Deputy Noonan has been given permission to raise on the Adjournment the question of the reported proposed closure of Barringtons Hospital, Limerick.
Adjournment Debate. - Limerick Hospital Proposed Closure.
(Limerick East): Will the Minister for Health be coming in?
I am sorry, the Minister is unavoidably absent and cannot be here. He would like to have been here to take the question, but has asked me to take it on his behalf.
(Limerick East): I have no objection to the Minister of State replying. However, I would naturally prefer the Minister to be here. The tradition in the House was that Ministers extended that courtesy to Opposition frontbench spokesmen.
Not always. That form of elitism is not ever constant.
(Limerick East): That was the position when we were in office. It may have changed now.
I doubt it.
(Limerick East): I am sure that the Minister of State and the Minister for Defence, who represents one of the Limerick constituencies, will be able to convey the burden of my message back to the Minister for Health and his Department.
First, I disagree with the decision to close Barringtons Hospital and I also disagree with the manner in which that decision was made. There was a meeting with the board of Barringtons Hospital on 8 June 1987 when the Department officials travelled to Limerick as part of an overall review of the provision of acute beds in the country as a whole. The situation was discussed in general terms but there was no suggestion that the hospital would have to close and certainly no suggestion of amalgamating the facilities in Limerick. On 14 August there was a further meeting with the officials in the hospital. That meeting agreed to set up a sub-committee on the specialty needs of the region. Now, that was a meeting between the officials and the board of Barringtons Hospital and no further word was heard. So, why was not the sub-committee set up to look into the specialty needs of the region as had been agreed? That is the first question to which I should like an answer.
There was no word until the decision to close the hospital on 10 December was announced. An official came from Dublin and announced to the hospital authorities the Minister's decision. There were other meetings, of course, not to do with the main issue. There was a meeting on 17 November when the Department of Health officials on the nursing side of the Department came to meet the matrons, representatives, staff and authorities of the three hospitals in Limerick. The Minister of State and the House are aware that a decision was taken nationally that there would be no intake of nurses to nursing schools in September. This was the national situation but, arising from the discussions of 17 November, not only was Barringtons Hospital authorised to take in the full complement which in a normal year would be done in September, but it was also authorised to take in four additional students from 1 February 1988. The other voluntary hospital in Limerick was also authorised to take in its intake, with a further five. As late as 17 November officials of the Department of Health were making arrangements with Barringtons Hospital and with St. John's Hospital which implied that both of these would exist long enough to carry nurses from the first point of entry on 1 February through a full three year training course.
Then, on 1 December, the Minister answered questions in this House. In reply to a supplementary question from Deputy Allen, Fine Gael spokesman on Health, the Minister said that any announcements which would result in the closure of acute beds in the country had already been made, or decisions were in the process of being implemented. There was no indication to the board of Barringtons Hospital that anything was in the process of being implemented for their hospital. Certainly, there was no implication whatsoever that the hospital was to be closed, or that any hospital in Limerick was to be closed. Ten days later, out of a clear blue sky, an official came from Dublin and closed down the hospital. That sequence in the decision making process requires an explanation. We can add to that the fact that when the Estimates were published a provision was made to allow Barringtons Hospital to continue for a full year and an adequate provision was made also for St. John's. We all know that there are cutbacks in the health services in general and both hospitals would have had to trim to live within the Estimates, but the facts are that the Estimates published and noted in this House in mid-October had a provision of £1.6 million for Barringtons Hospital which would, with economies, have carried it for a full year and a provision of £1.5 million for St. John's, the other voluntary hospital.
No discussion leading to a closure took place. A series of meetings took place which implied that the hospital would remain open. Permission was given to recommence nursing training from 1 February 1988 and provision was put into the Estimates. That sequence of events would correspond to our experience in Government. Comhairle na nOspidéal, we know, drew up a list of hospitals for closure and Barringtons Hospital was not recommended for closure. I sat in Cabinet when the former Minister for Health, Deputy Desmond, brought in proposals for the closure of hospitals and there was never one through that Minister from his officials to close Barringtons Hospital. What changed between 1 December and 10 December? What pressure was put on the Minister to change his decision and how is it that the officials of the Department of Health who had advised Minister Desmond in one direction now seem to have advised his successor in a different direction?
