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Dáil Éireann debate -
Wednesday, 12 Feb 1986

Vol. 363 No. 11

Private Members' Business. - Closure of Hospitals: Motion (Resumed).

Dún Laoghaire): In view of the large number of speakers this evening, the following arrangements have been agreed. By agreement and notwithstanding anything in Standing Orders, Members will be called in Private Members' Time this evening as follows: 7-7.10, a Fianna Fáil

speaker;

7.10-7.16,

a

Government

speaker;

7.16-7.22,

a

Government

speaker;

7.22-7.28,

a

Government

speaker;

7.28-7.34,

a

Government

speaker;

7.34-7.40,

a

Government

speaker;

7.40-7.55,

a

Fianna Fáil

speaker;7.55-8,a Fianna Fáil speaker; 8-8.10, a Fianna Fáil speaker; 8.10-8.15, a Government speaker; 8.15-8.20 a Fianna Fáil speaker; 8.20-8.30, a Fianna Fáil speaker.

Is that agreed?

It is not agreed but we have not enough votes to block it.

The following motion was moved by Deputy O'Hanlon on Tuesday, 11 February 1986:
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 closure.
Debate resumed on 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. Patick'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 assurance 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.
—(Minister for Health).

After many efforts to raise this matter by way of Private Notice Question and on the Adjournment, I am glad at last to have the opportunity to speak in support of the motion put down by our spokesman on health, Deputy O'Hanlon, calling on the Government to rescind their decision to close the hospitals mentioned until they have full consultations with the health boards on all aspects of these closures.

I will address my remarks to the hospitals in my own constituency, St. Dympna's in Carlow. This is one of the most cost-effective hospitals in the country. It has given a lead in psychiatric services over the years and is one of the few psychiatric hospitals which has opened itself to the community. The nurse-patient ratio in this hospital is one of the lowest and it serves a catchment area of 114,000 people from counties Kildare and Carlow. It has pioneered community nursing for the past 25 years and has been thoroughly integrated into community life. This is in line with the spirit of the document Planning for the Future. We have heard much about this document recently but it is actually one of the most abused documents that has ever been produced. It has been accepted by the staff of St. Dympna's and by the South-Eastern Health Board as a progressive document, but it has been used by the Minister for Health in a very selective manner to provide quotations in support of his argument. It is pointed out throughout the document that community care cannot be introduced except on a phased basis. Some people have mentioned a time of ten to 15 years, during which period necessary resources would have to be made available to the health boards in order to provide these community services.

The document states that the decline in importance of the psychiatric hospitals should take place gradually and as part of a planned progression to community-oriented service. It goes on to say that the psychiatric hospitals must not become forgotten places and that despite declining numbers they will be needed still for some years and must therefore be adequately maintained. Well developed community services are a prerequisite to achieving a decline in the hospital population. It is recognised that it will not be possible to rehabilitate all the patients for independent living in the community and it is considered that patients who cannot be rehabilitated to this extent should be allowed to spend their remaining years in the hospitals where they now live. These points are made throughout the document by the eminent people who drew it up, but none of this has been taken into consideration by the Minister in making this announcement. He used selective quotations from the document in support of his argument.

I have not yet met anybody who disagrees with the views put forward in Planning for the Future. It deserves great attention and its recommendations should be implemented as soon as possible. In order to achieve that, resources must be made available to the health boards. In his allocation to the South-Eastern Health Board the Minister gave £1.86 million to St. Dympna's Hospital. This amount will keep the hospital in operation for six months and it will have to close at the end of June, although no alternative arrangements have been made for the 343 patients resident there. The Minister says that it is his intention to provide community-based services. Those of us involved in the health services know that it can take up to ten years between the planning and completion of a project. The overall allocation to the South-Eastern Health Board for 1986 will be reduced by £6.35 million. How does the Minister expect us to provide new services when we will not be able to maintain existing services? The Minister has deliberately made this announcement now to divert attention from the reductions in the allocations to health boards and we will have more to say about this at a later time.

The impression has been given by the Minister for Health, and by the Minister for Finance who attended a meeting in Carlow last night, that this decision was in some way brought about by the South-Eastern Health Board. I categorically deny that. Under no circumstances was there any consultation with any member of the South-Eastern Health Board or with the chief executive officer. The chief executive officer may have been one of the people who sat on the committee which drew up Planning for the Future but that does not mean that he or any members of his board are responsible for the proposed closure.

Professionals in the psychiatric services have all opposed the Minister's decision. The community infrastructure must first be developed. Patients must be prepared for rehabilitation and the community must be prepared to accept patients back. The Minister's decision is irresponsible. We are asking that there should be no movement of patients out of the hospitals until such time as proper community-based psychiatric services are available.

I was glad of the Minister's indication last night that he would be prepared to have a local inquiry held in each area where the health board do not agree to a hospital closure. I can assure him that the health board will not be agreeing and therefore a local inquiry will be held in Carlow. If such an inquiry is held, the outcome will ensure that St. Dympna's Hospital will not be closed. Twelve hundred responsible people came to a meeting last night in Carlow to voice their opposition to his decision.

Members of the parties opposite have an opportunity tonight to register their vote against this decision and to save the hospitals in their respective areas. We know they have party loyalties but they also have a duty to their constituents. This is their opportunity and I call on the Members for Carlow-Kilkenny to oppose the Minister in this decision.

I want to begin by correcting the false impression some people have, and some people may be trying to create, in relation to this Fianna Fáil motion that the vote to be taken at 8.30 p.m. is about giving or not giving the Minister for Health the power to close hospitals. Of course, that is utterly untrue. There is no power in that vote to do that. The vote tonight, no matter what the outcome of it will be, will not be a vote either to close or not to close any hospital if only for the reason that has been pointed out on a number of occasions, that a hospital cannot be closed without the necessary local inquiry. Some years ago when I was in Opposition a motion I moved in this House was passed by this House but the Fianna Fáil Government of the day decided to ignore the motion and I found that nothing could be done about it. Since then I have been very cynical about motions in this House and what effect or power they have, as a result of that experience which a number of Deputies will recall. I do not rise to the bait, as Deputy Aylward put it, because this motion is purely and simply a political ploy such as is used by all parties — I am not being critical — particularly parties in Opposition. It is used to exploit to the greatest political advantage the misfortunes of the Government of the day. I state that not as a matter of criticism but as a matter of fact.

Like most party politically conceived motions, this one has many defects. It tries to please everyone and to promise everything, and in the process it does less than justice to the hospital I am interested in, St. Dympna's. It does less than justice to their case because it puts St. Dympna's on a par with some of the hospitals mentioned in the list and it does not deserve to be put on a par with those hospitals. In many ways this motion, in the way it is worded, could be harmful if it really meant anything. I will admit that other hospitals in the list in the motion each have a case, but I hold that the case of St. Dympna's is a very special one and it suffers from being contained in the motion. For that reason I express the hope that this motion and this discussion tonight will end the political point scoring on this and that the five TDs and two Senators in Carlow-Kilkenny will join together with one purpose in mind, that is to get the best deal possible for the patients and staff in St. Dympna's. We should be united on that issue because we have a strong, good case to make and we will not make it if we are going to continue political point scoring off one another.

