Deputy O'Rourke has been given permission to raise on the Adjournment of the House the question of Athlone Hospital. She has 20 minutes.
Adjournment Debate. - Athlone Hospital.
First, I express my thanks to the Chair for having given me this time on the Adjournment. I thank the Minister, who is already present, for taking this question tonight. It has been a night of health complaints and demands and I heard on the monitor the Minister replying to various points put to him. In his usual spirited style he talked about harassment and said that the demands which were being made on him were insatiable. My demands are not insatiable. I want to talk about the commitment which the Minister himself gave to Athlone a little over 12 months ago, although he may well say that times have changed and cite various reasons for changing his mind and doing a turnabout on this issue.
Speaking very plainly and realistically, I shall spell out the reasons for my being here tonight. First, I have been a Member of this House for just over two years and this is the third time that I have raised this issue on an Adjournment Debate. These were in the wake of several answers to parliamentary questions and all sorts of approaches, not just from myself but from all the major political parties. I am here tonight as a Deputy for Longford-Westmeath. If I appear to be partisan and provincial, as the Minister might see it, that is exactly why I am here. I am sent here to plead my case for my own town and constituency, as well as to take part on the wider national political scene.
Let me go back briefly over the recent historical background to what has now become quite a thorny question, that of Athlone Hospital. I shall not go back to what Athlone might have had 20 to 50 years ago "if only", because that is a very futile path to travel. I shall keep to the recent historical developments from 15 months ago. In December of 1983, the Minister for Health visited Athlone and made a very startling but welcome announcement in the hospital, first, as is proper, to his own party and later to the wider general public. He said that an elective — and I use that word deliberately because I shall come back to it — orthopaedic unit was being gladly sanctioned by him for Athlone. He rode out of town in a blaze of glory and nobody made one bit of political capital out of this. Everybody welcomed it and agreed that it was just what Athlone wanted and for so long. Not alone were we welcoming an elective orthopaedic unit, but what would come with it and in its wake, a full back-up, a fully staffed casualty department. That is really what had been needed all along. The elective orthopaedic unit was an added bonus.
I want to put on the record that in the whole Midland Health Board area, Athlone is the largest town, the largest centre of population. Yet it is the area with the very least hospital services.
The Minister made two further visits to Athlone on various health matters, a seminar and another matter. On each occasion he was asked by the press if the centre for Athlone was going ahead and they were told that it was. The reply to various parliamentary questions said that it was at stage one, then at stage two and finally at stage three of planning in October of 1984. Everything still seemed set fair.
Then, in November, the Taoiseach visited Athlone and at a public meeting to launch the national plan, Building on Reality, he gave a very firm commitment to Athlone Hospital. The Westmeath Independent of the same day had a headline on the front page: “Athlone Hospital Plan is on, says Taoiseach”. It cleverly gave a flashback to 12 months previously when the Minister sanctioned the orthopaedic unit. This was approaching Christmas of 1984. Everybody was still reasonably happy at the medical situation in Athlone. Then, quite coldly and out of the blue, the Midland Health Board, with no prior warning, in the person of Mr. Denis Doherty — the swiftest CEO of a health board that I have ever heard of, who will receive due recognition in the months and years ahead for his marvellous celerity of purpose and the way in which he responded to the Minister's request in the light of the economic realities spelt out in the national plan — came up with a wonderful jigsaw, but out of this one piece was missing and that was the town of Athlone. One can imagine how we felt. We read what was going to be given to all the various towns. Mullingar, rightly, would get a massive development, as would Tullamore, and even Edenderry — a grand place but a small place — Birr, Portlaoise, Longford, all would get varying degrees of development. I am donning my Athlone hat and asking, out of all that marvellous jigsaw, where was Athlone?
