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Dáil Éireann debate -
Wednesday, 15 Feb 1989

Vol. 387 No. 2

Adjournment Debate. - County Roscommon Psychiatric Hospital.

I thank the Chair for giving me the opportunity to raise the proposed closure of St. Patrick's Hospital, Castlerea, on the Adjournment. I propose to share my time with the former Minister for Health, Deputy Barry Desmond.

Is that agreed? Agreed.

This issue is important from the point of view of the health services in County Roscommon, the people of Castlerea and surrounding areas, and the patients in the hospital. It is worth recalling that three years ago the Coalition Government were severely criticised by the present Minister for Health and his Minister of State for their handling of the health services. I congratulate the Minister of State, Deputy Leyden, belatedly, on his appointment. This is the first occasion I have had an opportunity to do so across the floor of the House.

No Minister for Health in the history of the State was subjected to more abuse and blackguarded as much as Deputy Desmond was when he held that office. As a member of the Western Health Board I am aware that their allocation of £108 million is insufficient to run the health services in their area. The budget has been cut by £3.7 million and it is no coincidence that that is the amount it cost to run St. Patrick's Hospital in Castlerea last year. It is as a result of the cut in the budget that the board have had to consider closing institutions. The Swinford complex is a clear example of the Government's lack of a health policy. The complex is capable of catering for 156 patients but there are only 30 patients there at present at a cost of £91 per day to maintain. That is a scandal.

Three years ago the then Minister for Health tried to rationalise the health services and reform the system of care for psychiatric patients. He proposed to transfer funding to the Swinford complex and to transfer mentally handicapped persons from Castlerea, Castlebar and Ballinasloe to it. He also proposed improving community facilities for mentally handicapped persons. Unfortunately, the Swinford complex, which cost £12 million, is almost idle.

Tonight I am expressing my concern for the future of 130 patients of St. Patrick's Hospital, an institution which is scheduled to close in April because of inadequate funding. It is envisaged that at least 30 of those patients will be transferred to a new acute admissions unit at the county hospital in Roscommon. That unit will cost an additional £90,000 but that expenditure has not been approved by the Department of Health. It is also proposed to transfer a further 66 patients to a psycho-geriatric unit which will cost £200,000 but the Department of Health has not provided the funds. A further 20 patients will be transferred to a support hostel in Roscommon which will cost £130,000 but the money has not been provided by the Department. It is proposed to transfer 14 patients to supervised hostels which will cost £100,000. The £520,000 required to erect those facilities has not been provided by the Department.

We cannot ignore the decisions made by the Coalition Government in 1986. They envisaged opening an acute psychiatric unit at Roscommon hospital, providing hostel accommodation at St. Patrick's Hospital, Castlerea, providing psycho-geriatric facilities at the same hospital and retaining the administration of psychiatric services for County Roscommon in Castlerea. Deputy Desmond's plan was accepted by the people of the town, the staff and the patients of the hospital. It is unfortunate that since the change of Government we have not been made aware of the Minister's plan for psychiatric services. It was because of that that, as chairman of the special hospitals committee of the board, I invited the Minister of State to meet the committee for an exchange of views on those services in our health board area, but particularly in Roscommon. The Minister of State, generously, met the members of the committee for two hours on 14 November and gave an undertaking to arrange a meeting with the Minister for Health, Deputy O'Hanlon. However, that meeting has not taken place. I can only assume that if the Minister of State was not misleading and deceiving the members of the committee, and myself, in November, he failed to persuade the Minister of the importance of meeting the committee.

I should like to call on the Minister of State to arrange that meeting with the Minister, Deputy O'Hanlon, so that the members of the Western Health Board can learn of the Minister's plans for the psychiatric services in Roscommon. On the other hand, the Minister of State might clarify the position thus eliminating the need for that deputation to travel to Dublin. I do not want the Minister of State, Deputy Leyden, to tell us, as he did on Monday, that the CEO said a subcommittee of the health board could not meet the Minister. That is not true. The health board have chosen representatives from the various programmes to meet the Minister, if the Minister of State will arrange it.

