Dáil Éireann debate -
Thursday, 24 Mar 1988

Vol. 379 No. 5

Adjournment Debate. - Ennis General Hospital.

Mrs. Taylor-Quinn

I propose to divide my time between Deputies Donal Carey and Síle De Valera and if the Minister for the Marine, Deputy Daly, wishes to come in he is more than welcome.

I thank the Chair for giving me the opportunity to raise this serious matter on the Adjournment. At the last meeting of the Mid-Western Health Board a decision was made to downgrade Ennis General Hospital and to reduce the number of beds from 96 to 76. That 76 includes six day beds so the actual number of beds is 70 — 40 medical and 30 surgical beds. This is very serious because Clare is a very large county with a population of 90,000 people. Up to February or March last year there were 127 beds in the hospital and we were told that the reduction last year to 96 was a temporary measure, a holding operation. This year the beds have been further reduced to 76. The situation is intolerable.

Today in Ennis General Hospital they had to refuse to admit patients. The programme manager in Limerick has now directed the Regional Hospital in Limerick not to admit patients from the Clare catchment area. In Clare people have been returned home because of the inability of hospitals in the area to admit them. The authorities in Ennis tried to get a patient admitted to the Regional Hospital in Galway and they were unsuccessful. There are real, unexaggerated fears for the lives of people in the county.

In reducing the number of beds we are substantially reducing the number of surgical beds. There are two very efficient surgeons employed in the hospital. I am sure the Minister will appreciate that able professional men will not sit around for too long twiddling their thumbs if they cannot get the beds to cater for the number of patients they are capable of operating on. It is only a matter of time until one of those surgeons looks elsewhere for employment. There is a very efficient staff, two very good physicians, a good radiologist, a good anaesthetist and an excellent nursing staff. The nursing staff have catered for from 112 to 123 patients in recent times, while only having a staff complement to cater for 96 patients. They have been very dedicated and have provided an excellent service in the county. A number of them have now received notice along with a number of other workers in the hospital.

There is a very real problem in the county. I have come here this evening to ask the Minister for Health, whom I believe to be a reasonable and understanding man, to look at this serious problem and to see that the criteria applied in relation to the decision that was arrived at by the Mid-Western Health Board could not be the same as the criteria applied to Nenagh. The CEO in a meeting we had with him prior to the health board meeting stated specifically that he was applying the same criteria to both hospitals. I contend that the same criteria cannot apply, because Nenagh General Hospital services people who also have ready access to Ballinasloe hospital, Clonmel hospital and Limerick hospitals and they are not very far either from Portlaoise. The situation in Clare is quite different. From Clare to Limerick is as far as from Roscrea to Dublin and the problem is compounded by the fact that the road infrastructure from Clare to Limerick is not as good as the road infrastructure from Roscrea to Dublin.

The Minister is in a position to examine the problem. He knows there is a report on the general hospitals in his Department that specifically states certain things that should be done in relation to general hospitals. If he looks at that report he will find it recommends that the general hospital in Ennis should be upgraded and that a number of hospitals around the country should be downgraded and closed. It is unfortunate that the Mid-Western Health Board were not directed by the Department of Health to follow the guidelines in that report. Will the Minister advise the CEO to apply different criteria to the recommendation he made to the Mid-Western Health Board?

I am also asking the Minister to make a special subvention to the Mid-Western Health Board for Ennis General Hospital specifically. Only last week I read on the front page of The Kerryman that the chairman of the Southern Health Board was in a position to come to the Southern Health Board and make an announcement of an extra allocation of funds to that region in order to keep a ward open in Tralee General Hospital. If the Minister and the Department can do that for Tralee, surely they can do it for Clare? I am asking the Minister to do that. I know he is a reasonable person and will take into account the problems that arise in relation to Clare.

Is the Minister happy that Clare should be the only county on the entire west coast that will not have a major medical facility? Every other county on the west coast has a major medical facility and what was decided a few weeks ago in Clare substantially downgrades the facility we have. If we are to continue down that road we will end up with little more than a glorified district hospital.

Mr. Carey

I thank the Chair for agreeing to this Adjournment motion regarding a matter we raised on six or seven other occasions. I also thank my colleague, Deputy Taylor-Quinn, for allowing me time to speak. Deputy Taylor-Quinn has outlined the problem facing Ennis General Hospital following the recent decision of the Mid-Western Health Board to reduce the number of beds available in the hospital.

