Has the Minister of State a proposal to put to the House?
Private Members' Business. - Closure of Hospitals: Motion.
Dún Laoghaire): With regard to speaking arrangements, in view of the large number of Deputies who wish to speak on this motion, by agreement, notwithstanding anything in Standing Orders, Members will be called in Private Members' Time this evening as follows: From 7 p.m. to 7.20 p.m., a Fianna Fáil speaker; from 7.20 p.m. to 7.40 p.m. to 8.10 p.m., a Government speaker; from 8.10 p.m. to 8.20 p.m. to 8.30 p.m., a Fianna Fáil speaker.
Are the arrangements agreed? Agreed.
I move:
That Dáil Éireann calls on the Government to rescind their decision to close St. Dympna's Hospital, Carlow, Castlerea Mental Hospital, Roscrea District Hospital, Killarney Isolation Hospital and St. Patrick's Infant Hospital, Blackrock, Dublin and not to proceed with the proposed closure of Sir Patrick Dun's Hospital, Dublin, and the Eye, Ear and Throat Hospital, Cork, until full consultation has been held with the appropriate health boards on all aspects of these closures.
We have tabled this motion because of our concern at the lack of sensitivity on the part of the Government in bringing about the closure of these hospitals in the current year of 1986. We in Fianna Fáil believe that there is need for economies in the health services and it is fair to say that our members on the health boards have been very responsible in the manner in which they have behaved over the past three years. Despite a shortage in allocations from the Government, the health boards, including our members, have acted responsibly in dealing with the health services as best they could with the reduced allocations. It should not have been necessary for a Government to make such a decision as this over the heads of the health boards.
The decision of the Government must be a matter of concern to everybody who is interested in the care of patients. In fairness to the Minister, he has gone out front and tried to defend the indefensible, although he made it very cleat to us in the House on 30 January last that it was a Government decision. In that statement the Minister said that the hospitals due for closure included the list of eight hospitals referred to. That would suggest that there are other hospitals due for closure and that he named only eight on that occasion. I ask the Minister, if there are other hospitals due to close, what hospitals are they and has he consulted with the authorities responsible for their day-to-day administration?
The decision to close down the two psychiatric hospitals was a most extraordinary one. In effect, in less than six months the Minister would be throwing out into the community 600 patients from St. Dympna's in Carlow and St. Patrick's in Castlerea, or transferring them to other psychiatric hospitals in the area. He must know it is impossible in a period of six months to prepare these patients for this change. Many of them have been in these hospitals for 20 to 25 years. Many of the other hospitals are very old and would not be able to accommodate extra patients. While the population in these hospitals has reduced over the past 20 years, this decision to transfer patients would cause overcrowding. For many of the patients the hospitals threatened with closure are their homes. These patients have become institutionalised and it would be entirely wrong to send them to other hospitals without any preparation. Equally, it would be wrong to send them out into the community. What alternative arrangements has the Minister made, or what arrangements does he hope to make in the community before the end of June when he intends to close these two hospitals?
This night week in reply to the debate on the Adjournment in relation to Castlerea hospital the Minister of State had this to say:
The Minister announced his decision 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 six months to enable alternative arrangements be made.
From that statement it is obvious that the Minister intends these two hospitals to close down by the end of June. With regard to the phrase "in a controlled way" the announcement of the decision has caused panic throughout the health services. What alternative arrangements have been or can be made in such a short time? Each of the health boards studied the document The Psychiatric Services — Planning for the Future. I understand most submitted recommendations to the Minister. None recommended that any psychiatric hospital should be closed immediately. Indeed, in relation to Castlerea hospital, the Minister and the Minister of State told us that the unit for mentally handicapped would be opening in Swinford, but that will take only 30 patients from Castlerea, leaving over 200 still in need of placement.
Before any patients can be discharged, there is a need to build up the community services, the day care facilities and have hospitals and acute units in general hospitals available. There is need for more nurses and community psychiatric nursing. Above all, there is a need for rehabilitation and preparation of the patients. This is all about patient care which must be the priority of all of us in this House. I should like to ask the Minister to explain what the position will be in regard to staff at the end of the six months.
We all support the recommendations in the document, Psychiatric Services: Planning for the Future but I deplore members of the Government using that report to justify their actions because nowhere is it stated in it that any hospital should be closed down immediately or within the next six months as the Government intend doing. The Minister, and the Minister of State, said the report suggests that the programme should be implemented immediately. It is recommended in the report that the programme should go on for ten to 15 years in five year phases. The Government have decided to start at the back page and to justify their actions on the basis of the report is grossly unfair. The report states:
... there will still be small group who despite active treatment and rehabilitation, will need long-term in-patient care.
We all accept that statement and it will not be possible to give all the people who will be coming out of hospital the necessary rehabilitation. The report also states:
Well developed community services are a prerequisite to achieving a decline in the hospital population.
The report went on to state:
We can learn from mistakes made in other countries. It has been argued that patients were discharged too soon, inadequately prepared, had nothing to do during the day and became inactive and isolated... adequate support services and day care facilities were not available.
We are all aware of the position in Italy and the US. In Italy they introduced a law not to allow any further patients into psychiatric hospitals, particularly new patients. Many patients were let out among the community without proper facilities for them. Those patients lived rough and as dropouts without any service for them. The report also states:
We recognise it will not be possible to rehabilitate all patients for independent living in the community. We consider that patients who cannot be rehabilitated to this extent should be allowed to spend their remaining years in the hospital where they now live.
Despite that statement the Minister, and the Minister of State, said that they were acting in accordance with the report. The Government are in total conflict with it. Worse still they have used the names of eminent people to back up their actions. They used the name of the CEO of the South Eastern Health Board. Mr. Peter McQuillan, and I can guarantee the House that that official supports what is in the report and not what the Minister said on television or radio.
I do not think the names of people who are not Members and cannot defend themselves in the House should be used.
The person mentioned did not get a chance to defend himself last week.
I would agree with the ruling of the Chair if I was saying anything against such an official but I am defending him. The other official I wish to refer to is the chief nursing office in St. Mary's, Castlebar.