Athlone was to get an industrial unit. The Minister in Mullingar said that he was highly impressed by this development. I grew up in a factory called General Textiles in Athlone where we had in our heyday 1,000 employees. That day has passed, as it has passed for cotton mills everywhere. In our day, Gentex had a resident industrial nurse, a lovely lady, God rest her. She bound up cut fingers, gave Aspro or Disprin for headaches and if anyone had a fainting fit, she supplied the smelling salts. These were all very necessary in an industrial atmosphere. She did no more than that. Her patients were then sent to the nearest hospital, as was quite right. In fact, what we have been offered in St. Vincent's Hospital, with which the Minister says he is very impressed, is something similar to what that good nurse offered the workers of Gentex during those years — an industrial unit. The Minister says that the industrialists are very impressed. They are not one bit impressed. If they were, they would not have marched as they did in numbers, leading their respective workers to Tullamore, to the Midland Health Board headquarters, last Thursday.
As I say, the CEO, Mr. Doherty, responded with great alacrity to the Minister's call for help and submitted a rationalisation plan. That plan envisaged Mullingar, Tullamore, Edenderry, Birr, Portlaoise and Longford getting various extra services in one degree or other but, quite uniquely, Athlone was left out. How would the Minister expect us to accept this lying down? With his usual sangfroid he will be dismissive of me, but I do not intend to be dismissed in this instance. I do not care how provincial or biased I appear to the Minister. I intend to do the job I was sent here to do. I shall plead again and again for the Athlone case.
Representatives of the urban council met Mr. Doherty and his board but they were not in a position to give us a figure of the saving involved. The public meeting we called in Athlone to discuss the matter received massive support and the Minister for Defence, Deputy Cooney, who also represents the constituency, made a public commitment then. Deputy Cooney who is probably the most cautious politician in the House, stated categorically that in the light of discussions he had with the Minister for Health he would back that Minister and the Taoiseach and that the elective orthopaedic unit in Athlone would go ahead.
Two weeks ago I tabled a question for written reply by the Minister for Health asking him if he would arrange to meet a deputation from Athlone Urban Council. In the course of his reply the Minister said he did not see any point in receiving such a deputation. He pointed out that he was studying the correspondence he had received and it would take some considerable time to look through all the proposals put forward and reach a decision. In other words, the Minister lulled us all into a sense of security. He was telling us that it would take him some time to reflect on the matter after which he would speak to us. However, without one word in between he made an announcement in Mullingar on Monday. I regret I was unable to attend that function but I had accepted an invitation some time previously in connection with the local fire station. The first the people of Athlone were made aware of the Minister's volte-face in regard to their local hospital was when he made a speech in Mullingar on Monday, 18 February to mark the beginning of the first phase of the development at Mullingar hospital. The Minister said:
I understand that there is some disquiet [that is some understatement] in Athlone where there is understandable disappointment that the temporary orthopaedic [it is worth noting that the word "elective" was not included although that word was used by the Taoiseach and the Minister for Defence 12 months previously] is not now to go ahead. In particular it is quite correctly being put to me to explain now why the board and I seem now to be jointly approving a quite different approach.
The Minister outlined four reasons why he had changed his mind. He said there was a good level of service in Athlone and in doing so itemised the various out-patient clinics we have in the town. We are delighted to have such clinics but we are not dealing with out-patient clinics in medicine, surgery, orthopaedics, ophthalmology, ear nose and throat, paediatrics, oncology, obstetrics, gynaecology and dental. Those clinics have always been available at Athlone and were available when the Minister gave his commitment 12 months ago. The Minister also said that Athlone was not a central location. Surely it occupied the same position on the map 12 months ago as it does now. I find that excuse mind boggling. The third reason the Minister gave was the economic reality but the same economic reality existed 12 months previously when he rode into town with the good news as when he rode into Mullingar with the bad news. The fourth reason the Minister gave was the strong medical evidence that an orthopaedic unit should not be set up in isolation from a general hospital facility. We are not talking about an orthopaedic unit but an elective orthopaedic unit, a unit where people are screened medically and where the medical dangers, if that is the correct word to use, are almost non-existent.
In the course of his speech in Mullingar the Minister outlined what he had given to the various hospitals in the health board area. What is happening in Tullamore is most extraordinary. Suddenly they have two operating theatres, one completed and the second almost ready. The maternity services are being shifted from that hospital to Portlaoise with the result that there are two sections ready to house an orthopaedic unit which up to four weeks ago was to be accommodated in Athlone. It is startling how the pieces of the jigsaw suddenly fit together although they were in a different pattern 12 months ago. It is amazing.