I had a question for written reply on the Order Paper today asking if the Minister was satisfied with the make-up of the beds with 40 medical, 24 surgical, 6 day-only surgical and 6 ICU beds. From the reply he seems to be satisfied, but in terms of medical economics as practised by Comhairle na nOspidéal, consultants and other medical groups, 76 beds in a general hospital is below the guidelines. Confusion seems to exist between the Department of Health and the Mid-Western Health Board about the number of beds required. In a written reply to a question put down by Deputy Barry Desmond recently the Department of Health indicated there would be 80 beds in Ennis for 1988, so even four additional beds would be of some benefit to Clare people. The minimum beds set down by Comhairle na nOspidéal was 80 beds for an economic Ennis General Hospital. As Deputy Taylor-Quinn said, Clare will be the only county on the west coast without a general hospital. We have been accused in our own constituency of lying down under this matter.

I was very sorry yesterday to get a letter from the Taoiseach saying he saw no purpose in meeting Clare County Council to talk about Ennis General Hospital. I thought it appalling that a Fianna Fáil Taoiseach would not meet the Fianna Fáil dominated Clare County Council to discuss the problem of Ennis General Hospital. The other night I attended a public meeting which was dominated by Fianna Fáil people who are concerned about the hospital and at long last are aware of what cuts mean and the decisions that are going to be taken which will affect County Clare. Fianna Fáil people realise now the U-turn by Fianna Fáil, particularly by the Minister for Health. Previously in this House, I, like Deputy Taylor-Quinn, praised the Minister for his forthrightness in coming before this House and being open about what he proposed to do. I have read in a Tipperary paper that the Minister for Health said he was not going to implement the FitzGerald report on hospitals. Implementation of that report by stealth will be almost the death of Ennis General Hospital because, as Deputy Taylor-Quinn pointed out, one of the surgeons will surely make a move to leave. According to statistics I have from the Mid-Western Health Board, the number of surgical bed occupancies in Ennis General Hospital in 1987 amounted to 3,657. In the previous year the number of surgical bed occupancies was 2,163 and the theatres were then being reconstructed with money provided by the former Minister for Health, Deputy Barry Desmond. Clare people are concerned about this downgrading. Because of the general demeanour of the Minister for Health and his interest in his own profession Clare people thought they would have had the minimum required standards for a general hospital. The Ennis Action Committee, the consultants, nurses and doctors in Ennis General Hospital all indicated that 76 beds are not enough.

I appeal to the Minister at least to grant the Fianna Fáil-dominated Clare County Council an audience and explain to them why he feels 76 beds are sufficient. I do not want to go back to Clare as the messenger boy telling them that I am sorry, the Minister would not explain. I want the Minister himself to explain why he is confident about this matter, because all the experts in my constituency tell me it cannot work. How does the Minister see it working?

Miss de Valera

I thank Deputy Taylor-Quinn for giving me some of her time and an opportunity to talk about this very great problem. Great concern and anxiety exist in County Clare at the decrease in beds from 96 to 76 in Ennis hospital. It is difficult to accept such a decision by the Mid-Western Health Board, considering they made a decision in 1980 to promote the county hospital to a general hospital with 218 beds. This decision was confirmed on 2 May 1980. The 218 beds was based on the 1971 census in which the population of County Clare was 75,000. Clare now has a much increased population, 92,000 and the need is now for a greater allocation of beds than the Mid-Western Health Board are at present prepared to give.

To put things in perspective, let me give some facts and figures with regard to admissions to the hospital in 1987. The admissions were 3,439 plus 1,120 day admissions, out-patient surgery clinics 4,968, casualty 17,592, X-rays 23,000 approximately and specimens processed in the laboratory were about 50,000. The facilities in Ennis Hospital are certainly not being under-utilised. The Ennis allocation for 1987 from the Mid-Western Health Board was £4.019 million. The 1988 allocation is £3,008,390. There is obviously a large shortfall here.

We would not be realistic if we were not at present to accept that cutbacks must be made, but in this climate when we are trying to save money it is hard to see a decrease in beds in Ennis. The cost per bed per year for Ennis is £34,280. This figure happens to be the lowest in the Mid-Western region. For the regional hospital in Limerick the allocation is £41,470 per bed per year, so it seems there is an increase there compared to the cost per year for Ennis.