The difficulty is that if the Chair permits the Deputy in defending a person to name him a Member who takes a contrary view must be permitted to name a person. A political football may be made of an individual who does not have the right to reply and cannot take action against a Member who may say something defamatory about him. That is why I am anxious to exclude any reference to the name of an official.
I will not name names but I deplore the fact that the names of some of the people who helped to compile this excellent report are being used to justify something that is not in the report.
The report also states:
Each health board should draw up an outline plan for the psychiatric service. This should include targets and objectives to be reached in ten to 15 years time, perhaps in five year phases. Nothing could be clearer than that, but some people are prepared to use that report to justify actions that are totally in conflict with it.
This valuable report, which we should all support, has been brought into disrepute by the Minister, and the Minister of State. Their statements in regard to it must be damaging to the long term prospects for the future development of the psychiatric services. Those statements have cast doubt on the credibility of the report. It was unfortunate that RTE allowed the Minister time on his own on Today Tonight and on John Bowman's programme, Day by Day without having somebody opposite him to put the alternative view. Had such a person been present the integrity of the report would have been defended.
How much thought went into the needs and care of patients when the decision was made to axe the district hospital in Roscrea? If we are committed to the transfer of resources from hospital care to community care, as all parties say they are, surely it is an integral part of community care to keep a small district hospital in a town like Roscrea that does not have any other facilities. Such a hospital could be used for elderly patients, people who are living alone and suffer a coronary or develop pneumonia. If we have a facility we should keep it so that such people can be treated by their own family doctor. That would be more economic than sending such patients to Limerick hospital which would cost four times as much. It is important to keep patients within their own environment. That must be a priority with all of us. How much thought went into the decision in regard to Killarney Hospital?
With regard to St. Patrick's Hospital, Temple Hill, the first notice officials got of the decision to close that was on the morning the Minister made the announcement in the House. That voluntary hospital gave an excellent service for many years. While the bed capacity there has decreased, there have been 45 infants at the hospital for some weeks in 1986. That hospital is also a training school for nursery nurses. The present course is 18 months short of completion so I wonder whether the Minister has made any arrangements for the people concerned to continue their training. When the children Bill is enacted it will be necessary to have more nursery nurses. Has any thought been given to where these extra nurses will be trained?
I question whether the Minister and the Government have the power to close a voluntary hospital. They can withdraw funds from such a hospital but the matter of closure is questionable. If the announcement of the closures is any indication of what we may expect when the Health (Amendment) (No. 2) Bill is going through the House some of the Minister's colleagues on the backbenches may not support that measure because it is designed to empower him to close anything without reference to anyone. That Bill should have a stormy passage through the House.
I shall confine my contribution to the proposed closure of Killarney Isolation Hospital. This hospital which was built in 1939 has 44 beds of which 32 are occupied at present. It is very difficult to understand the thinking behind this proposal. There would be more patients in this hospital were it not for the concern and co-operation on the part of the medical and nursing staff and the officials of the Southern Health Board in the matter of cutbacks in the health services. Another important element in this context is that the cost of maintaining a patient at Killarney Isolation Hospital is only £33 per day whereas the corresponding figure is £120 in the Tralee Regional Hospital. Therefore, the cost of maintaining the 32 patients in Killarney Isolation Hospital amounts to £385,000 per annum. A 100 per cent occupancy of the hospital would involve a cost of less than £500,000 so we can hardly be expected to understand the reasoning for the proposed closure.
The medical, nursing and non nursing staff at the hospital are second to none. This is a well run hospital. It is considered to be one of the best in Kerry. Patients from all over the country are admitted to the hospital. We must have regard also to the fact that there is no hospital in Killorglin and that in respect of Killarney we are talking of a catchment area of about 60,000 people in terms of consideration of hospital beds. Killarney Isolation Hospital is fundamental to the whole operation of the health services in Kerry. There is also the consideration that the hospital is de facto a geriatric hospital. In the years since its establishment as an isolation hospital it has become slowly a hospital catering mainly for geriatrics as well as for people who require monitoring because of certain illnesses.
Nearby is St. Columbanus's Home, an institution for the elderly and for which there is a waiting list of 150 people. This figure is made up of 80 men and 70 women and of those cases 49 are certified as being in need of being admitted urgently to a geriatric hospital. Despite these circumstances the Minister proposes to close the isolation hospital which is an adjunct to the district hospital and St. Columbanus's Home.
It appears that the Minister failed to use his influence to have the Southern Health Board agree to close the top ward in St. Columbanus's Home, an operation that would have reduced the bed capacity there by 48. It would appear that his viciousness is being brought to bear on the health board and on the people of the whole south Kerry area by way of insisting that the isolation hospital be closed. This is a disgraceful step. The proposal should never have been mooted. We must bear in mind also that if this hospital is closed there will be pressure on the district hospitals throughout the county because the isolation hospital caters for the county as a whole. These are the hospitals at Cahirciveen, Dingle and Listowel. Did the Minister take this factor into account when making his decision?
On Friday last the Kerry Health Committee passed a unanimous decision that the Killarney Isolation Hospital should be maintained. This health committee are broadly based and comprise eminent doctors and shrewd business people and also prominent members of Fine Gael, Labour and Fianna Fáil. It is difficult to understand why the Minister is going against the wishes of that local committee.
Whether the decision has been taken by the Minister or by the Government, it is very bad and the Minister is not remotely apologetic about it. On 30 January, as reported at column 1258 of the Official Report, he said:
I hope that my party will not drift in that direction. We have not drifted and we have no apology to offer for this approach.
That represents a ruthless and uncaring attitude on the part of the Minister. It is something that the people in south Kerry will not forget for a long time.
As reported at column 1334 of the Official Report for the same day, the Minister said that:
The Government have decided that the first stage will involve the closure, scaling down or phasing out in 1986 of certain facilities which are demonstrably superfluous in the context of a rational, cost effective and integrated hospital system.