So much for the manner in which the decision was made. I would like now to deal with the decision itself. It is unjustified on medical, on social and on economic grounds. First, on medical grounds, it is a full working hospital, working for 24 hours around the clock. It has 84 beds, it has a full casualty unit. There were 34,400 people treated in that casualty unit last year. A further 8,700 people attended as out-patients. We have a total of over 43,000 people getting attention in the casualty and out-patients units. I do not think that there is a suggestion by anybody — and I have not heard the Minister for Health suggesting — that the excellent medical facilities and the renowned nursing care in Barringtons Hospital are not recognised by him and by his Department. I do not think that the Minister has made the case that there is any inadequacy in the medical service or nursing care. If he were to make such a case, it would not be true, because it is known far and wide that the medical facilities were excellent and the nursing care was renowned far beyond the city and county of Limerick. As a matter of fact, when the Pope visited this country in 1979 and came to Limerick and there was a massive crowd on the race course, it was Barringtons Hospital rather than any other hospital which was designated as the emergency hospital in case of accident or sudden illness occurring, in case of his Holiness the Pope requiring medical attention.
I do not think that anybody would cast any doubt on the qualifications of those who evaluate hospitals for internship for the Royal College of Surgeons. That college decided that Barringtons Hospital was an appropriate hospital for four interns and that they would proceed to fellowship doing their practical work in Barringtons Hospital. The normal county hospital, and there are many of them around the country, would be recognised by the Royal College of Surgeons as appropriate for one discipline, and in exceptional cases possibly two, but Barringtons was recognised for four. The quality of training must have been very high and the experience gained there must have been considered by the Royal College of Surgeons as appropriate for training surgeons. Everybody knows the emergency hospital for major accidents in Limerick, as far as Shannon Airport and Clare is Barringtons. I wonder what would happen now if there was a plane crash and Barringtons were closed?
Last year, 1,100 people were treated for ear, nose and throat operations. There is no other facility in Limerick which can take up that number of ENT cases. There is no slack in the Regional Hospital to do so and there is no facility in the other voluntary hospital, St. John's. I wonder will the prospective 1,100 ENT patients now join the lengthening queue of those who come from Limerick city and county to Dublin for treatment? On the medical side, nine of the 11 medical posts were shared with St. John's. Despite the pressures on Barringtons Hospital, a reasonable attempt was made to share facilities and to provide medical services as economically as possible. I do not see any case on social grounds for the closure of the hospital.
The hospital was founded by charter in 1889 in the reign of Charles IV. The charter says the hospital was founded for the benefit of the poor of Limerick and it carried out that mandate very well over the years. It is recognised as a hospital for the poor of Limerick. It is in the poorer parts of Limerick that you will find the greatest support for Barringtons Hospital. The decision to close that hospital is socially discriminatory. I am sure the Minister is aware of this and I would like to hear what the Minister of State has to say about it.
Barringtons is a down town hospital, two blocks from the city centre. It is a hospital where all accident cases are brought late at night. It is the hospital where victims of crimes of muggings and other incidents on the streets are taken. Everybody knows that Barringtons doors never shut. In common parlance in Limerick people do not say they are going to hospital; they say they are going to Barringtons. Many medical people, paramedics, ambulance attendants and nurses would argue that over the years if that down town facility had not been there patients would have had to travel a number of miles to the alternative facility in the Regional Hospital and those people would have died.
I cannot see any reason on financial grounds for closing Barringtons. There was an allocation of £1.6 million in the Estimates, and this was noted in this House. That was the result of a certain amount of trimming because it was a reduction of approximately 15 per cent on the previous allocation, but the hospital could have lived with it. The total wage bill there is £1.8 million but the redundancy package which the board of governors put in place would have reduced that figure by at least £200,000. The Minister is aware that the board can supply the names of staff who would voluntarily take redundancy.
In his announcement of closure, the Minister said the jobs of all staff would be preserved in the region. Therefore, to come into this House and say he was going to save £1.6 million is not true because all staff jobs are guaranteed. Even after the redundancy package — which I say would cost as much as £200,000 — is taken out of the budget, a residual £1.6 million will remain if the staff are deployed to other hospitals in the region. I cannot see where there can be a financial saving when we look at that kind of arithmetic.
The Minister has given a pledge to provide alternative facilities, especially on the casualty side. He has committed himself to an overall expenditure of £400,000 to provide extra facilities in the Regional Hospital and St. John's Hospital for casualty services. He is suggesting that £400,000 would provide adequate facilities. A minimum of £500,000 would be needed for the Regional Hospital to even modify and extend the present casualty facilities. A sum of £100,000 would not provide a decent first-aid station in St. John's. We are talking about very large sums of money if the 43,000 people who use the outpatients and casualty departments of Barringtons are to be catered for by providing extra facilities in the other two hospitals.