I support the Government amendment. I am glad to note from the amendment that the process of consultation has commenced with the South-Eastern Health Board in relation to St. Dympna's. I want to put on the record of this House the assurances which the Minister for Health has given me in relation to these consultations. These assurances are that the purpose of these consultations is not only to ensure that there will be no diminution of the services available to patients but that the quality of the service will be improved. Furthermore, I want to put on record that the Minister has confirmed to me that the employment entitlements of all of the staff will be fully respected. Again I emphasise that all of these consultations are taking place and must continue to take place in the context of the document Planning for the Future.

I want to make it clear that, while I have no reason to doubt the sincerity of these assurances, if I find there is any departure from the undertakings I have received I will be taking what some people might describe as drastic action. I am aware of the sufferings that the patients and their families have undergone and of the anxiety of the staff since the announcement was made, and I am not prepared to tolerate any further imposition of hardship on any of these people.

The decision to close St. Dympna's Hospital came as an absolute shock to me and in particular to my constituents not only in Carlow but also in Kilkenny. The patients and staff of the hospital were particularly distressed by the proposed closure. I ask the Minister if this is a cost-cutting exercise. If so, then it should be resisted fiercely by anybody and everybody who prides himself in the promotion of improved facilities for the weakest sector of our economy, the mentally handicapped and the psychiatrically ill.

The Minister last night referred to the rationalisation of the hospital services to provide another example of how the freeing of resources would permit a necessary development. What is the necessary development associated with the closure of this long established psychiatric hospital in Carlow which has at present 340 incare patients and a nursing staff of 140? The Department claim that that could be as high as 150; nonetheless, it is still a small staff. It is the least cost effective hospital of its type in the entire country. I suggest that the Minister look at some of the other institutions of a similar nature in other health board areas, and then perhaps he will have a different view.

The year 1981 saw the commencement of the important task of drawing up planning guidelines for the future development of the psychiatric hospital services culminating in what I regard as an excellent report, Planning for the Future. The Minister is now, as he states, endeavouring to implement that policy out of an adamant personal conviction, and in that he has my total and absolute support and I am confident that he has the support of every Member of this House and most people across the country.

Last night the Minister referred to the hospital as a 19th century building and not a pioneer in the development of psychiatric services. I would like to point out to him that it was the first institution of its type in this country which shed the high concrete walls and barbed wire effect and ceased to be regarded locally as a lunatic asylum. If that is not a pioneer effort, then somebody might tell me what is. I visited this hospital since the bombshell of the proposed closure hit it last Thursday week, and now I can stand here and tell this House publicly with conviction how moved I was to experience the excellent level of nursing care which all the patients of that hospital enjoyed. Many of the patients have come to regard it as their home. Some of them pleaded with me to ask the Minister under no circumstances to allow that hospital to close and thrust them out on to the street. I have to support the view that the Minister holds, that his intention was never to throw anybody on to the street, least of all that section.

This year we are spending £1,276 million on health and related services. That by any standard is an enormous expenditure of taxpayers' money, and the Minister not only has responsibility but he has an obligation to ensure that we get the best value for our money in terms of hospital care. In that way implementing this report will have the absolute and fullest support of all of us.

I take issue with the Minister over the stark announcement of the elimination of St. Dympna's Hospital in the light of the report on future planning. That makes neither good psychiatric nor economic sense. I am firmly convinced that there is need for the continuation of an institutionalised care centre such as St. Dympna's in the Carlow area. I would go further and say that in the interest of psychiatric care generally and in line with what is in the report, there should be more of these smaller sized institutions around the country. In that way we could provide a better service. We embarked upon a rationalisation programme resulting in bigger factories, bigger hospitals, bigger schools, but this brought about many problems. Will anybody deny a few extra shillings in income tax to the psychiatrically ill? If so, let them stand up and say so.

To some extent the motion before the House is political. Of that I have no doubt. In my view the amendment is no different. That makes it easy for me to support either the motion or the amendment. In the amendment there is mention of consultation. I urge the Minister to continue the process which he has now commenced in connection with psychiatric care institutions. Having entered into dialogue with all interested parties, I am sure he will come to the conclusion that not only should the present institutions remain open, but that he should encourage similar institutions around the country.

Because of the time limitation, I shall confine my remarks to the proposed closure of the Isolation Hospital, Killarney. To say that I was surprised when I heard the announcement on the RTE evening news would be an understatement. Because certain innuendos and statements have been bandied about in an endeavour to damage my integrity, indicating that I had prior knowledge of the Minister's decision, I want it clearly put on the record that, no more than any of the other Members, I had no previous knowledge.

In 1986 nobody would quarrel with the closure of an isolation hospital which was built for the treatment of infectious diseases. Medical science has long since eradicated these diseases and society is very grateful for that. However, the Isolation Hospital in Killarney cannot be put into that category. It has filled a vital role and served on many occasions as a safety valve in the accommodation of patients who could not find accommodation in the local district hospital. In evaluating the decision to close the hospital, four fundamental principles should be critically examined. The first deals with any disruption of the existing patients and the local economy; the second with continuity of employment; the third with continuation of full availability of hospital services; and the fourth with financial implications. I suggest that there is ample and good evidence that the Isolation Hospital in Killarney should continue to serve hospitalisation needs in south Kerry. There are 44 beds in the local district hospital. If you evaluate any town the size of Killarney, with an urban population of 8,000 and a perimeter population of approximately 4,000 because of extended housing, you will find that the decision to close this hospital would not be in the best interests. The town of Mallow has a slightly lower population and is 20 miles from the Regional Hospital in Cork, and Killarney is 20 miles from Tralee Regional Hospital. Mallow is maintaining a very substantial general hospital, however.

The State contribution to the Southern Health Board this year is £145,650,000. The impact of the cost of the isolation hospital is less than £360,000 — less than one quarter of 1 per cent of the total budget for the two counties. I suggest that endeavouring to find cuts over the wide range of the budget should be relatively easy. That £145,650,000 is the direct input from the taxpayer. The local contribution from the self-employed — which should represent something in the nature of 60 per cent of the population of Cork and Kerry — represents £202,000. If that represents 1 per cent of the profit income of those who are availing of hospital services in those two counties, then there is room for a substantial improvement there.

I am supporting the amendment on the grounds that discussion and dialogue will continue in connection with the points that I have made, with a view to continuing the services of the Isolation Hospital in Killarney for the benefit of the patients and the hospitalisation services in south Kerry.

As the Minister is well aware and as we indicated on a previous occasion in the House and in discussions with him, the announcement of the closure of St. Patrick's Hospital, Castlerea, came as a shock to all of us, in the sense that we were left in difficulty as to what precisely would happen to the 240 patients there. I was delighted yesterday evening to hear the Minister say that he had begun negotiations with the Western Health Board about the future of the patients in Castlerea hospital.