He included Killarney Isolation Hospital in the list of proposed closures. While I would not consider the continuance of a hospital in terms of the job content, we must bear in mind that there are 24 jobs at stake at the hospital and that the cost to the IDA of creating that number of jobs would be in the region of £500,000 at a minimum.
It is very difficult to understand, too, why the Minister of State who is in charge of tourism was not informed by the Government about the decision to close Killarney Isolation Hospital. The Minister of State lives within a few hundred yards of that hospital. It appears to the people of south Kerry that the Minister is inconsiderate, uncaring and has no regard for the weak and less well off sections of the community in Kerry. There are some doubts as to whether the decision is a Government one, but if it was, the Minister's influence within the Cabinet must be minimal. I appeal to him to change his decision and to get agreement from the Government to keep open Killarney Isolation Hospital. In this way the Minister will be ending the utter chaos and consternation that surround this question now.
I speak in support of the Fianna Fáil motion calling on the Government to rescind the decision announced by the Minister for Health regarding the closure of hospitals, with special emphasis on St. Patrick's Psychiatric Hospital, Castlerea, which is in my constituency. The announcement by the Minister on 30 January 1986 during the budget debate was a cold, callous and uncaring act against the most vulnerable people in our society. I refer to 250 patients in the case of Castlerea who are without a vote or a voice and, in many cases, without a relation in the world. It is my responsibility and that of my party to speak on behalf of those people, to call on the Minister and the Government to reverse this heartless decision by the hatchetman of this Coalition Government. The announcement was made without prior consultation with the health board or the staff.
When the Deputy is referring to the Minister for Health he should refer to him as the Minister for Health.
Would the Chair give me a simple word for it?
I refer the Deputy to Standing Orders.
Perhaps the Minister would respect the Members of this House. When speaking on television he referred to Members of this House as squalid politicians.
I am not accountable for what goes on outside this House.
I will refer to him in future as the Minister but it does not change my position as far as he is concerned. The closure announcement was made without prior consultation. It was conveyed to the majority of patients and staff by RTE radio and television. Panic and anxiety were immediately apparent among the patients, and naturally the staff. In his statement, the Minister conveyed the impression that resources are being provided to assist in the development of services which have a high priority, and in the Western Health Board area the Minister said funds are being provided to open a new complex for the mentally handicapped at Swinford, Country Mayo.
No such provision is being made, and the reallocation of £1.9 million from St. Patrick's Hospital to Swinford will not provide community psychiatric services for the 250 patients and 700 out-patients in County Roscommon. Where will the 1,521 people who attended out-patients clinics in 1984 be catered for in County Roscommon? In that county, hostels have not been provided to cater for patients: only six places in Loughglynn, with day centres in Roscommon, Boyle, Ballaghaderren and Strokestown, are to be available and no provision has been made for the 106 patients of over 65 years of age and the 55 patients in the Castlerea hospital who are between 30 and 65 years of age.
I appeal for support from all sides of the House and I call on the Taoiseach, in the light of the seriousness of the situation and the callous manner in which this announcement was made, immediately to remove Deputy Desmond from the post of Minister for Health. The Minister relied totally for support for his statement on Planning for the Future in regard to psychiatric services. I suggest that the Minister read chapter 3.2 of that document, where he will find the following:
The general policy of the development of community care to replace an exclusive programme of hospital care was acknowledged in a World Health Organisation (W.H.O.) report entitled "Changing Patterns of Mental Health Care" where the following recommendation was made:
The running down of existing mental hospitals should be phased so as to overlap with the building up of community-based services. In no case should the chronically ill or handicapped person be discharged from hospital until or unless adequate supporting services are provided in the community.
No such provision has been made for the patients in the Castlerea hospital, and no provision has been made in any other institution in County Roscommon. The welfare homes are over-crowded. On checking at the Sacred Heart Home in Roscommon today I found they have no room for additional patients. No provision has been made for the development of community services which the Minister said will be provided. The Minister's estimate in this respect should be given to the House because it will take years of detailed planning and development of services in County Roscommon to cater for the 250 patients and 700 out-patients of this hospital.
It is obvious that the decision by the Government was ill-considered, because there cannot be a continuation of the psychiatric services in County Roscommon which would cater for a population of 54,000 people. I call on the Minister to reverse this decision as quickly as possible. He now has an opportunity to enter into meaningful discussions with the health board and all concerned. The Minister has created great difficulty for the staff in Castlerea, many of whom have been there for many years, many of them living in Castlerea. The Minister obviously has no concern for their welfare or their future. He has no concern for the development of the Castlerea hinterland. I will not refer to the economic situation there, but the closure has serious economic implications for the town and the entire county.
I will relate my remarks to the action committee in Castlerea, to the community council there and to Roscommon County Council, the local health committee, the Western Health Board and everyone who will be seriously affected by the closure. The 250 jobs in the hospital are not taken up totally with nursing. There are 164 nurses, three psychiatrists, three junior psychiatrists and eight people employed as administrators, domestics and tradesmen serving this very important institution.
I call on the Minister to retain this hospital in Castlerea as a centre of psychiatric services in County Roscommon to provide all the facilities necessary for people who will require such services. Those patients cannot be moved from the institution. What the Minister will be performing in this case will be a form of official euthanasia, because the patients there will die if they are moved from the security of the hospital. That is a serious and grave decision for the Minister to make, or for the Government. It would not surprise me if that will be the least of the Minister's concerns, the least of his cares. It will be heart-rending——
The Deputy should not make remarks like that. It is lowering the debate and generating heat.
I have to express the concern expressed to me by the medical staff, the nursing staff in that hospital——
In one minute the Deputy has accused the Minister in a round-about way of submitting those people to official euthanasia, and he said it would not surprise him if the Minister did not mind whether they died or not. That is not worthy of this House.
It is worthy of the Minister.
I am ruling it out of order. As long as I am in the Chair I will do my best to keep up the dignity of the House. If that is to be tolerated here there will be no end to the depths people will descend to.
I am speaking the truth in this regard.
I will have to ask the Deputy to withdraw it and find other language, other phraseology——
I have made a statement here of the advice that has been given to me by people who know their business.
The Deputy will have to find other language.