But that is not the end of the story. There are 84 acute beds in Barringtons Hospital. The Minister says he will provide equivalent bed space elsewhere. He is not saying he will take 84 beds out of Limerick, he is saying he will provide these beds in St. Johns and the Regional Hospital. The figures I have, which have been agreed by the Mid-Western Health Board and checked by a well-known Dublin economist, have shown that it costs £10 a week less to keep a person in an acute bed in Barringtons than it does in St. John's, and it costs almost £90 a week less in Barringtons than in the Regional Hospital, Limerick. Therefore, not only is there no saving on the staff side and there will be extra expenditure of at least £500,000 on the Minister's figure on the capital side, but there is the extra cost of providing the beds elsewhere. I repeat, on the figures which are agreed by the Mid-Western Health Board, which are not challenged by the Department of Health and which have been vouched for by a leading economist in one of our universities, it costs £10 less to keep a patient in an acute bed in Barringtons than it does in St. John's, and almost £90 a week less in Barringtons rather than the Regional.
If St. John's are to provide any kind of casualty service they will need a second X-Ray room. There is an extra cost involved there. Also, Barringtons have two modern well-equipped operating theatres, St. John's have one. If St. John's are to take up any of the workload of Barringtons, they will need another fully equipped theatre, and that will cost a minimum of £500,000.
If the approach to the health cuts is a concentration on financial rectitude, and we all agree there has to be rationalisation and a trimming of costs, this is a bad decision not only because of the way it was taken. It is a bad decision not only on social and medical grounds, but it is a bad decision if we look at it in its rawest terms. It is a bad decision on simple financial grounds because it will cost the Minister and the Exchequer more in the current year, next year, the year after and as far as one can project.
The Minister is an impressive performer on television. He makes a good case. He made great play of the fact that there are two and a half acres in the other voluntary hospital and said that was the place to expand. When did we last hear the Department of Health expanding in current circumstances? The Minister forgot to say there were two acres in Barringtons and that when you build on a site it does not look very big. When people in Dublin hear that St. John's has two and a half acres they have a vision of rolling fields down by the river. There are two and a half acres in St. John's and two acres in Barringtons and the Department of Health acquired two terraced houses contiguous to Barringtons for £60,000 in 1986. There is a two acre site, owned by Limerick Corporation, available to the hospital if they seek it next door to Barringtons. The Minister need not say that there is no space for development.
The Deputy's time is up.
(Limerick East): I appreciate the fact that you have been very patient with me. I want to make a final point. The Minister will argue that the two voluntary hospitals are four hundred yards apart and that it does not matter which one closes but the 20,000 people who marched in the streets of Limerick gave the answer to that. The Minister will also say that because there is a private interest in St. John's that proves his point it is the better hospital. The reason there is no private interest in Barringtons is that their charter says it must be for the poor of Limerick and that cannot be changed except by an Act of Parliament.
I call on the Minister to defer his decision and to reaffirm the Estimate for both voluntary hospitals in Limerick. I am not asking him to spend extra money. I am merely asking him to examine the situation again and to consult all interested parties and it will be a good day for medicine and Limerick if he does that. I am authorised to say that the board of Barringtons will facilitate the Minister and help him in any way to streamline the services in Limerick city and Barringtons Hospital.
The Minister is unavoidably absent this evening. He had a prior engagement and he requested me to be present. I appreciate Deputy Noonan's concern about the closure of Barringtons Hospital. In order to put the matter in proper context, I should perhaps outline the background and the sequence of events which have taken place.
It is not well known that shortly after the Minister, Deputy O'Hanlon, took up office he initiated a comprehensive review of the acute hospital system. The group which carried out the review held discussions with the managements of all acute hospitals and had meetings with Barringtons and St. John's in June and again in August 1987. At the June meeting the desirability of rationalising both hospitals on the one site was discussed. At the August meeting, the policy of rationalising both hospitals was discussed again and both hospitals made submissions as to which hospital should be retained. Therefore, it was clear that both were aware that one of the hospitals would be closing.
At these meetings, it was pointed out to both hospitals that there was an apparent surplus of beds in the Mid-Western Health Board area as a whole. The health board had permanently closed a number of beds in their hospitals but it was clear that further rationalisation was still required. The review group indicated to the management of St. John's and Barringtons Hospitals and to the management of the Mid-Western Health Board that the voluntary hospital sector in Limerick needed to be rationalised on one site and that it would have about 100 beds. Both hospitals later put forward detailed submissions as to why each of them should be retained. It is very significant that neither submission suggested that both hospitals should be retained and it seemed that the logic of the situation was accepted by them.