In Mullingar the Minister paid tribute to the board who were very anxious to tackle the problem and were prepared to do so in a very responsible manner. He said:
For example, my decision to allow this major development of the general hospital in Mullingar to go ahead was made very much easier by the board's decision to close the old surgical hospital in Longford.
However, Longford will be getting a casualty unit. The Minister also announced approval for the casualty unit in Longford, approval for the orthopaedic unit at Tullamore, approval for increased maternity services at Portlaoise, approval for further expansion of geriatric services ar Birr and Edenderry but Athlone will only get temporary housing for geriatric patients while extra accommodation is being made available in such areas as Birr and Edenderry. The Minister generously said that when people leave hospital they may go to Athlone to convalesce in the excellent hospital there. It is not our intention to allow Athlone to become a temporary geriatric home or a convalescent home.
Dáil Éireann has had an Athlone day today. I understand that a deputation representing Coalition interests in the town met the Taoiseach for a considerable time this afternoon and that Labour Party representatives met the Minister. Perhaps it is fortunate that Athlone's case is being put to the Taoiseach and the Minister on the same day. The Minister, in the course of his Mullingar speech, said that when the dust settled and everybody talked common sense they would see that everything he said was correct. I do not subscribe to that theory. Athlone is the largest town in the Midland Health Board area and we do not have medical facilities. We may have out-patient facilities but we do not have a casualty service of any kind in the local hospital. Irrespective of what the Minister says in his reply we do not accept his latest turnabout and rebuff to Athlone hospital. I should like to thank the Minister for listening to my case and I plead with him to think of Athlone as a major town, a prominent industrial area that serves a vast hinterland. He should not renege on a commitment he made 12 months ago.
I should like to thank Deputy O'Rourke for the opportunity to make some brief comments on the position in Athlone and in relation to the future of the hospital services for the area. It is correct to say, as Deputy O'Rourke pointed out, that in December 1983 I visited the district hospital. I recall that I was introduced by my ministerial colleague, the Minister for Defence, to the hospital together with my local Labour Party colleagues. Members of the urban district council were present also. I was impressed by the hospital itself. I was certainly very impressed by the staff and the general structure of the hospital. It is equally correct to say that at that time I indicated that I was agreeable to the introduction of the interim orthopaedic unit for Athlone, the elective orthopaedic unit in Athlone for the Midland Health Board area. Subsequently I endeavoured to process the matter.
I must put a number of simple facts on record, otherwise it would become a matter of acute, personal political embarrassment to me and indeed not inconsiderable difficulty. After I had indicated that I was in favour of that development I endeavoured to process it. I was unsuccessful for a number of obvious reasons and I want to place them on record. Subsequently—I had not anticipated this—I had very intensive and vigorous sustained representations to my Department from the Institute of Orthopaedic Surgeons in Ireland. They indicated that on medical grounds they had serious reservations about the project. Basically their reservations revolved around the fact that, in principle, they are opposed to having a particular speciality in a district hospital unrelated to other general specialities. That was the objection. I had no indication from the orthopaedic surgeons concerned that they would be prepared to operate such a service. On reflection these reservations were fully supported by the chief medical officer of my Department. The viability of the scheme, as proposed, arose immediately and continued to develop. Subsequently, during 1984, I considered the matter again and did not make any particular progress.
Equally there was a demand that there should be a full general casualty service in the hospital itself. That is not possible in terms of a formal casualty service because for such a service one must provide a consultant surgeon, a consultant physician, one must have a 24-hour backup service in pathology — they cannot do the work otherwise — and one must have the full anaesthetic service. None of these services exists in Athlone hospital on a permanent, round the clock basis.
That is what I am here about.