We all appreciate that a number of those patients will be transferred to the new centre in Swinford. That centre was built for the purpose of dealing with mentally handicapped patients and I agree with the Minister that that is the proper place in which to have those patients treated. What concerns me more now, and has over the last fortnight, is the position with regard to the other approximately 200 patients who are in St. Patrick's Hospital, Castlerea. I was glad to hear the Minister say yesterday that he was prepared to make adequate provision for those patients who were in a position to be discharged into the community, supervised or unsupervised hostels, or under a community care programme. It is only right and proper that those who are able to look after themselves should, where possible, be treated in the community. This view is shared by many and has been given in all the documents published on psychiatry over the past number of years. I was delighted to hear the Minister say he is prepared to make the necessary provisions to have those people cared for in their local areas whether in Boyle, Ballaghaderreen, Roscommon or Castlerea. It is important for the patients, and their relatives, to know they will be catered for in their own community. I was glad to hear the Minister say that many of the staff will be utilised in this way.

I am very concerned about the other 100 patients many whom have been in the hospital for between 20 and 30 years. The hospital has become their home and I do not think they can be discharged to hostel accommodation supervised or unsupervised. Those people should be cared for in the Castlerea hospital. It is of vital importance to the patients, and their relatives, that they are left undisturbed in Castlerea for the rest of their lives. It would be irresponsible to disturb them in any way.

A report on the psychiatric services was submitted by the officials of the Western Health Board to the Department recommending the opening of an acute psychiatric unit in Roscommon. I appeal to the Minister to examine that proposal carefully. He should not stop the acute psychiatric service in Castlerea until there is alternative accommodation in Roscommon. The people of Roscommon county will not tolerate the closing of the acute unit in Castlerea if an alternative unit has not been opened in the county. I might add that the report prepared by the officials has not been considered by the members of the health board.

As chairman of the special hospitals committee of the health board I was surprised that the report which contains a five year plan for St. Patrick's Hospital, Castlerea, was only given to me recently. The proposals in the report are broadly in line with modern thinking in regard to psychiatric services.

I must stress that I am very concerned about those who cannot be moved to hostel accommodation. The Minister should ensure that they are treated in St. Patrick's. As was stated by a previous speaker, the motion before us is a political one to try to cause embarrassment to certain Members of the House. Having listened to the Minister last night, being aware of his concern for the patients in St. Patrick's and knowing that discussions will take place with the Western Health Board on the future of the institution I have no hesitation in supporting the amendment tabled by the Minister.

A sell-out.

In the seventies the Deputy came to the House and sold out on Roscommon County Hospital.

The Deputy will be remembered in Roscommon for supporting the closure of the Castlerea hospital.

(Interruptions.)

Deputies Naughten and Leyden should permit Deputy Crotty to make his contribution.

The motion before us deals with the closure of a number of hospitals. The closure of hospitals by their nature, is unpopular and insensitive.

And unnecessary.

I listened to the Minister last night and should like to compliment him on his dedication to his portfolio since he took office. He has performed very well. Last night he outlined an extensive list of programmes he put through since he took office.

I did not always agree with what the Minister was doing but I recognised that he was sincere and a hard worker. Certainly he has the interests of the people at heart.

Is the Deputy talking about the Bill dealing with contraceptives?

He has not the people of Castlerea at heart.

The psychiatric services are more sensitive than the services in any general hospital because many of the patients in those institutions have been there for many years. In some of the acute wards patients have been there for 30 or 40 years. I am aware that it is a traumatic experience for patients in those wards if their bed is moved even one foot. We should not make sudden decisions to close wards. I was pleased to hear that the Minister has agreed to have consultations with the boards concerned. Tonight I hope he will go a stage further and announce that, in regard to the psychiatric services in Carlow and Castlerea, he will not put a time limit on the closure.

The report on the psychiatric services points out in chapter after chapter that the services can only be phased out, that there should not be a cut-off point. I am sure the Minister realises the importance of that statement and in view of it I ask him to give a commitment to the House to phase out the services. It will not be possible to close St. Dympna's in 1986 although the Minister has withheld half of the funds for that hospital for this year. He paid the South Eastern Health Board funds to cover the first six months but the funds for the remainder of the year are being withheld.

All Members will accept that St. Dympna's will not be closed this June, or in June 1987. I am aware that the decision is not a cost-cutting exercise but the implementation of recommendations in the report on the psychiatric services. We should take serious note of the recommendations in that report. It states clearly that services must be phased out and that monitoring committees should be established to supervise the phasing out of psychiatric services in institutions. The Minister, and those involved in the psychiatric services, accept that there is a need for change. I should like to pay tribute to those who work in that service. As a member of the South Eastern Health Board from its inception up to last June I was aware of the great work done in many psychiatric hospitals, including St. Dympna's. I have always admired those who work in such hospitals under difficult circumstances.

I welcome the Minister's efforts to change the scene in regard to psychiatric services and I am sure those who work in psychiatric hospitals will give the Minister their full support in his efforts to introduce community services. But it is not possible to close down these services overnight. In defence of the South-Eastern Health Board who have been the subject of some criticism from the Minister, the board have five small hospitals within their area. These hospitals are very well run and the board should not have been criticised by the Minister. I served on that board for 15 years and I know that they run a tight ship and are short of staff and facilities. In better times when the goodies were handed out, that board did not seek anything. They worked to a very tight budget.

In accordance with the order of the House I must call the next speaker.

They sought facilities only when that was absolutely necessary. I am asking the Minister to give serious consideration to phasing out the hospitals and to give the regional boards a commitment that he will abide by the spirit of Planning for the Future which we all accept.

I am glad to have this opportunity of registering my protest at the action of the Minister for Health who, regretfully, has just seen fit to leave the House. I do not think I would be out of order in accusing the Minister of being mad but I shall not do so because that would result in your not allowing me to be here at 8.30 to register my protest by way of my vote. However, I must question the sanity of some of the Deputies on the other side.

The Deputy should not introduce into the debate the state of health of anyone.

It is no answer for the Fine Gael and Labour Members and for a Labour Minister of State to say that they cannot support our motion because of the Government amendment. The Government amendment makes it clear that these hospitals are to be closed and included among those is St. Dympna's so the Deputies will not be let off the hook by the argument they have put forward.

(Interruptions.)

Order, please. Deputy Nolan without interruption.

With a patient population of 350 and staff compliment of 280, St. Dympna's is one of the most economic hospitals in the country. The patient-staff ratio is the lowest of all our psychiatric institutions. The hospital's record in pioneering psychiatric advances leaves in the shade many of the more widely known establishments. The commitment, dedication and professionalism of the staff there would have to be seen to be believed. It is regrettable, though typical of this Minister, that he has never seen fit to visit that hospital.

In announcing the decision to close St. Dympna's Hospital, the Minister is putting into practice what is obviously agreed Government policy, that is, to cut expenditure at any cost. While the Minister may try to deny this, the Minister for Finance has said in public that this is the position. This callous action by so few has far-reaching implications for many, for the families, for the patients and the staff concerned. The Minister should admit his mistake before he compounds matters by endeavouring to implement his closure proposals.

Senator Connor should leave the House.