I am expressing deep concern that people are being sent out of this hospital without prior notice, without a proper programme of pre-education. They will suffer. I know this to be true. In 1948 when this hospital was used as a TB sanitorium, the position was known and was stated by a nurse who spoke of the heart-rending scenes. He said that he wished never to see such heart-rending scenes again. Many who left at that stage never returned to St. Patrick's Hospital in Castlerea. That is how serious this issue is and why we have to highlight it in the House and why I appeal to the Minister.
Reports were submitted to the Department, one from the Western Health Board on 26 January 1986 which was not sanctioned by the Western Health Board.
The Deputy's time is up.
This report is not approved by the Western Health Board and any other report within the hospital has not been approved by the Western Health Board. Those reports have no official sanction so the Minister cannot rely on them to support his arguments for the closure of St. Patrick's Hospital in Castlerea.
I move amendment No. 1:
To delete all words after "That" and substitute the following:
"Dáil Éireann notes that following the announcements of the Government decision in Dáil Éireann on 29th and 30th January last, the Minister for Health has commenced the process of consultation with the authorities of St. Dympna's Hospital, Carlow, St. Patrick's Hospital, Castlerea, the District Hospital, Roscrea, the Isolation Hospital, Killarney, Sir Patrick Dun's Hospital, Dublin, the Eye, Ear and Throat Hospital, Cork, and St. Patrick's Infant Hospital, Blackrock, to give effect to the policy decisions relating to these hospitals and further notes the assurances given by the Minister that the best interests of the patients and the rights of the staff in these hospitals will be fully taken account of in the implementation of these essential measures to develop and improve the delivery of the health services."
I wish to report major progress in the development of our hospital services. Since 1983 I have approved capital schemes amounting to over £200 million. These include new general hospitals or major new extensions to general hospitals at Cavan, Castlebar, Mullingar, Galway Regional Maternity, Portiuncula, Ballinasloe and Tralee; and in Dublin at St. James's and The Mater Hospital.
In addition significant developments have been completed or approved at Ennis, Croom, Tullamore, Cork Regional — cardiac unit, Victoria/South Infirmary Hospitals, Cork, Limerick Regional — dialysis unit, Barringtons and St. John's Hospitals, Limerick, Ardkeen and Kilkenny; and in Dublin at St. Michael's Dún Laoghaire, Rotunda, Cappagh, Harcourt Street Children's Hospital, and The Meath.
At geriatric hospital level major new schemes have been completed or commenced at Carlow, Dundalk, Ballymote, Longford and The Royal Hospital, Donnybrook.
While significant improvement and upgrading schemes have been completed or are in progress at St. Mary's, Mullingar, Listowel and Raheen; and in Dublin at: Brú Caoimhín, St. Mary's and Leopardstown Park.
On the psychiatric services side the following units have been or are being built St. Luke's Hospital, Clonmel and acute psychiatric units at Beaumont and Tralee: and a new psychiatric day hospital at Elm Park, Dublin.
In addition, by the end of 1986 I will have spent £10 million on improvement schemes in district psychiatric hospitals.
In the mental handicap area we now have new centres at Cheeverstown, County Dublin, Swinford, County Mayo and Belcamp, County Dublin.
Improved residential facilities and expanded community services have been provided in Drumcar, County Louth, Cootehill, Limerick, Galway, Cork, Waterford, and Dublin city and county.
In addition many minor improvement schemes are being undertaken in mental handicap centres throughout the country.
On the physically handicapped side there are major schemes at various stages at St. Mary's School for the Deaf, Cabra, National Blind Centre, Rathmines, Central Remedial Clinic, Barrett Cheshire Home, Cheshire Home, Monkstown, St. Joseph's School for the Deaf, Cabra, St. Mary's School for the Blind, Merrion, Open Door Day Activity Centre for Physically Handicapped at Bray, Crisis Intervention Centre for Multiple Sclerosis Society at Longford, Residential Facilities-Resource Centre for Physically Handicapped at Sligo and St. Laurence's Cheshire Home, Glanmire.
In addition to this long list of developments through the period of office when I devoted myself unceasingly to this work, we have now coming on stream major developments at Wexford, Ardkeen, Drogheda, Sligo, Naas, Nenagh, Galway, Limerick and Navan; and in Dublin at St. Vincent's, Blanchardstown, St. Colmcille's, Tallaght, Temple Street and Cappagh.
This list gives the lie to spurious political and vested interest propaganda that the health services are being run down. This year the health budget is £1,276 million current and £58 million capital and 58,000 employees. Of this budget some £200 million will be spent on our psychiatric services. In my period of office over £220 million has been allocated to the health capital programme on my recommendation. I have no apology whatsoever to make to any Deputy from any constituency for this outstanding allocation of social resource expenditure to our health services in times of grave recession and Exchequer constraints.
I have no apology to make to this House when, in the best interests of patients and hospital re-organisation, I have closed down hospitals such as Mercers and St. Ultan's Hospitals in Dublin. Likewise, I have closed Trim maternity and Longford county hospitals with the co-operation of the North-Eastern and Midland Health Boards respectively.
These closures are part of the overall overdue rationalisation of the hospital services in Dublin, Cork city and in many other areas of the country such as the Midlands, which have proved a model of co-operation in their long awaited development of effective hospital services. Indeed, the rationalisation of hospital services which I now propose provides another example of how the freeing of resources would permit of a necessary development. I refer to the proposed geriatric assessment unit at Ardkeen hospital and the CAT scanner at the Regional Hospital Galway largely overlooked in much of the criticism of my proposed rationalisation.
I come now to the closures in the hospital area and I will deal with the psychiatric hospitals later. They are Sir Patrick Dun's Hospital, Dublin, St. Patrick's Infant Hospital, Blackrock, Eye, Ear and Throat Hospital, Cork, Killarney Isolation Hospital and Roscrea District Hospital.
