Deputy Liam Naughten has been given permission to raise on the Adjournment the question of St. Patrick's Psychiatric Hospital, Castlerea, and I understand he has agreed to share his time with Deputy Leyden.
Adjournment Debate. - Closure of Castlerea (Roscommon) Hospital.
I should like to thank the Chair for giving me the opportunity to raise this serious matter on the Adjournment. I note that the Minister of State will be replying to this debate and I regret that the Minister has not come to the House to deal with this because it was he who announced the closure of this institution on Thursday. Like other Roscommon public representatives, the people of the county and, in particular, the population of Castlerea, I was stunned on Thursday to hear the announcement by the Minister.
I was surprised by the manner and style of the announcement in the course of the Minister's budget speech and the fact that the decision was reached without consultation with the Western Health Board who are responsible for health care in that area. I recognise the services that the staff at St. Patrick's have given to patients in that institution. Although I am a member of the Western Health Board, and a member of the special hospitals committee responsible for psychiatric care, I was not aware of the Minister's intentions before Thursday. In fact, the board were carrying out a programme of rehabilitation of people who were institutionalised in psychiatric hospitals. We had opened new centres in Ballaghaderreen, Boyle, Strokestown and Roscommon town.
All public representatives were stunned when they heard that the hospital which caters for 240 patients was to close without alternative accommodation being made available for patients. The lack of consultation with the Western Health Board is to be deplored. I cannot understand why the Minister took this decision. Very few of the patients at the hospital are able to care for themselves and many would not be suitable for participation in a day care programme. I do not know what will happen to those patients if the institution closes down. Many patients have spent 30 years in the hospital and must continue to be cared for in an institution. One also must consider the anxiety of the relatives of those patients. They do not know what will happen to their relatives if the institution is closed down.
What will happen to the 262 members of the hospital staff if it is closed? Will they be transferred to other institutions? The Minister said that nurses will not lose their jobs, but where will they be transferred to? I cannot understand how the Minister can say that the closure of the institution will result in a major saving if at the same time he tells us that staff will not lose their jobs. If some of the staff are transferred to Castlebar or Ballinasloe they will have to move house because the distance between Castlerea and those towns is too great for them to be able to commute daily. Is the Minister aware that, due to the way the recession has hit local industries, it is almost impossible to sell a house in Castlerea.
The Minister should take into consideration the difficulty relatives will experience if the patients are transferred to Ballinasloe or Castlebar. Many of those patients will not have visitors if they are transferred because their relatives will have too far to travel to see them. It is difficult to understand why a hospital that was constructed in 1936 is chosen for closure. It is important to point out that on 16 January an official from the Department of Health visited Castlerea with a view to sanctioning improvements for that institution. I am puzzled as to why the Western Health Board were grant-aided for the provisions of lifts in the hospital last year, and it was decided to close it on 29 January this year. That is an indication of the lack of planning in the Department. Officials in that Department do not know whether they are going backwards or forwards. It is time the Minister got to grips with this.
Some people say that Castlerea hospital is being closed to facilitate the opening of the Swinford centre. Would it not have been proper to provide the facilities scheduled for Swinford at Castlerea? It would have been better to utilise the fine cutstone buildings in Castlerea rather than embarking on an expensive new project at Swinford. That suggests a lack of planning in regard to this and other decisions in the Department.
As a member of the Government the Minister has a social responsibility to the people of Castlerea and surrounding areas. The population of the town is 2,000 people. The conversion of the local telephone exchange to automatic and the transfer of the Land Commission officials meant the loss of 60 jobs. At the Edson factory 20 employees are on short time. Fenner Stone and IDE Fashions have closed down. If anything happens to the 261 jobs at Castlerea hospital it will spell disaster for the area. The Minister should take those facts into consideration when he reviews the position.
In my view the Minister should withdraw the closure order and negotiate with the health board the position of patients and staff in St. Patrick's. The patients are well cared for in the hospital and are happy there. It is as economic to look after them in the hospital as it would be under a community care programme. I also believe that the only way these people can be treated in a humane way is to leave them where they are to avoid their anxiety at being transferred to another institution where they would not know the staff or other patients. I appeal to the Minister to review the closure order for the hospital and to enter into negotiations with the Western Health Board in regard to its future.