The Minister should discuss his interpretation of Planning for the Future with the interested bodies, the health boards, the unions and the hospital staff and try to find some formal agreement on his plans for the care of the patients of all the institutions in question. In his precipitate, rash and impetuous action, the Minister is acting out the role of the wild west cowboy who shoots first and asks questions later. The Minister should admit he has been wrong. It is dictatorship for a Minister to decide unilaterally to close any hospital but particularly a psychiatric hospital of the standard and standing of St. Dympna's. It is Government by diktat. Contrary to what the Minister has stated, there was no prior consultation with anyone about the proposed closure of St. Dympna's Hospital, Carlow.

Last evening the Minister for Finance attended a public meeting in Carlow. If the Minister for Health is interested in hearing what the people think of his proposal to close the hospital, he should discuss the matter with the Minister for Finance. The people of the area are disgusted. They were not interested in Alan Dukes going down to try to placate them——

The Minister for Finance.

——by stating that there has been adequate consultations with the health board prior to the announcement. That was nothing short of a lie. There was no prior consultation with anyone on this matter.

There should be no reference to lies.

An untruth, then.

There is ample precedent for what I am saying. I wish to put it on record that there should be no reference in the House to the state of a person's health.

The actions of some people in the past fortnight bring that into question. Regarding the Minister's interpretation of Planning for the Future, that document which he continues to misquote, he said on television recently that he was entitled to close any hospital he wished, that he was merely implementing the recommendations in the plan. He quoted from the plan the recommendation that each health board should draw up an outline plan for the psychiatric service. He failed to read the next line which is that this should include targets and objectives to be reached in ten to 15 years time and perhaps in five year phases.

What are we to think of a Minister who in his speech on the budget announced that overnight he was to close eight hospitals? The Minister has misused on many occasions this fine report on the psychiatric services. In the past few days he has quoted selectively from it to support many of his actions while failing to quote relevant features of the plan when it suited him not to quote them. He has discredited and belittled this fine report. The timespan in that report in respect of the targets and objectives is between ten and 15 years and not within six months as is the case in regard to St. Dympna's. The financial allocation allows that hospital to operate up to the end of June.

All of us, Government, Opposition, health boards and staffs agree on the direction and the thrust of the Planning for the Future document but if various Government Ministers continue to bend, twist and wrap the findings of this report to suit themselves and their plans, the time and money spent on drawing up this very valuable document will represent another case of the misspending of time and money. I support totally a policy of community care for the mentally disabled but that kind of policy cannot be put into practice overnight and it must not be one on the cheap. To implement it suddenly and on the cheap would have disastrous effects. We must ensure that those people suffering from a wide range of mental disabilities receive care that is at least as good as the care they are receiving now and preferably better. This would involve a lot more than reducing the number of hospital beds. It would involve the creation of wide ranging and varied alternative facilities. It would involve the provision of supportive services for those thousands of very vulnerable people who are mentally disabled and who have little contact with the rest of the community. It would require also the redeployment of thousands of skilled, partly skilled and unskilled staff and a switch of capital resources. None of these provisions is cheap and I urge the Minister to bear that factor in mind. Provided the necessary funds are released there is every reason to expect steady progress towards the concept of community care in the next few years.

In justifying the closing of St. Dympna's, the Minister said, among other things — he was speaking in an RTE interview — that the nurses were using outmoded practices, such as day on, day off rosters, segregated nursing and lack of open door policy. The staff in that hospital have never worked such a roster. A comprehensive integrated nursing service has been the norm since 1968. St. Dympna's complex provides maternity, general and psychiatric care, plus X-ray facilities, out-patient clinics and optical, dental and child care clinics. The hospital has pioneered community nursing for the past 25 years.

The Minister said he wants to move the patients out of high walled three storey institutions. Carlow was the first institution to take down its high walls. Some of the patients go about the town of Carlow like any other citizens.

I take issue with the Minister for the manner in which he announced the closure of this hospital, coldly in the course of a budget debate. I would have thought that the 50 years of tradition which that hospital represents would have merited at least a personal call to the CEO of the South Eastern Health Board, a man of considerable attainment and ability, which was proved by his inclusion in the study group appointed in October 1981 by the Minister's Labour Party colleague, Deputy Eileen Desmond.

It is economic folly to suggest closing such a fine institution, having invested so much money in it in the past number of years. This heartless and hopeless Minister for Health stands indicated not just before the people of Carlow: he stands guilty of gross mismanagement in front of the people of Ireland. While he proposes to close St. Dympna's Hospital, his Department are financing a new £3 million geriatric hospital in the grounds of the same hospital. What kind of management is this? There is neither sense nor reason to that type of carry-on, and that is all it can be described as.

The selfrighteous posturing of this Minister is doing himself and the Government no good. I call on the Carlow-Kilkenny Deputies to stand up and talk with their feet: they have an opportunity tonight to show the people that they are serious about it by voting for our motion.

In my early days as a school teacher——

Would the Chair indicate if I will be called on to speak to The Workers' Party amendment?

My hands are bound by the order made at 7 o'clock.

What arrangements were made to inform Deputy Mac Giolla and me? There has been no communication with us.

The Whips do that.

I am asking if you can arrange to give me some time to speak on our amendment.

I have no control over the matter. An order was made at 7 o'clock.

If the Deputy had been here at 7 o'clock he would have heard the arrangement.

I was not here because I was on other business in the House. I ask the Chair to see if it is possible to provide time, either from the Government side or Fianna Fáil——

An order was made at 7 o'clock through the Whips which indicated the speakers. I have no control over what Deputies will do in their contributions. It is a matter for themselves.

It was customary in schools years ago to use proverbs for headlines. One of them was: "Health is better than wealth". It is a headline, obviously, that the Minister for Health and the Government would not agree with, because I am certain that the overriding consideration which led to the closures of these hospitals was concern for money. The Minister can put any gloss he likes on it, but we are well aware it was budgetary considerations that led to this announcement of the necessary pruning that had to be done.

The areas listed in our motion will suffer. Deputy Pattison accused us of being the people who put St. Dympna's on a par with other areas. We did not read out the litany of closures. It was the Minister who read out that litany, which included St. Dympna's. When Deputies there go through the lobby tonight they will be voting "amen" to all those closures.

We have been talking about planning for the future. These closures are a reaction to the present. At a meeting in Carlow last night the Minister for Finance made that clear when he said that the closure of these hospitals would release resources. That would enable carrots to be dangled in front of people, such as an acute geriatric unit, a psychiatric unit in Naas, a 20 bed-unit to replace the 230-bed unit in Carlow, something else for Kilkenny, something else for Waterford. Punts, not people, were the consideration when this decision was made.

The Minister for Health did not follow us to Carlow last night. I hope his party colleagues tell him that the seething fury of the people there at the closure announcement was the death sentence for his party there. The feelings of the people of Kildare, Laois, Carlow and Kilkenny are prompting them to say that Dympna's will be there long after Desmond has gone.