May I first deal with the closure of the above five hospitals? Sir Patrick Dun's was originally earmarked for closure on completion of Phase 1c of St. James's Hospital in 1989 and services have run down recently with an average occupancy rate of only two-thirds of the hospital's capacity in 1984. The major medical specialty at present being provided at the hospital, i.e. gastroenterology, can be incorporated into St. James's immediately, and it is not expected that the closure of the other specialties will create any major problems for the other acute hospitals in south Dublin.
St. Patrick's Infant Hospital in my constituency functions as a home for the infants of unmarried mothers until they are either adopted or their mothers decide to keep them. The number of children for adoption has declined considerably and many unmarried mothers retain their children. Of the 90 beds in St. Patrick's only 40 are in use. Given the low occupancy rate for this hospital and the fact that these children can be placed with foster parents or in Eastern Health Board facilities, this hospital is being closed.
The services now being provided by the Cork Eye and Ear Hospital are being transferred to the Cork Regional Hospital and to the Victoria-South Infirmary Hospitals. This in line with our policy that specialist services should, where possible, be located on a general hospital campus. The re-organisation will be to the benefit of everybody in Cork. I have met no Deputy or member of the Cork Voluntary Hospitals Board who is opposed to this decision.
Killarney Isolation Hospital has 44 beds but in recent years the use of these beds for isolation purposes has been declining. This hospital is, in fact, the last GP staffed isolation hospital in this country. It has a low occupancy and has been increasingly used for geriatric purposes. I have no doubt but that the closure of this hospital for isolation purposes is the correct decision particularly in view of the fact that isolation beds are provided at the new Tralee General Hospital. If there are any problems in that regard it should be remembered that 110 beds are to be opened in the hospital in Tralee.
Roscrea District Hospital is a very old hospital and in an extremely poor state of repair. In view of this and aware that there is an adequate number of long stay beds in north Tipperary the decision to close is justified.
With regard to psychiatric hospitals, there is no major problem and the Deputies should calm down. I have given my reason for closing some units and I am sure that Deputy O'Hanlon shares my concern in that regard. An expert group was appointed by my predecessor, Deputy Eileen Desmond, in 1981 with the task of, among other things, drawing up planning guidelines for the future development of the psychiatric services. This group included four experienced officers of the Department of Health, including the Department's inspector of mental hospitals as well as a clinical director in child psychiatry, a professor of psychiatry, a chief psychiatrist, two other consultant psychiatrists, a chief nursing officer and the chief executive officer of a health board. The main thrust of their conclusions, published in December 1984 was that "the psychiatric needs of a community should be met by a comprehensive and integrated service made up of a number of treatment components and largely located in the community". The group also stated that "in particular, there must be a decided shift in the pattern of care from an institutional to a community setting with close links between psychiatry and other community services". Finally, the group called for the implementation of this programme in all parts of the country without delay.
Not to close hospitals.
I am implementing this policy. I would stress that I am doing so not only as a matter of adamant personal conviction but also as part of a collective Government decision.
It is in this framework that the closure of St. Dympna's Hospital in Carlow and St. Patrick's Hospital in Castlerea must be considered. In relation to St. Dympna's I would point out that the chief executive officer of the South-Eastern Health Board was a member of the group which drew up this report. This hospital, which was established to provide services in the Carlow and south Kildare catchment area, is one of five psychiatric hospitals in the South-Eastern Health Board area. It has the largest numbers of psychiatric hospitals in any single health board area. In addition, there are associated acute psychiatric units in Ardkeen and in Clonmel general hospitals.
The Carlow hospital is a 19th century building and has not been a pioneer in the development of psychiatric services in recent years. In fact, the patient population which has dropped from 398 in 1965 to 318 in 1975, increased to 392 in 1982 and now stands at about 340 in-patients. There have been some adverse reports at health board level and adverse publicity for its services in recent years. The hospital has become overcrowded as liberal admission and slow discharge policies were the norm. The level of facilities for patient comfort are bleak and the rehabilitation of patients not adequate.
In this situation it is necessary to take some action. I am certain that the closure of the hospital will lead to a better treatment model and lifestyle for most of the 340 patients accommodated there and will, moreover, permit of the provision of better services to those patients from the catchment area of the hospital who will require psychiatric services in the future.
The closure of this hospital will also facilitate the opening of the geriatric assessment unit at Ardkeen Hospital, Waterford, a much needed facility in the South-Eastern Health Board area.
As evidence of my commitment to provide proper facilities when and where they are medically justifiable, I am providing over £4 million in capital funds for a new purpose-built 100 bed geriatric unit in Carlow to replace the existing substandard accommodation in the Sacred Heart Hospital in Carlow. This accommodation is now being constructed.
In St. Dympna's as of September 1985 there were four medical staff, 133 nursing and allied, four paramedical, 37 catering and housekeeping, 18 maintenance, 11 clerical-administrative and six other grades, total of 213 staff plus 33 locums. The 1985 budget was £3.7 million of which £2.8 million was pay. The staff of St. Dympna's Hospital will, as far as possible, be redeployed to positions in Carlow and its environs in which they will be providing a service which is more relevant to the needs of psychiatric patients and to their specialised skills. These persons, while providing a better psychiatric service, will continue to generate employment and income in the area. As I said, I give employment on behalf of the State to 58,000 people throughout the health services and their interests are always fully taken into account whenever any necessary policy changes are being made.
I must, however, be primarily concerned for the welfare of the patients. The prospect of change frightens many people but especially those whose livelihood revolves around the hospital. The type of care most appropriate to patient needs has now been set out in the report and it is my job to ensure that these services are made available even where local interests find this new service very difficult to adjust to after all these years.
However, change there must be — it is long overdue — and discussions commenced last week between senior officers of my Department and officers of the Eastern and South-Eastern Health Boards to make adequate arrangements for the closure. Last December the in-patients of the hospital were assessed by a consultant psychiatrist employed by the health board in order to decide their suitability for placement in community or other services. That initial assessment showed that, of a total of 344 patients in the hospital at that time 70 had potential for rehabilitation to the community and 88 were mentally handicapped. These two categories alone account for nearly half the patients in the hospital and gave an indication of the potential there is now for transferring patients to the community or for placing them in more suitable accommodation.