I thank Deputy Naughten for giving me some of his time to discuss this issue as I had also sought a question on the Adjournment. I do not wish to debate this issue with the Minister of State, Deputy Donnellan, because he did not make the decision to close St. Patrick's hospital. Nevertheless, he is here representing the Department of Health and he should convey our views to the Minister in relation to this issue. I regard it as one of the most ruthless decisions ever made by a Minister for Health, to throw 250 patients out on to the streets of County Roscommon, and that is what he is doing by closing the hospital. No provision has been made for these patients.
There are 250 patients in the hospital complex but there are roughly 700 outpatients being serviced by the hospital in Castlerea. They are being cared for by a nursing staff of about 170 who provide care and attention for many people who require psychiatric assistance in the catchment area of the hospital. In all, it cares for an area comprising 54,000 people. The Western Health Board put forward a document called Report to the Special Hospital Care Standing Committee — Plan for Development of Psychiatric Services by Pascal McDaid on 24 January 1986. It is highly unlikely that this document has been studied by the Minister, perhaps he has not even seen it.
The psychiatrists and the nursing staff in St. Patrick's Castlerea, are prepared to discuss any development which is in the best interests of the patients, but the announcement by the Minister is not in the best interests of the patients in that hospital. There are about 250 patients and 55 of them have been in the hospital for between 30 and 55 years. More than 100 of them are over 65 years of age and they cannot be cared for in any other institution. They are happy and content although they are the most deprived people in society and we have a responsibility to ensure that they are secure. The Minister's announcement was a cold, callous act and I wish he was here so that I could say it to his face. It is the most ruthless decision that a Minister for Health ever made. In a letter to the Western Health Board the Minister ordered them to transfer £1.9 million from St. Patrick's, Castlerea, to the new complex in Swinford. He is playing one location against the other but the people of Mayo have indicated their support for the campaign which was launched in Roscommon over the weekend for the retention of the hospital in Castlerea and its full medical staff. They want a discussion with the Department of Health in relation to the development of psychiatric services in the Western Health Board area, particularly in the catchment area of Castlerea. We must maintain these services because there will be a continuous need for specialised, residential psychiatric care for the foreseeable future. I cannot see a lessening in the demand for these services. In 1984, over 1,500 people sought psychiatric assistance from the hospital.
Fianna Fáil will be putting down a motion calling on the Minister to withdraw the closure order pending full and detailed discussion with the health boards, medical and nursing staff. In the document Planning for the Future, the Minister undertook to have full discussions with all interested parties before he implemented the plan. We now realise that he is using the most deprived people to support financial cutbacks by the Government. He should seek cuts elsewhere because the hospital in Castlerea is not the place to implement them. I appeal to Deputies in the eight hospital areas involved to vote against the Minister having further powers when the hospital Bill comes before us in the near future. It will be an opportunity to ensure that the Minister will not have the power to close this or other hospitals. Fine Gael Deputies are being sold down the river by the so called socialist Minister for Health. It is about time they pulled the plug on the Government because if they do not face the issue now not only will the patients and nursing staff be removed from the area but any Deputy who votes to give the Minister extra powers will be voting away his or her rights in the future.
The people of Castlerea are very angry and this will be a fight to the finish. All political groups will work together to persuade the Minister to reverse his decision to close. They have taken action at county council and local health committee level and they will also lobby TDs and Senators. They will take to the streets and if the Bill is not passed in a certain time. I hope that they will take out an injunction against the Minister to ensure that he cannot proceed with the closure of St. Patrick's. I give my categorical assurance that Fianna Fáil will back them in regard to this issue because today's fight for St. Patrick's Hospital is tomorrow's fight for the county hospital, Roscommon, and other hospitals which may be affected by future Ministerial decisions.
I appeal to the Minister of State, who is from the west, to use his influence in the Department of Health to ensure that there is a change of heart and that they will come to the table to discuss the whole issue with the Western Health Board so that whatever decisions are taken will be in consultation with the Western Health Board. The Minister for Health and Social Welfare should be a caring and considerate man but this Government seem to take satisfaction from closing hospitals or factories. It is a bankrupt administration. The Minister for Health is responsible for closing institutions, the Minister for Industry, Trade, Commerce and Tourism has also closed factories throughout the country. They are the official undertakers. The Minister for Education announced the closure of Carysfort training college.
