Thank you for allowing me to discuss the threatened closure of the County and City Infirmary, Waterford city and Lismore District Hospital in west Waterford. I was disappointed earlier this afternoon when you disallowed the Private Notice Question I tabled on the grounds that in accordance with Standing Orders there was no urgency attached to this issue. However, there is great urgency in this matter particularly with regard to the threat to close the District Hospital, Lismore.
These two hospitals are situated in the region of the South Eastern Health Board but they are quite different in their form of financing. The District Hospital, Lismore, is financed totally by the South Eastern Health Board and the County and City Infirmary is financed by a direct subvention from the Department of Health. My collegues, the people of Waterford and I take an extremely serious view of what is proposed.
With regard to the District Hospital, Lismore, the urgency is all the greater because of the fact that a special meeting of the South Eastern Health Board has been called for Thursday, 7 May in an effort — I believe — to rescind or reverse the decision taken by the board last week whereby 14 of the 27 members present voted against the proposals put forward by the chief executive officer. In other words, the closure of five hospitals in the area, including Lismore, was averted by a 14-13 vote. As we know from reading the newspapers at the weekend, Deputy M. J. Nolan, from the Kilkenny-Carlow constituency, was summoned by the Taoiseach and apparently castigated for not having supported the proposals of the chief executive officer. Certain moves are afoot at present to reverse that decision which would mean the death knell for Lismore District Hospital. My colleague, Deputy Desmond, said that this is surgery of another kind.
During our period in Government we had to make terribly difficult decisions. We made cutbacks in the health service and we accepted that in line with overall cutbacks in public expenditure. I am not running away from that but it is a case of how it is done. I maintain that the present proposals are draconian and should not be entertained. The Minister for Health should ensure that savings are made without closing hospitals which are essential for the old, the infirm and the sick. I know that you, a Cheann Comhairle, are familiar with the terrain of west Waterford and that you know how central Lismore is to that region. It will be traumatic for the elderly people in the area if their local hospital is to be taken from them. The District Hospital in Dungarvan, the closest to them, will not be able to cater for them and it is quite likely that they will be hospitalised in Waterford city which, for many, is 40 or 50 miles away. Their relatives or friends will not be able to visit them, which is an awful thought.
I visited Lismore District Hospital yesterday and the fear of closure had to be witnessed to be believed. There are 21 beds in the hospital which are all occupied so it is not a question of low bed occupancy. I ask the Minister to ensure that the health board make cuts in a way which will ease the pain and trauma to which I referred. I was a member of the South-Eastern Health Board for three-and-a-half years and, as a result, I am very doubtful as to the value of health boards. I often wonder whether it was wise to move away from the old health authorities which had much greater local autonomy. While health boards may seem to be a money saving device because of rationalisation, getting rid of duplication and so on, they have not worked out for the best. I am told that spending on the health services at present is three times greater in real terms than it was in 1973. However, the quality of service has not improved and if these cuts are implemented the cost will be reduced slightly but the hospital services will be reduced by 100 per cent in some cases, like Lismore.
I will endeavour to give Deputy Cullen an opportunity to contribute if the Ceann Comhairle agrees. The meeting of the health board on Thursday in Kilkenny is very important and I hope that a decision to close Lismore Hospital and others will not be taken. Who is making these decisions? Must they be as drastic as those required by some members of this board, the chief executive officer and his officials? Is this the way to go about it? Must they put hundreds of people out of work? Could they make cuts in administration? Could they do what has been suggested in Dublin over the last few days and look for a cut in working hours? Could they get people to work for one day a month without pay, thereby effecting the cuts? I do not want to be cynical about the matter but the slogan at the election said that there is a better way. There must be a better way than closing essential hospitals. Have other avenues been explored? I have very serious reservations in that regard.
The hospital in Lismore has a budget of about £250,000 per annum. Can someone tell me what the saving would be if that hospital was closed and the patients transferred elsewhere? The fact is that they cannot be accommodated elsewhere. Therefore, extra accommodation will have to be built wherever they are to be taken in, be it Waterford city or Cork city as some of the patients in Lismore County Hospital come from the eastern parts of County Cork.
Is there going to be any saving? I do not believe there will be and I would like to see the economics worked out. Could it be that it is proposed to close a hospital with no money being saved, and with people having to go through the terrible suffering and pain of not knowing where they are going to be sent, which could be so far away that their relatives and friends may not be able to visit them. I would like to have it explained how the savings are going to come about before something awful is done such as closing this hospital.
Let me turn to the County and City Infirmary in Waterford. That hospital has its origins as far back as the 15th century. It is situated in its present location for the past 100 years. It has a staff of 100 people and at any one time there could be up to 40 trainee nurses. It is primarily an acute medical and surgical unit. It carries out one-third of all operations in the greater Waterford area and together with Ardkeen General Hospital carries out all the surgical operations in the greater Waterford area. At present, Ardkeen is working to its maximum and cannot carry out any more surgical operations as it is at present constituted. Where are those extra operations to be carried out? Last year, there were 1,600 surgical operations carried out. The surgical unit in Ardkeen is working to full capacity. Therefore, I am asking where are those 1,600 operations going to take place? Can money be saved by transfering the patients to Kilkenny, Kilcreene, Dublin or Cork? I do not believe so. It is false economy.
Let me point out the background to the threatened closure of the County and City Infirmary. Its allocation for 1987 as notified by the Department of Health is £1,065 million which is a reduction of £339,000 over 1986. In percentage terms, that is a reduction of 24.1 per cent. We have all read about reductions in the allocations to voluntary hospitals in other parts of the country, primarily in Dublin and Cork. The North Infirmary in Cork has been particularly highlighted but none of the hospitals which I have seen highlighted has had a percentage cut in its allocation as great as 24.1 per cent. That is the percentage cut which is being sought in the case of the County and City Infirmary in Waterford. To make matters worse, the infirmary is one of the few hospitals in the country which has year after year in recent times when cutbacks have been the order of the day conformed with the financial expenditure limits put on it by the Department of Health. What do they get for good housekeeping? They receive a savage cut in their allocation for 1987. The injustice of it defies understanding and description.
I pointed out that there is no alternative accommodation or personnel available for additional surgical operations in Ardkeen and there will not be for perhaps another seven or eight years. The new hospital at Ardkeen which was so badly needed only commenced operations four months ago and the hospital will not be fully completed for seven or eight years. I could see the rationale of amalgamating the two hospitals and having all surgical operations carried out in one unit when the new general hospital at Ardkeen was completed, but at this stage I cannot see the sense of it and I do not believe there is any sense to it. I ask the Minister to use a bit of commonsense and stop making false economies and pretending he can save £339,000 by just a stroke of a pen. He cannot do it.
If that hospital closes, which it almost certainly will as it cannot bear the brunt of a cut of 24.1 per cent on top of all the other cuts it has had to endure during the past number of years, the Minister will not save that kind of money if the patients have to be transferred to Cork, Kilcrene or Dublin. It will probably cost him more. I would plead with the Minister to examine closely the case of the County and City Infirmary again and see that it gets a fair deal, which it is not getting at present. The overall cut in the budget of the South-Eastern Health Board is 7 per cent. Why should the infirmary in Waterford have to suffer a cut of 24.1 per cent? I ask the Minister to see to it that hospitals which are badly needed are not allowed to close because if those cuts are maintained they will have no option but to close. Find those savings somewhere else. There must be a better way.
