1986 with both the Jervis Street and Richmond budgets being transferred. All the staff, from the gate staff up to the theatre staff, will be going to Beaumont. I am prepared to provide within that framework luxury accommodation for on-call junior hospital doctors and for consultancy staff who may have to stay overnight. Not many stay overnight but those on call would.
I am prepared to provide accommodation within the framework of the hospital for the nurses on call, but that is not acceptable. They want another private residence built in the grounds of the hospital for the doctors costing another £2 million or £3 million in public expenditure. I would remind Deputy O'Hanlon that these days are over and done with. There is nothing wrong with a young nurse or a student nurse going to her home in Dublin during the day or having accommodation within the framework of the hospital. It is not that traumatic. There are thousands of young people in the public sector in stressful employment who have to live outside of the area where they work. I am not disposed to spending a great deal more money building nurses homes especially when student nurses are paid such substantial salaries and are provided with meals within the framework of the hospital. A young girl in Dublin on an AnCO training course gets £30 a week and pays for her own accommodation.
We must have a sense of proportion in these issues. I have made these points trenchantly to the staff concerned and I have not been thanked. I am providing all essential on call accommodation given the levels of remuneration applicable to student nurses and other categories of staff and given the fact that around Beaumont there are hundreds of families willing to provide at low cost accommodation for people working in the hospital. It is far better for a young woman not to have to spend all her time in the rather artificial atmosphere of the nurses home. She should work in the hospital and then come back to a normal social environment. That is a more mature approach. I have informed the Beaumont hospital board of my decision on these matters and the board are considering how best to cope with that situation.
I am extremely concerned about the manner in which the hospital project has progressed. The basic capital cost of the framework of the hospital is £40 million and the equipping and commissioning of the hospital brings it up to £52.7 million. The new hospital in Beaumont is very badly needed and I am disappointed that obstacles are being placed in the way of getting the hospital into operation. Perhaps the Leader of the Opposition is hoping that if we delay it long enough he will have his name carved in front of the hospital. That does not worry me unduly. What worries me is that the physical accommodation provided in Jervis Street and in the Richmond is deplorable despite the fact that the service provided is excellent. I am awaiting a formal response to the proposals I put to the consultants and, if the response is negative, I do not accept that they have a right to an independent free standing private hospital at Beaumont. I am not in the business of providing that.
They did not want the Minister to provide it. They are prepared to provide it themselves.
It is basically wrong to get 100 consultants together and ask them all to put up £5,000 for a building that they can all use. In terms of the use of a public facility and the use of public land that is not only wrong in principle but extremely wasteful.
It is better than having them driving from Dún Laoghaire to Beaumont.
Any consultant living in Dún Laoghaire working in Beaumont will have private beds within the hospital into which he can put his patients. The patient will be paying for the bed, he will not be paying the consultant or into a trust fund, he will be paying the hospital through the VHI. That is the way it should be. There is a slight obsession that B. Desmond somehow or another is determined to destroy private practice and to destroy the practice of private outpatient facilities. I do not propose that. I have said that they should work together in a public and private framework in the one structure. I have the considered opinion within my Department that that is the rational thing to do. Putting it at its lowest level of argument if we were now to start off building a private hospital in it and building new residences and so on we would finish up deferring the opening of the hospital for another two or three years and that would be extremely costly and inappropriate.
It has been suggested that I am cutting back in providing the funds for the hospital itself. The main building was completed in July 1983 and the group has begun accepting delivery of non-perishable items of equipment. A sum of £2.18 million has been spent on equipment to date and the total equipping of the hospital will cost £10 million. The most expensive items of equipment will be ordered nearer the commissioning date as the warranty begins to run from the date of delivery. Immediately I have an absolute understanding in regard to the date of opening I will place orders for the perishable equipment.
We are coming up to the wire in terms of the race for the opening of Beaumont. I would ask Deputy O'Hanlon to talk to the consultants concerned. I feel many of them are anxious to co-operate. The Irish Medical Association is now involved, and when things become complex and involved everybody takes up positions. Deputy O'Hanlon might be of enormous assistance to myself and his party by assuring the consultants that there is not a perverse desire on my part in this proposal and advocating that the prevailing uncertainty should end. If within a matter of a week or two the uncertainty is compounded I would have to abandon the date of July 1985 and, if I do that, the responsibility will not be hung around my neck. I will put the correspondence formally on the record in the appropriate form and the people of Dublin can judge for themselves. Unfortunately, because of limited resources this is the way we run things here.
The Dáil adjourned at 5.30 p.m. until 2.30 p.m. on Tuesday, 12 February 1985.