This is an indication of how bankrupt this Government are and how they are prepared to take decisions which are against the best interests of our people. I hope all Members of this House will withdraw any power the Minister has to close hospitals. I know my colleague Deputy Naughten is deeply concerned about this issue and I have no doubt about his commitment to the retention of St. Patrick's Hospital in Castlerea. I hope when it comes to a vote on the new Bill to give the Minister this power that he will come into the lobby with me and my colleague, Deputy Doherty, to ensure that this Bill is defeated.
(Interruptions.)
I should like to apologise for the absence of the Minister for Health, Deputy Barry Desmond, who is appearing on a television programme. People may say he is appearing on a television programme because he wants to dodge this issue here this evening but that is not so. I presume he is discussing this very issue on television.
Now we know, television takes precedence over Dáil Éireann.
I will bring the message to Deputy Leyden. The closure of St. Patrick's Hospital, Castlerea, must be seen in the context of national health services policy. "The Psychiatric Services — Planning for the Future" report published last year identified the development of a community based psychiatric service as the most effective way to meet the psychiatric needs of the population. The development of modern treatment methods for psychiatric illness has meant that the concept of large psychiatric hospitals, developed in the 19th century, is now an anachronism. The Government's plan Building on Reality identified the shifting of resources from institutional care to community care as a major objective of health policy.
The "Planning for the Future" report was drawn up by professionals in the psychiatric services including consultant psychiatrist, nursing officer and chief executive officer representation. Their report starts by stating: "What is required now is a programme to implement these recommendations in all parts of the country. This programme should be initiated without delay so that mentally ill persons can benefit from an effective and progressive service.
The Government decision to close Castlerea hospital is based on the need to start this process of change immediately. St. Patrick's Hospital, Castlerea, was built in 1943, with separate male and female blocks, and was used for seven years in the late forties and early fifties as a TB sanatorium. The patient population has dropped steadily over the years from 414 in 1965 to 336 in 1975 and down to 251 patients by the end of 1984.
The psychiatric hospital service, like its predecessor the TB sanatorium, has outlived its usefulness now that more modern and effective treatment methods are available. The building itself is no longer suitable for good psychiatric care as it was not built to allow patients privacy or independence. Its sanitary facilities are not of good quality and I am sure the patients have not regarded it as a place of comfort or a home despite the fact that 75 per cent of them are over five years in the hospital.
The entire in-patient population of Castlerea hospital were recently assessed in order to determine their future needs in line with the "Planning for the Future" recommendations. This assessment will form the basis for discussions between officers of my Department and those of the Western Health Board in order to determine the appropriate placement of the 226 patients involved, together with the future admission facilities to be made available for Roscommon.
The types of services to be provided in local towns throughout Roscommon will include day centre and day hospital places; supervised and unsupervised hostels or domestic residences for patients who have no homes of their own and geriatric care as 40 per cent of these patients are now over 65 years.
The closure of Castlerea hospital will also facilitate the opening of the new mental handicap centre at Swinford which will have 190 residential places. Mentally handicapped patients should never be placed in psychiatric hospitals unless they also suffer from a psychiatric illness. Yet in the 1981 census of psychiatric hospitals, the three psychiatric hospitals in the Western Health Board had a total of 321 in-patients whose primary diagnosis was mental handicap. Forty-five of these patients were in Castlerea, 172 in Ballinasloe and 104 in Castlebar. The coming on stream of the centre at Swinford will allow for the transfer of some of those patients to a centre designed for their care and will reduce the psychiatric hospital patient numbers further.
The Minister announced his decision in this House last Thursday so that action could be taken to implement this decision in a controlled way. He has provided funding for the hospital for at least the next six months to enable alternative arrangements to be made. There will be no hardship on patients or their relatives and I object to the scare mongering tactics of local political interests on this issue. The staff in the hospital will, as far as possible, be redeployed to other appropriate positions. Now that the policy is clear, the alternative services will have to be provided and the changes envisaged in "Planning for the Future" will become a reality for the Roscommon area.
The Dáil adjourned at 9 p.m. until 10.30 a.m. on Wednesday, 5 February 1986.