The closure of this hospital must be condemned first because of the manner of the announcement, but especially because of its consequences. Why was the decision announced without full consideration? Our motion calls for full consultation. Perhaps there will be negotiations, but will the Minister discuss the matter with an open mind? If St. Dympna's is to be replaced, has he the resources or the physical structures to replace the hospital? It is obvious to anybody with concern for health that there will have to be hostels, sheltered workshops, smaller units. We will have to integrate people into the community. Not alone will the patients have to be conditioned but the public must be conditioned as well.

The Minister for Finance said the closure of these hospitals would release resources. Is the Minister big enough to admit that he has made a mistake? In his sudden, insensitive announcement he said that there would be no hardship to the patients or the staff. What competence had the Minister to say how the statement by itself would affect people's health? Even the manner of the announcement would have caused hardship to the patients. I know patients who have been in Carlow for years. It is their home; they have nowhere else to go to. To take them out of that environment would hurt them. There are 330 patients in St. Dympna's, 2,000 more out-patients, and a history of short-stay patients. Last year, 182 new patients were taken in.

The whole tone of treatment in St. Dympna's is in line with modern thinking. It was set in train by Dr. Blake who initiated a programme well in advance of his time, of de-institutionalisation and rehabilitation to get patients back into the community. St. Dympna's was a pioneer in that. From the point of view of economy, cost efficiency and the ratio of nurses to patients that hospital comes out on top. People who will not respond to treatment there will need a haven in Carlow for the rest of their lives. I will tell the House about an 80 year old lady left on her own in Kildare town who rang me to ask what will happen to her son who has been in Carlow since he was 28 years when the hospital is closed.

It is no use telling us that finance will be made available. That is an unbelievable statement because the finance will run out in June. Suitable alternatives cannot be found in six months or in six years. The deanery in Kildare, which we purchased in 1977 to provide 20 adult places for male and female handicapped people, is still there. The Minister would not meet us when we sought a meeting. For 19 years we have been looking for an extra unit in Naas Hospital without success. The Minister must admit that he has been wrong. If the Minister thinks about the good of the patients he must ask himself when and where he can provide a better service for them. If the health boards embark on providing that service, will the Minister provide the money? The Minister has an obligation to answer the question that many will ask "What will happen my son when the hospital is closed?"

The Deputy's time is up.

If the Minister can answer that to our satisfaction we will give him some credit, but the Minister does not deserve credit now.

Deputy Seán Doherty, to conclude at 8.10 p.m.

I consider the Minister's action akin to that of a member of a junta Government rather than a democratically elected Government. The Minister's announcement last week was that of a despot. The decision to close St. Patrick's Hospital, Castlerea, and St. Dympna's was both crude and cruel and was flagrantly in breach of section 38 of the 1970 Health Act. The Minister was prepared to direct the health board to close that hospital. Only last night he had the audacity to tell the House that he will now request the co-operation of the health boards in holding local inquiries so as to give effect to his decision in relation to both hospitals. The Minister has sent a circular to the Western Health Board reminding them that he will invoke section 31 of the 1970 Health Act if the chief executive officer of the board is prepared to continue with Castlerea Hospital and thereby cause overexpenditure. That is the misuse of the law which the Minister is employing to support his wrong decision to close this hospital. We on this side of the House do not have short memories and we recall that the Minister showed scant concern for the law in another situation.

The Minister's decision was cruel in that he attacked the most vulnerable and weak in our community. Last week, in a most offensive and ugly manner, the Minister publicly offensively described my colleague and I on national television as squalidly and politically posturing. Both Deputy Leyden and I consider it our public duty to defend people who are without a voice.

Deputies

Hear, hear.

The psychiatric patients in Castlerea do not have a voice and we will not tolerate the Minister bearing down on them relentlessly, displaying a lack of understanding and knowledge as to what is really required. We are aware of eminent psychiatric opinion about the phasing out of this type of institution. There is no conflict there. But it is not possible to close this hospital immediately without making the necessary arrangements for the patients. The Minister must be prepared to give great increases in the allocations to the health boards to ensure that we can provide the necessary framework for community care.

At the moment we have far from adequate community care in the catchment area of St. Patrick's. In one institution, because of lack of finance, a community care centre was opened in the old sanitorium in Roscommon. Within a matter of days the roof collapsed and the staff had to return to St. Patrick's Hospital and the patients had to be removed. After spending an inadequate amount of money for some work, unsuitable accommodation was made available so that the centre could be used for the purposes now proposed. In all the other centres throughout the county there is confined accommodation, no toilet facilities and so on. There is a totally inadequate number of centres and it is impossible to provide centres between now and 1 July, the date on which the Minister proposes to terminate the services in Roscommon.

Does the Minister really understand what community care requires? Is the Minister aware of what must be made available to those people? Has the Minister taken into account that the community must be educated to accept and understand these people? Does the Minister recognise that many of the patients in Castlerea see it as their home and depend on the staff, whom I compliment on their dedicated service to the psychiatric patients against all the odds? The reality is that there is not a proper facility to provide for these patients if the hospital is closed down immediately. If the Minister is seriously concerned about providing a service for the psychiatric patients in Castlerea he must take into account that the requirements in the document Planning for the Future must be fulfilled.

I challenge the Minister to publicly deny that he has sent out officials from his Department——

The Deputy has three minutes.

——to canvass for space in other psychiatric institutions so that he could relocate patients from St. Patrick's and St. Dympna's. I challenge the Minister to deny that those officials are unwilling to proceed with the type of decision he is enforcing on them and attempting to implement without discussion. I understand the Minister has suggested Swinford as possible accommodation for psychiatric patients with a mental handicap. Swinford was intended for mentally handicapped patients and it is not appropriate for patients with a psychiatric condition. The Minister will deny that that is his intention, but my information is that there is really only one patient with mental handicap suitable for accommodation in Swinford. Let the Minister do the honourable thing and not leave a £12½ million centre in Swinford closed. Let the Minister provide the money and open it to accommodate the mentally handicapped and let the Minister provide the necessary finances to accommodate psychiatric patients in community care.

The other night the Minister waved a document in a way in which only a dictator would and stated that the document was approved by the Western Health Board. That document had not come before the members of the Western Health Board or come before the committee of which I am a member; but the Minister was prepared to present it as fact when that document had not the acceptance of the staff nurses in St. Patrick's Hospital, Castlerea. I understand from some of the nursing staff in Castlerea that they believe that the Minister did not want any consultations with them because he does not have trust or confidence in his own unions.

The Deputy has one minute.

The Minister has handled this in a deplorable way. The Minister has been most offensive in the way he has gone about his duty and has brought about great frustration, fear and worry, not alone for the patients and staff but for the community, who recognise that the patients will be in a very dangerous condition not alone for themselves but for the public if placed in the community without adequate services.

Will the Deputy please conclude?

I must ask my colleague, Deputy Liam Naughten, to oppose the Minister and Senator John Connor to make sure that Seanad Éireann will oppose the Minister. I ask Deputy Naughten not to pretend to the people of Castlerea that his job is to support his party. He must let his conscience rule and he should not act the hypocrite.