There is concern with regard to the running of the Mid-Western Health Board and health boards generally. The Mid-Western Health Board have a substantial allocation of £83 million and within that they should be able to run the kind of health services and health care we would expect in the Mid-Western Health Board region particularly in County Clare. Unfortunately, this does not seem to be done at present. I would like the Department of Health to ask the Mid-Western Health Board for details of accounts on administration costs, particularly with regard to expense accounts. I would like to see a greater accountability to the Minister on behalf of the health boards in general. It is a question of priorities and I do not believe the priorities of the Mid-Western Health Board are those of the people of Clare at this moment.

We need retention of the Ennis hospital and we would like to see it expanded not only because of population concern but because of the existence of Shannon Airport, because of Symtex, because of Moneypoint and indeed, as has been pointed out by my colleague from the opposite benches, because of the distance involved, particularly for those people who live in west Clare. It is paramount that they have the kind of service that we wish to see in Ennis Hospital. We want to see that hospital being maintained and, if at all possible, improved. I would ask the Minister to impress on the CEO of the Mid-Western Health Board the need to ensure that Ennis Hospital continues as an acute hospital and that the hospital needs at least a complement of 96 beds.

Minister for Health (Dr. O'Hanlon)

I appreciate very much the concern of the Deputies about services at Ennis General Hospital. I am glad of this opportunity to set the record straight regarding Ennis, as of late there has been much rumour and speculation concerning the future of this hospital.

When I took up office as Minister for Health in March last year it became clear to me that if we were to contain the level of public spending on the health services and yet maintain an acceptable standard of health care some rationalisation of existing services and facilities was unavoidable. As more than 50 per cent of the health budget goes on the hospital services it was evident that particular attention would have to be paid to this sector to ensure that services and facilities which were no longer essential to the system were phased out or adapted to meet the challenge of changing practice in hospital medicine. Accordingly, I set up a review group to examine the entire hospital system.

The review group's findings underlined the fact that in the country as a whole there was a surplus of acute hospital beds by reference to established and agreed planning guidelines and in particular there were more beds than could be adequately supported by the funds available and which were agreed by this House as being adequate to fund a satisfactory level of health care. Specifically in the Mid-Western Health Board area a similar pattern emerged and it was imperative that hospital services in the area be rationalised. This House is already well aware of the initiative taken by me to phase out public hospital facilities at Barringtons Hospital and to strengthen and improve the services at St. John's and Limerick Regional Hospital.

I would like to say first of all that the level and scale of services at the general hospital in Ennis is a matter for the health board to decide in the first instance. The board have the statutory responsibility for the administration of health services within their own area and in my view they are best placed to decide on what the local needs are.

My Department have maintained close contact with the Mid-Western Health Board in relation to the measures they were proposing to contain expenditure within approved limits and indeed I met with the chairman and chief executive officer of the board as recently as 9 March last. In considering the organisation of hospital services in the area the Mid-Western Board took account of the fact that hospital beds were situated in several different centres within a relatively compact area and clearly this was not a sound basis on which to develop an efficient hospital service. In the case of the maternity unit at Cahercalla, Ennis, the board decided that the annual number of births was not sufficient to justify a consultant staffed facility at this centre. Accordingly, it was decided to transfer this maternity service to the Regional Maternity Hospital in Limerick. At the same time it was only logical that the gynaecology work carried out at Ennis General Hospital should be transferred to Limerick Regional Hospital. I am aware that some concern was expressed about this decision but I am satisfied that this new arrangement is in the best interests of mothers and their babies.

The board have given detailed consideration to the provision of hospital services for County Clare and decided that Ennis General Hospital should continue to provide acute medical and surgical services for its present catchment population. The catchment population of Ennis General Hospital is not the population of the whole of Clare because 27,000 people in Clare are in the catchment area of Limerick Regional Hospital and another 5,000 are in the catchment area of Galway Regional Hospital. In determining the precise level of services to be provided and the number of beds required it was necessary for the board to consider the population of the area and its characteristics; the number of patients who travelled outside Clare for hospital services and the relationship which exists between Ennis General Hospital and Limerick Regional Hospital. At this point I would like to emphasise that the board's priority in relation to hospital services is the development of a full range of specialised facilities at Limerick Regional Hospital to serve the whole population of the mid-west.

