Deputy Griffin gave me notice of his intention to raise the subject matter of subsections (3) (4) and (5) of section 38 of the Health Act, 1970, in respect of their relation to health boards.
Adjournment Debate. - Health Services Cuts.
I should like to thank you for giving me an opportunity to raise this grave and urgent matter and for bringing it to the attention of the Minister. I am pleased he is present to give his views and to answer the queries I raise.
I am obliged to bring to the attention of the House the concern and disquiet felt by the public at the proposed closure of many hospitals throughout the country, particularly in the South Eastern Health Board, where it is proposed to close five hospitals. This is being done in an arbitrary off-hand way without an in-depth investigation of the medical and social implications of these closures. It is purely a book-keeping exercise. The allocations for this year by the Minister for Health are totally inadequate and many CEOs are in an impossible position as they have to cut their cloth according to their measure and trim many services. The closure of hospitals is totally outside their jurisdiction. If they close they are doing so illegally and irregularly and against the spirit and the letter of subsections (3) (4) and (5) of section 38 of the Health Act, 1970. Subsection (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).
Subsection (4) states:
A health board shall not exercise its powers under subsection (3) in relation to the discontinuance of the provision and maintenance of a hospital, sanatorium or home save with the consent of the Minister.
Subsection (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, sanatorium or home save after having caused a local inquiry to be held into the desirability of the discontinuance.
Those subsections give the definitive view of the role which a health board or a CEO may take in the proposed closure of hospitals. Those subsections are in marked contrast to Document F.127 which emanated from the office of the chief executive officer of the South Eastern Health Board dated 30 April 1987. If the Minister so wishes, I will give him a copy later. Under the heading "Proposals to Reduce Services and Costs in 1987."
Paragraph I says:
Finance Report F.126 dated 24.4.1987 set out the financial picture for the Health Board for 1987, and outlined the proposed approach to making the decisions necessary to reduce the scale of the Board's operations in order to remain solvent and avoid collapse of the services all round.
It goes on to list a number of reductions and (ii) is pertinent to this case as it refers to reducing the number of small support hospitals. Further on at paragraph 3.2 under the heading, "Reduction in number of support hospitals," it lists the hospitals which will be closed as in-patient centres. The Auxiliary Hospital, Kilkenny, will have a closure of 36 beds with a loss of 19 posts and will have an annual expenditure of £280,000. The hospital in Bagenalstown, County Carlow, will lose 35 beds and 17 posts and will have an annual expenditure of £260,000. The hospital in Brownswood, County Wexford, will lose 112 beds and 64 posts and will have an annual expenditure of £780,000. The hospital in Lismore, Co. Waterford, will lose 21 beds and 12 posts and will have an annual expenditure of £140,000. In my native town of Tipperary, St. Vincent's District Hospital will lose 42 beds and 24 posts and will have an annual expenditure of £390,000. I am particularly aware of the case of St. Vincent's Hospital, Tipperary, which is a 42-bed hospital. A fortnight ago the CEO directed the matron not to admit further patients. As a result of that on Friday in that 42 bed hospital there were no patients. The CEO persists in instructing the matron not to admit further patients.
It is stated in the last page of that document that:
The effects of these cuts may be summarised as follows:... Para 3.7 Reduction in the number of support hospitals ...
The CEOs and the health boards by instructing its members to adopt this proposal are acting contrary to the Act and what is being attempted has no basis in law. What is being done is in flagrant disregard of the Act and is usurping the power of the Minister to whom this House gave in 1969 the sole right to discontinue the provision and maintenance of a hospital and that only after the hearing of a local inquiry.
To ensure that I would not misinterpret the Act I went to the trouble of reading the debates on that legislation when it was discussed in this House. As reported at column 2019 of Volume 242 of the Official Report, the then Minister for Health, the late Deputy Childers, said as follows:
As regards the closing of a hospital I propose that we repeat the sections in the 1947 Act so as to provide a democratic procedure and provide that the Minister must hold a local inquiry before directing the closure of a hospital or institution. I hope that will satisfy the House.
He went on to say:
If I had the time to notice this obvious difference between the 1947 Act and this Bill, I think I would have said to my officers: "In modern times and with the need for greater communication and with more interest being shown by people in institutions we should have that inquiry arrangement put into the Bill". I am sorry I did not do it. I think it is perfectly reasonable to do it and I hope that satisfies the House.
He went on to say as reported at column 2027:
As I have said, you can give the widest interpretation to this Bill. I guarantee an inquiry before the closing of a hospital or an institution and I do hope the House will bear with me in regard to this.
Later on in the debate he was commended by many Members on all sides of the House for taking their point of view into consideration. On Report Stage the then Minister moved an amendment to the Bill. Apparently, when drafting the Bill the two relevant subsections which I quoted were omitted and, as reported at column 923 of Volume 243, the then Minister moved the following amendment:
In page 21, between lines 22 and 23, to insert the following subsections:
"(4) A health board shall not exercise its powers under subsection (3) in relation to the discontinuance of the provision and maintenance of a hospital, sanatorium or home save with the consent of the Minister.
(5) The Minister shall not give a direction under subsection (3) in relation to the discontinuance of the provision and maintenance of a hospital, sanatorium or home save after having caused a local inquiry to be held into the desirability of the discontinuance".
This is an amendment which relates to a request from all sides of the House that a local inquiry should be held before a Minister would direct the discontinuance of a hospital, sanitorium or a home and restores the position in this sector of the Bill to what it was under the Health Acts 1947 and 1953. The same thing applies where a health board takes the initiative in the discontinuance of a hospital, a sanitorium or home. The consent of the Minister will be necessary for the closure. I do not think that these kind of inquiries are likely to arise very much.