I support the amendment to this motion and I have listened carefully to what the Deputies on all sides of the House have had to say on the issue of hospital closures and their effects on the health services. I have also, at the weekend, listened to the honest views of my constituents and to the media debate on this issue. I am also fortunate in my position as Minister of State at the Department of Health that I have had an opportunity to hear the well informed views of officers of my Department, whose prime concern is with the advancement of health services in this State. Despite the conflicting views I have heard from some sources, I am confident that the changes to be made are in the best interests of the health services and that I can, in conscience, support the move to close some of our out-dated institutions in the near future.

In listening to the debate in the House, I have noted that the majority of contributions centered on the closure of the two psychiatric hospitals in Carlow and Castlerea. I comment on this for two reasons. Firstly, it suggests to me that, broadly speaking, the need for some rationsalisation of acute hospital services in this country is, by and large, accepted by Deputies. It indicates that there may be some light at the end of the tunnel in regard to the incessant demands for more and more acute hospital services without any reduction in the services they are designed to replace.

Secondly, it has been on all too rare thing, in my experience as a Deputy and as a Minister of State, for interest to be expressed in the psychiatric services or in the plight of patients in our psychiatric hospitals. Apart from the occasional glare of adverse publicity, they have largely been forgotten in the competing, and more vocal, demands of other sectors for attention. The debate has at least focused attention on the needs of psychiatric services and on the Planning for the Future report with which I am sure many Deputies are, for the first time, becoming familiar.

The decision to close Carlow and Castlerea is not a matter of taking panic action but a statement of intent on which definite plans can be made for the future of patients and staff. I expect that very good plans can be drawn up between the Department of Health and the health boards to make sure that these closures are brought about with due care and consideration and that the next six months will see approval from this House and from the public for the steps being taken to implement these closures. The fact that the closure of Castlerea hospital will mean the opening of the new £12 million purpose built centre for the mentally handicapped at Swinford will also be seen as a major bonus to the west when the dust has settled on the all too hasty reaction which has come in response to these well thought out closures.

A Deputy

Where will the patients go?

I will deal with that shortly. Coming from a rural western constituency I appreciate the economic importance of the hospitals at Castlerea, with an annual budget of £4 million, and Carlow with an annual budget of £3.7 million, to these towns and their spinoff effects on the livelihood of the local people. This is why I have been at pains to stress that a change in the type of services to be provided does not mean an end to the flow of Government funds to these areas. The interests of staff, I have been assured, will be looked after in making arrangements for closure. With community care, the money available will be spread more widely in the catchment areas. However, the benefits to patients must take precedence over economically dominated opposition to an end to institutional care.

I do not believe a word of it.

Even if some of the Members of the party opposite do not understand exactly what is being done, Deputy Haughey should because he was a Minister for Health for quite a number of years.

(Interruptions.)

I am convinced that the changes in the employment and business patterns of these towns will only have temporary effects, that the redistribution of resources will be a net gain to patients, staff and local business interests.

Finally, I should address myself to the concerns of patients in Carlow and Castlerea hospitals and their relatives throughout the surrounding areas. I know that in the past two weeks they have been at the mercy of media hype and political opportunism in trying to find out what is to be their future. I know they fear that people may be turned out of psychiatric hospitals, possibly to return home, without any preparation for the new life style that this will involve. I am sorry that these have been encouraged by some poorly informed sources in the media and in politics. The people who work in Castlerea Hospital and in St. Dympna's and the patients will be looked after.

The Irish Medical Times of 14 February 1985 opens its editorial by saying that any fool can close a long stay hospital but that it takes more time and trouble to do it properly and compassionately. I am not here to defend long stay hospitals as my colleagues on this side of the House have done it adequately and well. I am here on behalf of the hospital about which very few people know. It is a short stay hospital, St. Patrick's, Temple Hill, run by the Sisters of Charity. It surprises me to hear Government Deputies whingeing about the motion before the House being a political one. Of course it is a political motion, we are in the vocation of politics. That is what this House is all about and I respectfully suggest that we should not be running down the vocation of politics. I am proud to be a politician. Of course it is a political motion and the amendment is also political. So be it.

The Minister for Health represents the constituency of Dún Laoghaire in which St. Patrick's hospital is situated and he has represented that area since 1969. He knows the wonderful work done by the staff and the Sisters of Charity since the mid-forties to the present. St. Patrick's Hospital caters for the children of unmarried mothers. The editorial in The Irish Medical Times encapsulated the purpose for which the hospital was set up. It said that the 90-bed infants' hospital at Blackrock, County Dublin, had only a 50 per cent occupancy for the last few years. Most of the babies in the hospital are the children of single mothers and are left there pending adoption or until their mothers reach a decision on their future while they are re-organising their lives to enable them to care for the babies themselves. The hospital is owned and run by the Irish Sisters of Charity and totally funded by the Department of Health which, last year, gave it a total of £590,000. It is run in conjunction with the Society of St. Patrick's, an adoption society in Haddington Road and also works in conjunction with the Catholic Protection and Rescue Society. The administrator at St. Patrick's said that they would be holding talks with the Department of Health on the future of the hospital. She said they would like to keep it open if they got money but she did not know if the Irish Sisters of Charity could provide this money.

I urge the Minister to keep St. Patrick's Infant Hospital open. If the use for which it was intended has now diminished by fewer children being placed there, it could be utilised by a combination of child care and care of the elderly. There are all sorts of uses to which the hospital could be put.

I should also like to pay tribute to the trainee nursery nurses. In the main they have another one and a half years to do to complete their course. There is a tremendous need for nursery nurses and it is very unfair of the Minister to deal with the Order and the nurses in the way he has. He closed the hospital and then talked about consultation. He said that he had commenced the process of consultation with the authorities at St. Patrick's Infant Hospital, Blackrock, to give effect to the policy decisions relating to these hospitals. It appears to be particularly undemocratic of the Minister to announce the closure of a hospital and then to enter into consulations about its closure. If the Minister's decision is final, it appears to be worthless to engage in the sunburstry of pretence and entering into consultations when, at the end of the day, the conclusion will be that the Government decided to close the hospital and therefore it will be closed. I am asking the Minister to take account of the alternatives, the need to protect the staff, the facility itself and the Order.

I listened to Government speakers and they failed to justify this Government decision. I listened to two Ministers of State and three back benchers criticising the Minister tonight. They expressed their concern and opposition to what he was doing. The Minister himself and his Minister of State are the only two Members who defended the action.

We in Fianna Fáil have presented a very worthwhile case in a very reasoned and objective way, without any bias. As Deputy Andrews said, this is a political motion. It is important to recognise that we are not playing party politics with this motion because it is not an occasion for party politics. The welfare of patients is at risk and there are people in this House tonight whose livelihood and jobs are at risk. I appeal to Government Deputies to consider the patients and the staff when they vote on this motion because the amendment is very clearly in favour of closing the hospitals.

The Minister of State, Deputy Donnellan, said many people did not understand what was happening, and I certainly agree with him. As an example of why we do not understand what is happening, I will quote an answer from the Minister for Health to a question in this House one week before the closure was announced. On 22 January on Question No. 13 the Minister was asked what financial provision he had made for the implementation of the report on the psychiatric services, Planning for the Future. He said:

The health boards are now developing detailed plans for their areas in accordance with the guidelines given in the report. The present stage in planning is concerned with determining the location and types of facilities which will be required to provide a service which is essentially community based. The capital and other requirements will depend on the outcome of this planning process.