In deciding which hospital should be retained, the Minister, Deputy O'Hanlon, had careful regard to the outcome of the meeting with the Mid-Western Health Board and management of St. John's and Barringtons Hospitals. In addition, he obtained an architectural report on the suitability of both hospitals as to their future participation in the public hospital health service in the area. All the evidence from the outcome of these meetings and the architectural aspect pointed to the retention of St. John's. Having carefully examined all the evidence before him, the Minister decided that St. John's Hospital should be the site on which the voluntary hospital services in Limerick should be located.
There are a number of reasons for this decision. St. John's has a more spacious site, the building is in better condition due mainly to the fact that £500,000 was spent on improving the fabric of the building in 1986. St. John's is more readily adaptable to the changing emphasis in the practice of acute medicine. For example, it has a unit which is extremely suitable for day hospital services containing as it does an endoscopy room, two five-bed rooms and an area for a theatre. There has been a considerable shift in emphasis from traditional inpatient care to treatment on a day basis. The mechanical and electrical services are superior to those at Barringtons. The Minister arrived at his decision purely on the basis of the physical facilities and the management co-operation of the two bodies concerned.
Since the Minister announced his decision, he has been accused of inconsistency in view of the statement made in the Dáil that there would not be any further hospital closures other than those which had already been announced or were in the process of being closed. I should like to make it clear that detailed discussions regarding the future role of the two voluntary hospitals in Limerick have been in progress since June 1987. It is very important that the House should know that and that it is totally consistent with the Minister's speech in the House in December 1987.
(Limerick East): No indication was given but it must have been in the Minister's mind.
The boards of both hospitals were well aware from the discussions that took place in June and August 1987 what lay in store for the future.
(Limerick East): I have seen what the Minister said. There is nothing to support——
The Deputy had 20 minutes in which to make his case. He should let the Minister reply.
As the process which led to a decision had been under way for a number of months, in full consultation with the management of the hospitals concerned, there is no conflict whatsoever between his statement in the Dáil and his subsequent announcement about Barringtons Hospital. Since he announced his decision, many people have expressed great concern about the effect the closure will have on hospital services in Limerick. At the start of 1987, acute hospital services in the Mid-Western Health Board were being delivered from nine different locations, five of which were in Limerick city. Clearly, this was not a sound basis on which to build an efficient hospital system and, while subsequent bed closures by the health board reduced the number of locations to seven, it was clear that further rationalisation was still required. It is more economical to effect these closures in one hospital rather than have them spread over a number of centres.
On a point of order, the Minister of State referred to five acute hospitals in Limerick city. Where are they?
Deputy O'Malley knows he cannot interrupt the Minister of State. Perhaps when the Minister is finished he can put a question to him.
There have also been fears expressed that the casualty services in Limerick will be adversely affected as a result of the closure of Barringtons. The position is that in a city the size of Limerick we simply cannot afford to have two 24-hour casualty services available seven days per week. Indeed, it is worth mentioning that Tallaght, which has a population roughly the same size as Limerick, does not have a casualty service and that in Dublin as a whole there are only two hospitals in the accident-emergency rota after 5 o'clock each evening.
What about Roscommon?
It is clear that a significant proportion of the casualty cases which attend at Barringtons are of a minor nature and should be properly dealt with by general practitioners. Moreover, the numbers attending at night-time were relatively low, about 14 per night. The closure of Barringtons requires some improvements to be carried out in the accident and emergency departments in Limerick Regional and St. John's and plans for this work are already well under way. A casualty service will be available at St. John's Hospital and considering that it is only 400 yards from Barringtons the new location will not present any difficulties. This service will operate on a daytime basis from 8 a.m. to 8 p.m. since, as I have already said, it is simply not viable to maintain two 24-hour casualty units within a few miles of each other. This change will not present any difficulties since the numbers attending at Barringtons outside these hours is quite small. As already announced, it is the Government's intention that the inpatient facilities will transfer to St. John's and the Regional Hospital as appropriate by 31 March 1988.
The Minister met the board of Barringtons Hospital and confirmed the decision to them. The logic of the situation is that one of the two voluntary hospitals in Limerick had to close. This was an extremely difficult decision for the Minister to make but he was satisfied that he made the right one. He is also satisfied that with the necessary improvements at Limerick Regional and St. John's the two hospitals will provide a very adequate general hospital service for the people of Limerick. I hope this clarifies the situation for the House.
I will give Deputy O'Malley an opportunity of putting a question and perhaps the Minister will reply.
Could the Minister of State name the five acute hospitals to which he referred as being in Limerick city?
The five hospitals in question are Barringtons, St. John's, the Regional Hospital, St. Munchin's and St. Camillus.
St. Munchin's is a maternity hospital.
The Dáil adjourned at 9 p.m. until 10.30 a.m. on Thursday, 4 February 1988.