The kinds of alternative services which will be considered on a joint basis by my Department and the health board are: development of day care facilities in the community; provision of residences for persons who, after a period of preparation, are capable of living reasonably normal lives in the community; provision of supervised hostels for persons who need more regular attention; transfer of mentally handicapped persons to the mental handicap service. I am utterly opposed to such persons spending the rest of their days in any psychiatric hospital. They should never have been admitted in the first instance and now that we have an alternative framework no more will be admitted.
The Eastern Health Board will in future be involved in making arrangement for psychiatric services for the Kildare area and I am not alone in coming to this conclusion. The two reports were adopted by the South-Eastern Health Board. One report stated that the Kilkenny unit will be planned to provide access to it by the Carlow catchment area and disengagement of the South-Eastern Health Board from provision of psychiatric services in County Kildare. It went on to say that the inclusion of County Carlow in the Carlow-Kilkenny community catchment area was feasible. County Kildare and County Tipperary (North Riding) are not included in this plan. The report said that new purpose-built 50 bed psychiatric units would be required in Kilkenny to serve Carlow-Kilkenny and in Wexford to serve County Wexford. That is the plan and there is nothing unique about it. Once the pressure comes they run like scalded cats away from it.
Will it be ready by next June?
(Interruptions.)
The Minister has ten minutes to conclude.
Do not make me sick.
The Eastern Health Board will in future be involved in making arrangements for psychiatric services for the Kildare area. An acute psychiatric unit is included in the planned developments at Naas General Hospital. It is now my intention, in so far as it does not conflict with the overall planning, that the psychiatric unit will be provided without delay as the first stage of the hospital development. The capital money required to enable this to be done will be available forthwith. This will mean that in future no person from the Kildare catchment area — 74,000 of the total of 114,000 for the hospital, mostly Kildare — will be admitted into a psychiatric hospital unless he or she has been first fully assessed in this acute unit.
This leaves the question of acute in-patients psychiatric services for County Carlow. This county, which has a population of less than 40,000, would be adequately served by an acute psychiatric unit of about 20 beds. I would propose that such a unit will be located in Carlow linked, as is proposed by the health board and endorsed in the working party report, to the acute psychiatric facility in Kilkenny. While I would be prepared to assist the South-Eastern Health Board with capital money to enable these various developments to take place, I also consider that the health board should release some at least of the capital money which is now at their disposal to the benefit of the service which they are providing, and I am sure Deputy Ormonde knows what I am talking about.
St. Patrick's Hospital, Castlerea, was built in 1943, with separate male and female blocks, and was used until the late forties-early fifties as a TB sanatorium. The patient population has dropped steadily over the years from 414 in 1965 to 336 in 1975, down to 251 patients by the end of 1984, and 226 now in 1986. In St. Patricks as of March 1985 there were eight medical, 162 nursing and allied, five paramedical, 51 catering and housekeeping, 24 maintenance, nine clerical and administrative, and nine other grades — a total of 268 staff plus five locums. The 1985 budget was £4 million of which £3.3 million was pay. The building itself is not suitable for good psychiatric care. Seventy-five per cent of the patients have been in the hospital for five years or more.
In common with other hospitals, the entire in-patient population of Castlerea hospital was 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, and the other facilities needed. Thirty three of the patients are mentally handicapped and 73 are assessed as suitable for supervised and unsupervised hostels in St. Patricks. I am aware that there are a number of in-patients who are in the hospital for social reasons rather than for psychiatric treatment.
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 for both psychiatric cases and mentally handicapped persons; and geriatric care, as 47 per cent of these patients are now over 65 years.
Has the Minister provided money for these proposals?
The closure of Castlerea hospital will also facilitate the opening of the new Mental Handicap Centre at Swinford which will have 190 residential places, and which was completed almost a year ago at a capital cost of £12 million. In addition to the 33 mentally handicapped persons at Castlerea, there are about 220 mentally handicapped persons also between Castlebar and Ballinasloe psychiatric hospitals. A psychiatric hospital is not a fitting environment in which to care for the mentally handicapped. After years of shame, I hope the House will at least accept that statement.
It is imperative that we bring on stream the centre at Swinford. This will allow the transfer of some of the patients to a centre specifically designed and staffed for their care. It will correspondingly reduce the psychiatric hospital patient numbers further.
I would emphatically point out to Deputies that my Department have received from the Western Health Board a draft report for the Roscommon catchment area concerning the future delivery of the psychiatric services in this area in accordance with the recommendations of "Planning for the Future".
Not sanctioned by the Western Health Board.
This draft report in accepting the need for a much reduced hospital at Castlerea, proposed the provision of an acute psychiatric unit for Roscommon County Hospital. I would very much like to pursue this proposal with this health board. It is fully in accordance with my policy and that of the expert group, that nobody — I repeat nobody — should in future be admitted into a psychiatric hospital as a long stay patient without first being fully assessed in such a unit and that short term treatment be provided if necessary and prior to any long term admission being considered. Senior officers of my Department will examine this proposal in detail with the professional staff of the Western Health Board in the immediate future. In fact, a meeting took place today between officers of my Department and the chief executive officer of the board and I look forward to a report of this meeting.
Was it cordial?
I have been berated because of alleged lack of prior consultation on these measures. My answer is — go and read the psychiatric working party report.
We did.
And read the multiple reports on hospital reorganisation. Unfortunately, on this island prior consultation has time and again meant "no change — what we have, we hold". And time runs out time and again on the best interests of patients and staff. Time and again local political opportunism — squalid I would stress — has frustrated social advancement.
Nonsense.
Accordingly I announced my decisions so that actions could be taken to implement these decisions in a controlled way. I have provided funding for the hospitals concerned for at least the next six months to enable alternative arrangements to be made. There will be no hardship on patients or their relatives, The staff in the hospitals will, as far as possible, be redeployed to other appropriate positions.
On a point of order, is the Minister saying that there will be no hardship on patients or their relatives——
That is not a point of order. Allow the Minister to conclude.
It is a point of order.
It is not a point of order. Please resume your seat.