That announcement was made one week before the Minister came her to make his announcement, and one day after the budget. I am satisfied that this is the result of a decision made at a Cabinet meeting. It was a precipitous decision without any care or concern shown for patients, relatives or staff. This is very obvious because one week after giving that answer the Minister came here and told us he was closing these hospitals — not a change of use. The Minister showed no concern for the patients or their relatives in the catchment areas of the eight hospitals concerned, and for people throughout the country. Now people are afraid because they do not know which hospital will be closed next.

In fairness to the Minister I will say this: he went out and defended what was a Government decision at a time when Fine Gael Members and Fine Gael councillors the length and breadth of the country were saying that a Labour Minister did this; it was not a Fine Gael decision. It was a Government decision and the amendment makes this very clear: it states that this is to give effect to policy decisions. The Minister says he is entering into consultations but this amendment is to give effect to policy decisions, and the policy announced here by the Minister on 30 January was that these hospitals were due for closure in 1986.

He reiterated that last night when he told us he was funding these hospitals for the first six months of this year. In other words, these hospitals will have to close at the end of June 1986. That is the Minister's decision. He also told us last night that consultation meant there would be no change. That is the most serious attack on democracy I have heard since I came into this House. It is a dictatorial attitude. We have a Bill before this House in the name of the same Minister which will give him the power to close any unit or any hospital he likes without reference to anybody. We must bear that in mind. That is another good reason why Government members should support our motion.

My colleagues, in a very unbiased and balanced way, have dealt with the various hospitals, including St. Patrick's, Templehill, but there was no answer from the Minister. He had no answer to our questions about the hospital in Killarney, not even a question of change of use. It too is going to be closed. Roscrea hospital, whose patients should be integrated into the community, will also be closed. The psychiatric hospitals, which are of major concern, were dealt with admirably tonight by Deputy Leyden and by a number of speakers from the catchment areas of those hospitals.

No alternative arrangements have been made. No alternative arrangements can be made before the end of June, and that was pointed out by Government speakers, Deputy Crotty in particular. I ask the Minister to remember that a very important study on schizophrenia is being carried out in three hospitals in this country, two of them being St. Patrick's, Castlerea, and St. Dympna's, Carlow. This is another very good reason why the Minister should not have interfered with these hospitals. As I said, no alternative arrangements have been made, except that 30 patients out of over 200 will be catered for in Swinford. That is the only alternative which may come on stream in 1986. Last night the Minister told us alternative arrangements were made in relation to Carlow, but he did not tell us what they were. We know there are no alternative arrangements made for Carlow.

We in Fianna Fáil fully support this document, Psychiatric Services — Planning for the Future, and Government members said they too supported it. Everything the Government are doing at present is in total conflict with that document. On radio and television the Minister quoted two lines of that document saying that the programme should begin immediately. Of course it should, but under the programme the first step is to set up community care facilities which are vital and necessary before discharging patients from hospitals. There is not one word in what the Minister or his Minister of State said there to night to show they are doing anything, apart from providing 30 places in Swinford. That is the only alternative arrangement made for 600 patients who will be thrown out of hospital before the end of this year.

Not only members of Fianna Fáil, Government backbenchers and the two Ministers of State who spoke here tonight, but members of the health boards, the hospital staff and many members of the public who have shown their support at meetings held throughout the country all support that document. Nobody is complaining about the closure of these hospitals in the future, in ten or 15 years when alternative facilities are provided. If it is a question of party politics, why are all of these other people complaining? This document suggests that there should be a phased programme of development over ten to 15 years, and we fully support that. When the programme is in operation we will be prepared to close the hospitals, but we must make sure that people who have been in hospital for 15 or 20 years will remain in the same hospital for the rest of their lives. That is recommended in the report. Nowhere does the report say that hospitals should be closed this year.

Various Government speakers support our motion and I ask them to vote for it because, as I said, the Government's amendment is very clear. They are asking for time to negotiate with the health boards and to give effect to their policy decisions. Their policy is to close these hospitals. That is what the Government have decided and it is what their amendment states they will do. There is no point in Members coming in here and saying they were delighted to hear the Minister say last night that he would negotiate. What he said last night was that he was funding the hospitals for six months only.

I ask Members on the other side to come into the lobby with us to ensure that this vicious decision of the Government will not be implemented and to ensure that we do our duty in caring for the mentally ill and the other patients in the hospitals concerned. It will not bring down the Government. They can have a vote of confidence after they are defeated, but Members will be doing justice to the less privileged in our society.

Amendment put.
The Dáil divided: Tá, 73; Níl, 68.

  • Barrett, Seán.
  • Barry, Myra.
  • Begley, Michael.
  • Bell, Michael.
  • Bermingham, Joe.
  • Birmingham, George Martin.
  • Boland, John.
  • Bruton, Richard.
  • Burke, Liam.
  • Carey, Donal.
  • Cluskey, Frank.
  • Collins, Edward.
  • Conlon, John F.
  • Connaughton, Paul.
  • Coogan, Fintan.
  • Cooney, Patrick Mark.
  • Cosgrave, Liam T.
  • Cosgrave, Michael Joe.
  • Coveney, Hugh.
  • Creed, Donal.
  • Crotty, Kieran.
  • Crowley, Frank.
  • D'Arcy, Michael.
  • Deasy, Martin Austin.
  • Desmond, Barry.
  • Desmond, Eileen.
  • Donnellan, John.
  • Dowling, Dick.
  • Doyle, Avril.
  • Doyle, Joe.
  • Dukes, Alan.
  • Enright, Thomas W.
  • Quinn, Ruairí.
  • Ryan, John.
  • Shatter, Alan.
  • Sheehan, Patrick Joseph.
  • Skelly, Liam.
  • Farrelly, John V.
  • Fennell, Nuala.
  • FitzGerald, Garret.
  • Griffin, Brendan.
  • Harte, Patrick D.
  • Hegarty, Paddy.
  • Hussey, Gemma.
  • Kavanagh, Liam.
  • Keating, Michael.
  • Kelly, John.
  • Kenny, Enda.
  • L'Estrange, Gerry.
  • McGahon, Brendan.
  • McGinley, Dinny.
  • McLoughlin, Frank.
  • Manning, Maurice.
  • Mitchell, Gay.
  • Mitchell, Jim.
  • Molony, David.
  • Moynihan, Michael.
  • Naughten, Liam.
  • Nealon, Ted.
  • Noonan, Michael.
  • (Limerick East)
  • O'Brien, Fergus.
  • O'Brien, Willie.
  • O'Keeffe, Jim.
  • O'Leary, Michael.
  • O'Sullivan, Toddy.
  • O'Toole, Paddy.
  • Owen, Nora.
  • Pattison, Séamus.
  • Spring, Dick.
  • Taylor, Mervyn.
  • Taylor-Quinn, Madeline.
  • Timmins, Godfrey.
  • Yates, Ivan.