Following a detailed examination of all the factors involved the board decided that a total of 76 beds covering the specialties of general medicine and general surgery and intensive care-coronary care would be sufficient to provide an adequate level of service. The board are currently drawing up a budget in line with the proposed bed complement and the level of service to be provided.

Deputies will be aware of course that even in spite of the current difficult financial situation certain improvements have been carried out at Ennis General Hospital in recent times. For example, a scheme of upgrading of the operating theatres and surgical wards was carried out in 1986. In addition the board carried out an extensive scheme of fire prevention works throughout the hospital.

I am aware of course that from time to time the hospital has experienced some overcrowding difficulties. This is common to all hospitals at times. However, these are due mainly to seasonal factors and the situation is being kept under regular review by the board in consultation with officers from my Department. I would like to deal with one or two points that were raised. First, this is not a downgrading of the hospital. The hospital will continue to fulfil the role it has always fulfilled in providing an acute medical and surgical service for the people.

Mr. Carey

It is not economic.

Dr. O'Hanlon

In the middle of February, just a month ago, there was a debate on Barringtons Hospital. The closure of Barringtons Hospital will release further funding for the Mid-Western Health Board which must have a spinoff beneficial effect for Ennis Hospital.

Mr. Carey

We have more patients in Ennis.

(Interruptions.)

An Ceann Comhairle

The Minister must be allowed to speak without interruption.

Dr. O'Hanlon

But it was not necessary for the two Deputies from Clare to stand up in this House and make a spirited case for retaining Barringtons Hospital. Had they succeeded there would not be the same moneys available to the Mid-Western Health Board and Ennis would be in further difficulty.

Mr. Carey

It is exactly the same money.

(Interruptions.)

Dr. O'Hanlon

A month ago, that is what the two Deputies thought of Ennis hospital when they stood up to defend Barringtons.

Mrs. Taylor-Quinn

That is Fianna Fáil propaganda.

Dr. O'Hanlon

It is intolerable that anyone would suggest that there should be five acute hospitals in two and a half counties.

An Ceann Comhairle

I gave Deputies the right to come in on the Adjournment on the assumption that they would behave in an orderly fashion and have an orderly debate. If the Deputies persist in interrupting I will adjourn the House forthwith.

Mr. Carey

If the Chair will give me an opportunity I would like to apologise.

An Ceann Comhairle

Deputy Carey, please be fair. You have had your say.

Dr. O'Hanlon

As I was saying, the closure of Barringtons Hospital releases extra funding for the Mid-Western Health Board and that must have a spinoff beneficial effect for Ennis hospital. Both Deputy Carey and Deputy Taylor-Quinn came into this House and, I accept they had to vote with their party, but both of them stood up and spoke spiritedly in favour of Barringtons Hospital.

Mrs. Taylor-Quinn

The Minister could have closed St. John's, releasing the same amount of money.

Dr. O'Hanlon

To have kept the hospital open would have meant that there would be even less funding available for Ennis in their own county.

Mr. Daly

Propaganda is catching here.

Dr. O'Hanlon

The FitzGerald report was referred to by Deputy Carey. We are not implementing the FitzGerald report. If the FitzGerald report was being implemented we would be closing Ennis Hospital.

Mr. Carey

And Nenagh and Monaghan.

Dr. O'Hanlon

But we are not doing that. I want to assure the people of Clare and the people of Nenagh that their future is assured, that there is no downgrading nor threat to the provision of acute medical services or acute surgical services. The measures taken by the health board are acceptable in the circumstances and I am satisfied that Ennis General Hospital will continue to provide an excellent service for those patients who require it.

I would like to assure the Deputies and the people of Clare that there is absolutely no threat to acute hospital facilities in Ennis hospital. Finally, nothing could do more harm to the hospital than unfounded rumours as to its future since these tend to undermine the confidence of the people, who have to use the hospital, and the confidence of the staff who have to work in the hospital. To come in here and suggest that we are implementing the FitzGerald report which would have closed Ennis hospital is deplorable on the part of Deputy Carey when he knows that what we are doing is the direct opposite. We are protecting the acute medical and surgical services in Ennis hospital.

Mr. Carey

By reducing the number of beds.

Mrs. Taylor-Quinn

Protection by reduction.

The Dáil adjourned at 5.30 p.m. until 2.30 p.m. on Tuesday, 19 April 1988.