It has a radiology service but does not have the full casualty service. There is no assurance whatsoever — and this has been borne in on me, despite whatever embarrassment I may suffer in the matter I always believe in trying to tell the truth as it comes to me, and I am not so brilliant that I can anticipate everything, with profound respect to my colleagues here — that a full casualty service would follow from simply having an elective orthopaedic service in the area itself. Subsequently the health board received their allocation towards November 1984. I asked the health board to bring forward plans for living within the allocation in 1984. In mid-December the chief officer of the health board notified his organisation of those proposals which did not include the provision of an orthopaedic service in Athlone itself. By 19 votes to five the plans were accepted by a large majority of the health board. I understand that following my general approval in principle of the plans — when I attended at Mullingar last week — again the health board, by an overwhelming majority, accepted the plan proposed by the management team of the health board. That plan would enable the health board to remain within their 1985, 1986 and 1987 allocations.
In brief, they were that the maternity services for Laois-Offaly would be concentrated in Portlaoise to form one viable unit out of the two non-viable units at present in Tullamore and Portlaoise. Then the paediatric service would be set up in Portlaoise in association with the maternity unit there. The proposal is to establish an orthopaedic service in Tullamore and later services in ENT and opthalmology as resources are freed. There would then be the long stay units for geriatrics in Offaly provided at Edenderry, Tullamore and Birr, as opposed to the one central unit at present in Tullamore.
The management team of the health board proposed also, in relation to the Athlone District Hospital, that they would continue to provide an extensive range of out-patient clinics, as at present, and would continue to play an important role in catering for geriatric patients from Offaly as Tullamore General Hospital began to take up the regional speciality work. Finally, it was proposed to establish an industrial medical and nursing unit at Athlone District Hospital in association with local industrialists.
I have said all of that.
That is the main part of the plan. It was in that context that the interim orthopaedic unit in Athlone was not proposed to be gone ahead with. I have had detailed discussions with my colleagues in the Labour Party this afternoon, when I met Senator McAuliffe, John Keneghan, Danny Duffy and Niall O'Shea who comprised a deputation to me. I explained the situation at very considerable length and it is not unfair to say that they were quite upset and very concerned about the situation but I have had to explain to my colleagues the situation as I have found it in recent weeks. As would be perfectly understandable, I have discussed the matter with my colleague, the Minister for Defence, and briefly with the Taoiseach, as has been indicated by statements in the newspapers.
I have indicated that I am prepared to examine, in consultation with the management of the health board, how particular problems in the Athlone area can be dealt with. Serious reservations have entered into the effective coping with the situation when accidents occur and when medical emergencies occur. I am examining that situation. I am in this situation — I have devolved on the health board a budget for 1985, 1986 and 1987. I have asked the health board to bring forward plans. That is the plan that was brought forward by the health board——
In response to the Minister's request——
I am regularly berated for not accepting the proposals of health boards. In this instance I have indicated to the health board that I am prepared to accept their overall plan. It has had the overwhelming support of the members of the health board in terms of its provision——
The Minister should not be hiding behind skirts——
——and I cannot attribute any other motives to the health board in that regard. As the first Minister for Health who endeavoured to do something in the midlands in terms of the major redevelopment of Mullingar Hospital, where we are putting in £8 million this year, bringing it up from 118 beds to 180 immediately and then on up to 234 beds——
What about Athlone?
——where we are providing, for the first time ever in the history of the State, a paediatric service for the maternity services in the Midland Health Board we are doing that effectively. In particular we have given substantial services to Portiuncula.
I cannot do everything. I appreciate Deputy O'Rourke raising the matter in her customary spirited way this evening. I want to assure her and my colleagues present in the public gallery that I am examining the situation but it has to be in consultation with the management of the Midland Health Board.
The Minister will have to give Denis Doherty a knighthood.
Of all the health boards with which I have had to deal——
Oh, they are great, they are marvellous.
I have had an outstanding relationship with the chief executive officer of that health board, Mr. Denis Doherty.
I bet the Minister has.
Do not tell us he is doing the Minister's dirty work for him.
He is one of the finest chief executive officers in the country. Nothing will be done for my part without full consultation with the health board. I have indicated that I have accepted their overall plan. It is within that general framework that my further consultations will take place.
I appreciate this opportunity of putting the matter on record in so far as I am in a position to do so at this time.
The Dáil adjourned at 9 p.m. until 10.30 a.m. on Wednesday, 27 February 1985.