Níl

  • Ahern, Bertie.
  • Ahern, Michael.
  • Andrews, David.
  • Aylward, Liam.
  • Barrett, Michael.
  • Brady, Gerard.
  • Brady, Vincent.
  • Brennan, Mattie.
  • Brennan, Paudge.
  • Brennan, Séamus.
  • Browne, John.
  • Burke, Raphael P.
  • Byrne, Seán.
  • Calleary, Seán.
  • Collins, Gerard.
  • Conaghan, Hugh.
  • Connolly, Ger.
  • Coughlan, Cathal Seán.
  • Cowen, Brian.
  • Daly, Brendan.
  • De Rossa, Proinsias.
  • Doherty, Seán.
  • Fahey, Jackie.
  • Faulkner, Pádraig.
  • Fitzgerald, Liam Joseph.
  • Flynn, Pádraig.
  • Foley, Denis.
  • Gallagher, Denis.
  • Gallagher, Pat Cope.
  • Geoghegan-Quinn, Máire.
  • Harney, Mary.
  • Haughey, Charles J.
  • Hilliard, Colm.
  • Hyland, Liam.
  • Kirk, Séamus.
  • Kitt, Michael.
  • Lenihan, Brian.
  • Leonard, Jimmy.
  • Leonard, Tom.
  • Leyden, Terry.
  • Lyons, Denis.
  • McCarthy, Seán.
  • McCreevy, Charlie.
  • McEllistrim, Tom.
  • Mac Giolla, Tomás.
  • Molloy, Robert.
  • Morley, P.J.
  • Moynihan, Donal.
  • Nolan, M. J.
  • Noonan, Michael J.
  • (Limerick West)
  • O'Connell, John.
  • O'Dea, William.
  • O'Hanlon, Rory.
  • O'Keeffe, Edmond.
  • O'Kennedy, Michael.
  • O'Leary, John.
  • O'Malley, Desmond.
  • Ormonde, Donal.
  • O'Rourke, Mary.
  • Power, Paddy.
  • Reynolds, Albert.
  • Treacy, Noel.
  • Tunney, Jim.
  • Walsh, Joe.
  • Walsh, Seán.
  • Wilson, John P.
  • Woods, Michael.
  • Wyse, Pearse.
Tellers: Tá, Deputies Barrett(Dún Laoghaire) and Taylor; Níl, Deputies V. Brady and Browne.
Question put: "That the motion, as amended, be agreed".
Amendement declared carried.
The Dáil divided: Tá, 73; Níl, 64.

  • Barrett, Seán.
  • Barry, Myra.
  • Begley, Michael.
  • Boland, John.
  • Bruton, Richard.
  • Burke, Liam.
  • Carey, Donal.
  • Cluskey, Frank.
  • Collins, Edward.
  • Conlon, John F.
  • Connaughton, Paul.
  • Coogan, Fintan.
  • Cooney, Patrick Mark.
  • Cosgrave, Liam T.
  • Cosgrave, Michael Joe.
  • Coveney, Hugh.
  • Creed, Donal.
  • Crotty, Kieran.
  • Crowley, Frank.
  • D'Arcy, Michael.
  • Deasy, Martin Austin.
  • Desmond, Barry.
  • Desmond, Eileen.
  • Donnellan, John.
  • Dowling, Dick.
  • Doyle, Avril.
  • Doyle, Joe.
  • Dukes, Alan.
  • Enright, Thomas W.
  • Farrelly, John V.
  • Fennell, Nuala.
  • FitzGerald, Garret.
  • Griffin, Brendan.
  • Harte, Patrick D.
  • Hegarty, Paddy.
  • Hussey, Gemma.
  • Kavanagh, Liam.
  • Bell, Michael.
  • Bermingham, Joe.
  • Birmingham, George Martin.
  • Keating, Michael.
  • Kelly, John.
  • Kenny, Enda.
  • L'Estrange, Gerry.
  • McGahon, Brendan.
  • McGinley, Dinny.
  • McLoughlin, Frank.
  • Manning, Maurice.
  • Mitchell, Gay.
  • Mitchell, Jim.
  • Molony, David.
  • Moynihan, Michael.
  • Naughten, Liam.
  • Nealon, Ted.
  • Noonan, Michael.
  • (Limerick East)
  • O'Brien, Fergus.
  • O'Brien, Willie.
  • O'Keeffe, Jim.
  • O'Leary, Michael.
  • O'Sullivan, Toddy.
  • O'Toole, Paddy.
  • Owen, Nora.
  • Pattison, Séamus.
  • Quinn, Ruairí.
  • Ryan, John.
  • Shatter, Alan.
  • Sheehan, Patrick Joseph.
  • Skelly, Liam.
  • Spring, Dick.
  • Taylor, Mervyn.
  • Taylor-Quinn, Madeline.
  • Timmins, Godfrey.
  • Yates, Ivan.

Níl

  • Ahern, Michael.
  • Andrews, David.
  • Aylward, Liam.
  • Barrett, Michael.
  • Brady, Gerard.
  • Brady, Vincent.
  • Brennan, Mattie.
  • Brennan, Paudge.
  • Brennan, Séamus.
  • Browne, John.
  • Burke, Raphael P.
  • Byrne, Seán.
  • Calleary, Seán.
  • Collins, Gerard.
  • Conaghan, Hugh.
  • Connolly, Ger.
  • Coughlan, Cathal Seán.
  • Cowen, Brian.
  • Daly, Brendan.
  • De Rossa, Proinsias.
  • Doherty, Seán.
  • Fahey, Jackie. Faulkner, Pádraig.
  • Fitzgerald, Liam Joseph.
  • Flynn, Pádraig.
  • O'Hanlon, Rory.
  • O'Keeffe, Edmond.
  • O'Kennedy, Michael.
  • O'Leary, John.
  • Ormonde, Donal.
  • O'Rourke, Mary.
  • Power, Paddy.
  • Foley, Denis.
  • Gallagher, Denis.
  • Gallagher, Pat Cope.
  • Geoghegan-Quinn, Máire.
  • Haughey, Charles J.
  • Hilliard, Colm.
  • Hyland, Liam.
  • Kirk, Séamus.
  • Kitt, Michael.
  • Lenihan, Brian.
  • Leonard, Jimmy.
  • Leonard, Tom.
  • Leyden, Terry.
  • Lyons, Denis.
  • McCarthy, Seán.
  • McCreevy, Charlie.
  • McEllistrim, Tom.
  • Mac Giolla, Tomás.
  • Morley, P. J.
  • Moynihan, Donal.
  • Nolan, M. J.
  • Noonan, Michael J. (Limerick West)
  • O'Connell, John.
  • O'Dea, William.
  • Reynolds, Albert.
  • Treacy, Noel.
  • Tunney, Jim.
  • Walsh, Joe.
  • Walsh, Seán.
  • Wilson, John P.
  • Woods, Michael.
Tellers: Tá, Deputies Barrett(Dún Laoghaire) and Taylor; Níl, Deputies V. Brady and Browne.
Question declared carried.

Close the hospitals down. Close everything down.

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