If a building is not in a state of collapse or hopelessly outmoded and outdated, then within the next 20 years there will be some use for it, either as a geriatric institution or for some purpose or other. Nevertheless, I heartily agree with the suggestion that there should be a local inquiry.
Before the amendment was agreed to, the late Deputy Hogan inquired:
... but as regards the discontinuance of an institution which is mentioned here — a premises — he mentions holding a local inquiry. Does that mean just a private inquiry or is it a local public inquiry?
The Minister replied:
No, it would be a public inquiry.
Mr. Hogan then remarked as follows:
Because in the amendment the words "a local inquiry" are used and that may be interpreted as merely a private inquiry. "Public local inquiry" is mentioned elsewhere in the Bill.
The Minister replied as follows:
We did not think it necessary to put it in there because it is inconceivable that you could have a private local inquiry about such a matter.
The amendment was then agreed to. Therefore, I am further strengthened in my belief that if any CEO or any health board directs that a hospital be closed they are acting contrary to the spirit and wording of the Health Act, 1970 and I ask the Minister to state unequivocally and definitively tonight whether he has given his consent for any health board to discontinue the provision and maintenance of a hospital and if he has, to give us the details here tonight. I would also like him to tell us if he has caused or is about to cause a local inquiry to be held into the desirability of the continuance of the provision and maintenance of a hospital and if so, to give us the details. If he is not about to cause a local public inquiry to be held it is illegal and irregular for a CEO or a health board to order the closure of a hospital. I ask the Minister to countermand tomorrow any such illegal or irregular orders which have been made to date to any health board by a CEO and to allow these hospitals to continue to admit patients until the Minister has consented to and held a public local inquiry into the desirability of the discontinuance of the provision and maintenance of a hospital.
As can be witnessed daily from television reports there is much public concern over these closures. Nurses and domestic staff and others concerned with the future of the health services have taken to the streets to show their opposition to the proposed health cuts. I ask the Minister to reply to the questions I have asked. I hope that if he has not given his consent or has not caused a local inquiry to be held, he will inform the CEOs of the health boards tomorrow that they have acted illegally, irregularly and in contravention of the Health Act, 1970.
The first point made by Deputy Griffin was that the allocations were inadequate. I would like to point out to him that the total amount of money was agreed to by the Government and that I then allocated an amount to each health board. The total amount agreed to by the Government to be spent on health this year was £1,314 million. This is an increase of £16 million on what was the Government's intended expenditure last year. As everybody both inside and outside of this House knows, the real problem facing the health boards at present is that they are now obliged to effect savings as a result of an over expenditure of £55 million during the past two years, £36 million in 1986 and £19 million in 1985, an over expenditure which was allowed by the previous Government which included Deputy Griffin's party.
It is interesting that in the Estimates produced on 20 January by the Fine Gael Party the health boards would not have fared any better. In many cases they would have fared much worse than under our Government. I ensured that each health board would get an increase over the allocation which they received last year. It is also interesting that exactly two weeks ago this night the House agreed with the total expenditure on health, and the amendment of Deputy Griffin's own party, Fine Gael, to the Progressive Democrats' motion included in its first line "living within the allocation for 1987." It is important to clear that point.
We could still live within the allocation without closing hospitals.
The Minister, without interruption.
As I have said, the health boards have done better under our Government than they would have done had Fine Gael been returned to office, as outlined by Deputy Boland in his Estimate on 20 January.
In relation to the question of the closure of hospitals, there are two avenues under section 38 of the Health Act of 1970 by which a hospital provided and maintained by a health board may be closed. In the first instance, a health board may decide, for whatever reason, that a hospital should be closed. In this case the board's decision is covered by section 38 (3) of the 1970 Act. They can close the hospital only after obtaining my consent to the closure, which I give under section 38 (4) of the 1970 Health Act.
Alternatively, there is a provision under section 38 for a hospital to be closed on the direction of the Minister without the consent of the health board. In this instance I could not have a hospital closed without first having caused a local inquiry to be held into the desirability of the closure under section 38 (5) of the Health Act of 1970. Listening to Deputy Griffin quoting the late Deputy Erskine Childers, the then Minister for Health, I want to make it absolutely clear that I am not giving any direction or have not done so in relation to any hospital in the South Eastern Health Board area. I have not given a direction to close any of the five hospitals referred to by Deputy Griffin.
In the recent past, no hospital has been closed on the direction of the Minister and by the holding of a local inquiry. It is not my intention to proceed to close any hospital in this way. However, a number of health board hospitals have been closed by a decision of a health board and with the consent of the Minister. Two examples in recent years were the closure of the small maternity hospital at Trim in my own health board area and the surgical hospital at Long-ford. In both these instances the health boards concerned felt that a more effective service could be provided by making alternative arrangements and the decision was made to close the hospitals with the consent of the Minister for Health. Recently the South Eastern Health Board decided to close five district hospitals at Kilkenny, Bagnalstown, Brownswood in Enniscorthy, Lismore and Tipperary town. The board sought my consent to these closures and having considered the issue very carefully, I gave my consent as requested since the maintenance of these five hospitals was not a priority with the board in the context of their non-capital allocation.
At this stage, it is not my intention to discuss the future role of any individual hospital because I have, as the House is aware, asked officials of my Department to visit again the health boards and, indeed, the voluntary hospitals to ensure a rational health service, and until such review is complete I do not intend to deal specifically with individual hospitals.
The Dáil adjourned at 11.25 p.m. until 10.30 a.m. on Thursday, 4 June 1987.