It is a point of order. What the Minister says is an untruth.
Please resume your seat.
If the Minister withdraws that statement I will resume my seat. It is an untruth.
Please resume your seat. You are being disorderly.
It is an untruth when the Minister says there will be no hardship on patients or their relatives if the hospital in Kerry is closed. I ask him to withdraw that statement.
The Minister has one minute to conclude.
That is an untruth. I am asking the Minister to withdraw the statement that there will be no hardship on patients or their relatives.
That is not a point of order. Please resume your seat.
Perhaps the Minister would withdraw the statement.
The Minister has one minute to conclude.
As examples of the progress we can make I will mention certain hospitals such as St. Davnet's in Monaghan, St. Conal's in Letterkenny, St. Senan's in Enniscorthy and St. Bredan's and St. Loman's in Dublin. I do not propose to let the recommendations of the recent report suffer the same fate of long delay.
There are still 11,000 in-patients in our 22 health board psychiatric hospitals and there are 6,600 staff whose skills are vital and are appreciated but are not fully utilised. We must break the mould of long-stay residential and custodial treatment. Patients and staff must move out into the community. Mental illness is part of all our lives and we must all share our lives with those who need our help. I challenge this House to join with me in this historic effort to transform these services. It will be a sad day in Irish public life——
It is a sad day for Ireland.
I will hold local inquiries in relation to both Carlow and Castlerea Mental Hospitals, if the health boards concerned refuse their co-operation to me. I am confident these inquiries will show that it is merely narrow and sectional interests that are holding back progress in the psychiatric services. I have the reports of the health boards in relation to both hospitals.
The Minister should go to the Philippines. He would make a fine Minister of Health for Marcos.
If necessary I will give the directions to improve the services. I challenge Deputies in this House to join with me in that endeavour.
The Minister said it would be a sad day in Irish life if the health boards concerned refused their co-operation. The fact is that in all of his actions he has not invited the co-operation of anyone. He has behaved in a way that demonstrates to all, particularly the patients, their families and the doctors and nurses looking after them, that the only thing to be considered is his view. The Minister has taken the view that in his passing role as Minister for Health — and it is becoming more passing each day — what he decides is right for the patients, the nurses, doctors and all concerned.
The Leas-Cheann Comhairle will be aware of the impact of this decision on the Roscrea District Hospital. I will tell the House how the patients and staff of that hospital became aware of the impact of this decision on them. The first indication they got was an announcement in a news bulletin on the day after the budget of what had been dramatically indicated here by this Minister. Without any consultation with anyone, he decided to close the hospital. There was no prior consultation or concern for the patients or staff. The sad day the Minister spoke about has arrived. This Minister has a notion that he should teach the nation standards to which we must all adhere. The reality is that he is the person who must learn the lessons.
What happened in relation to the hospital in Roscrea is an example of many misstatements by the Minister to support his position. He said the hospital was old and that is accurate. He also commented that there is an adequate number of beds for geriatrics in the region but that is totally inaccurate. I challenge him to present any facts on which he can base that remark. The Leas-Cheann Comhairle can bear out what I say from his own personal experience. Even in the County Hospital in Nenagh or in the Hospital of the Assumption in Roscrea there is always pressure to find places. When there is no room in the County Hospital in Nenagh — the beds are in the corridors, to the shame of the Minister — they are relieved to have accommodation in the geriatric unit in Roscrea. Any Minister who can say there is adequate accommodation for such patients in the region is ignoring the reality. In his statement the Minister said:
I am aware that there is an adequate number of long-stay beds in North Tipperary. The decision to close is justified.
I ask the Minister to state what survey has been carried out of geriatric needs in the region. Is there even a consultant geriatrician? The answer to both questions is that there has been no survey and there is no consultant geriatrician. Yet this Minister has the gall to state that there is an adequate number of long-stay beds in North Tipperary and that the decision to close is justified.
From listening to people who are much better informed than the Minister in his passing experience in this office, we can learn some points. First, in a local community centre, as in the case of Roscrea, there is the sense of security for people in their own environment. There can be many visits and contact with friends and relations. That means so much to patients, the youngest of whom is 69 years. This has been demonstrated to be good medicine and good, effective and caring treatment.
This Minister has the gall to talk about his outstanding allocation of social expenditure. The public will not so regard it. Even in economic terms, hospitals such as Roscrea are cheaper from the point of view of the State than having to move people to another part of the region to hospitals that will need extra accommodation.
The community concerned should have been consulted through their representatives on the health board and the social agencies active in Roscrea. In him omniscience the Minister has decided that the end will come in June but would it not have been more reasonable to consult with the various interests to see what can be done to ensure that there are places for patients after June? What kind of autocratic dictatorship is it to say that the hospital will close and that we will find places afterwards? The approach of the Minister has been quite offensive. He walked into the House on the day after the budget and made the announcement and he has aggravated the felony tonight in the attitude he has adopted.
The health boards, the community organisations and the nursing and medical personnel are anxious and ready to consult but they need time. They cannot be told they have exactly two months to make up their minds. The very least the Minister should have granted was adequate consultation. On behalf of the people of the region I demand of the Minister that he rescind the decision. Then he should engage in consultations. If he does that, he will find that people are ready to consult with all and sundry, including this Minister for as long as he is there, with a view to providing even better facilities for our old people. Is he suggesting that he has adequate advice and information in a region where he has refused to allow the appointment of a consultant geriatrician to the Mid-Western Health Board?
What kind of arrogance is it that allows a Minister to come in here and say there is adequate accommodation when those of us who live in the area know that the opposite is true? If the Minister visited either the Hospital of the Assumption in Thurles, or the corridors of Nenagh County Hospital, or the hospital here concerned, he would see that there is no such thing for these people. Perhaps the next time before he announces his diktat he will ensure that he will get a more favourable response from the people. The anger I have expressed this evening is only a small measure of the anger I witnessed in Roscrea in response to the Minister's decision and the manner in which it was announced.
I hope the Minister will have the humanity and humility to recognise that there is more to being a Minister than just pontificating, particularly for a Minister for Health. It is time he started to engage in real consultation. I am asking him for that reason to rescind this decision. We are ready to consult, even during his short period of office.
We are here tonight to discuss the high-handed action of the Minister in his budget speech when he announced his intention to close eight hospitals without any consultation with the health boards concerned and without any consideration for either patients or staff. The suddenness and insensitivity of the announcement amounted in the words of one hospital administrator to a "shocking performance". Imagine psychiatric patients finding out about the closure on radio and television. Does the Minister have any idea what effect this must have had on these patients, many of whom have been in hospital for many years and regard the hospitals as their homes? How callous and unfeeling of any Minister to subject such patients to such treatment. The sledge-hammer mentality of this Minister is once again evident and he appears to invite confrontation and agitation with all his decisions. All this is rather strange when one considers his own performance in Opposition when he opposed virtually every suggestion for cost-saving exercises by the then Minister for Health, Deputy Woods.
Lest the Minister should get carried away with his own self-importance and his belief that he is all powerful, let me bring him back to reality and the Health Act, 1970. We all know that he would like to change this Act and he has already promised to amend the legislation. Until this Act is amended the law of the land is as I will outline. Section 38 (3) states:
A health board may and, if directed by the Minister, shall discontinue the provision and maintenance of any premises provided and maintained by it under subsection (1).
Section 38 (5) states:
The Minister shall not give a direction under subsection (3) in relation to the discontinuance of the provision and maintenance of a hospital, sanitorium or home save after having caused a local inquiry to be held into the desirability of the discontinuance.
The Minister is once again in breach of the law of the land and feels in his arrogance that he is above the law. Until he changes the Act he is bound by it in the same way as everybody else. Judging by the reactions of some of the Government backbenchers, I do not think it will be so easy to change that law. Can the Minister see Deputy Liam Naughten supporting a change in the law that would close St. Patrick's Hospital, Castlerea? Can he see Deputy Begley supporting an amendment which would lead to the closure of the Killarney Isolation Hospital? I do not think so.
What does the Minister intend to do to these patients? Where does he intend the patients to go in the meantime? While he mouthed pious platitudes about transferring the emphasis to the community, he reduced the overall budget to the various health boards. The South Eastern Health Board will face a shortfall of £6 million this year since deficits from 1984 and 1985 will be the first charge in 1986. As a result there will have to be a cut in the community care budget. To suggest that the community can cope with these additional patients is utter rubbish.
Any responsible politician will agree that there must be rationalisation of the health services and that the emphasis must be changed from hospital-based to community-based services. I recently went on the record on this matter on radio. This cannot be achieved overnight. The change of emphasis would require a massive injection of capital over a prolonged period. Community-based facilities are at present totally inadequate. The community and the hospital services will have to run parallel but the Minister is not prepared to provide the capital or spend the time to do that.
The Minister claims his decision was based on the document Psychiatric Services: Planning for the Future but he appears to have read only the last page. The document contains 191 pages and a lot of good sense, but the plan was meant to be implemented over a long period, not overnight. Let us look at some of the relevant sections in the document. It is stated in section (7) on page 15 that there will be a small group who, despite active treatment and rehabilitation will still need long-term in-patient care. It is stated on the following page that well developed community services are a prerequisite to achieving a decline in the hospital population. It is recognised on page 46 that it will not be possible to rehabilitate all patients for independent living in the community but it is considered that patients who cannot be rehabilitated to this extent should be allowed to spend their remaining years in the hospital where they now live. These are the things the document says. It does not recommend that anything be closed down in six months. The final statement in the document is that each health board should draw up an outline plan for the psychiatric services. This should include targets and objectives to be reached in ten to 15 years' time, perhaps in five-year phases. This is a far cry from six months.
The Minister's treatment of Mr. Peter McQuillan, CEO of the South Eastern Health Board, on the Today Tonight programme last Wednesday was nothing short of despicable. For any Minister to condemn or to castigate one of his own officials without giving him an opportunity to reply is nothing short of scandalous. Mr. McQuillan has given both his time and expertise for the benefit of the underprivileged and his reward was a castigation by the Minister on our national television station. I suspect that these officials will be slow to assist the Minister and others in similar projects if this is the treatment they can expect.
The Minister states in his amendment that he has commenced the process of consultation with the authorities of the various health boards. Surely it is a case of closing the door after the horse has bolted. Let us consider the situation in St. Dympna's, Carlow. The net allocation to the South Eastern Health Board for 1986 announced following the budget was a figure of £85.55 million. The net expenditure on St. Dympna's in 1985 was £3.47 million. I would point out that St. Dympna's is the most economically run psychiatric hospital in the country. In the 1986 allocation the Minister has withheld £1.835 million, being half of the allocation for St. Dympna's because the Minister intends to close it in June 1986. Does that not make a mockery of the Minister's amendment in regard to consultation? All the consultation under the sun cannot change the fact that the Minister intends to close this hospital in June. I see Deputy Kieran Crotty opposite. Let him and his colleague, Deputy Dowling, support the amendment tomorrow night.
There are 343 patients in Carlow, of whom 105 are open ward psychiatric patients who could be accommodated in the community if we had the necessary facilities. We cannot possibly have such facilities when we are faced with a shortfall of £6 million this year. There are 38 mentally handicapped patients and we will all concede that they should never be in a psychiatric hospital but until we get the facilities we have nowhere else to put them. Of the remaining patients, 73 are secure ward psychiatric patients who cannot be let out into the community because they would be a danger either to themselves or to the community. What is to become of these? There are 84 psychogeriatric patients who at this stage of their lives regard St. Dympna's as their home. What is to become of them on 1 July 1986, in six months' time?
Let us look at the facts in relation to St. Dympna's. As I have said, it is the most cost effective of all the psychiatric hospitals in the country. The nursepatient ratio is the lowest in the country. In spite of the Minister's allegations on the radio recently, the staff at St. Dympna's have worked a comprehensive, integrated service since 1968. They pioneered community nursing over the past 25 years and their hospital has been thoroughly integrated into the community life in Carlow.
Debate adjourned.