I should like to quote from column 2249 of the Official Report of 11 February 1986, where the Minister, Deputy O'Hanlon, stated:

We recognise it will not be possible to rehabilitate all patients for independent living in the community. We consider that patients who cannot be rehabilitated to this extent should be allowed to spend their remaining years in the hospital where they now live.

Those were the remarks of the Minister for Health on 11 February 1986. I call on him now to honour those commitments. The position has not changed. All that has changed is his role from having been then Opposition spokesman to being Minister for Health now. The buck stays with him. If he is an honourable man, which is the image he tries to portray — although at times I find it very difficult to see any such people on the far side of the House — I call on him to honour that commitment given in this House on 11 February, 1986.

Indeed, there were many commitments given at that time which were not honoured, commitments on the part of the present Minister of State at the Department of Health, Deputy Leyden, when obviously he did not foresee himself holding his present office. I think he was then Opposition spokesman on Posts and Telegraphs.

With your permission, a Cheann Comhairle, I should like to quote again what the present Minister of State, Deputy Leyden, had to say at column 2256 of the Official Report of 11 February, 1986:

I appeal for support from all sides of the House and I call on the Taoiseach, in the light of the seriousness of the situation and the callous manner in which this announcement was made, immediately to remove Deputy Desmond from the post of Minister for Health. The Minister relied totally for support for his statement on Planning for the Future in regard to psychiatric services. I suggest that the Minister read chapter 3.2 of that document......

I say to the Minister of State, Deputy Leyden, that he has had over three years in which to read chapter 3.2 of the document Planning for the Future. I appeal to him and to his Minister to ensure that the provisions of chapter 3.2 are adhered to and are implemented in so far as the psychiatric services in Roscommon are concerned. We are left with an acute psychiatric/geriatric unit at St. Patrick's Hospital in Castlerea. I appeal to them to ensure that, until such time as an alternative service is provided, psychiatric care for the patients of Roscommon remain in Castlerea. The Minister also has an obligation to ensure that high support hostel facilities continue to be provided at Castlerea.

Nobody can understand the position in which the people of Castlerea find themselves. We are faced with the prospect of our hospital being closed down.

Yet the requisite funds have not been allocated by the Department of Health for the provision of alternative facilities. It is callous to expect St. Patrick's Hospital, Castlerea to live within their budget for this year. For example, 70 staff at that hospital must go before 1 April next. The Minister of State is well aware of that fact. The obligation rests squarely on him to ensure that this does not happen.

Again, the Minister of State will be well aware from his constituency colleague, Deputy Doherty, who is chairman of the Western Health Board, that nothing can be done to prevent the closure of St. Patrick's Hospital, Castlerea without there being additional finance allocated by the Department of Health or the Minister implementing the provisions of section 38 of the Health Act, 1970. I call on the Minister this evening to protect the future of people who live in institutions in Castlerea, who are unable to vote, some unable to talk or explain their present difficulties. There is indeed an obligation on the Minister to do so.

I might point out to the Minister of State that his Minister protected the Regional Hospital in Galway in his letter of allocation. I believe the Minister of State present has an obligation to protect St. Patrick's Hospital, Castlerea.

I might also point out that we have had a drastic cutback of £440,000 for community care services, leaving the Western Health Board with very few such services. That cutback and the additional pressure that will be placed on those services resulting from the earlier discharge of patients from all our hospitals, particularly the general ones, because of shortage of funding will lead to a disastrous position within our health board area.

I ask the Minister to use his good offices to ensure that the provisions of section 38 of the Health Act, 1970 are implemented as far as St. Patrick's Hospital, Castlerea is concerned.

I might now quote from column 2258 of the Official Report of 11 February, 1986 when the present Minister of State had this to say:

I call on the Minister to retain this hospital in Castlerea as a centre of psychiatric services in County Roscommon to provide all the facilities necessary for people who will require such services. Those patients cannot be moved from the institution. What the Minister will be performing in this case will be a form of official euthanasia, because the patients there will die if they are moved from the security of the hospital. That is a serious and grave decision for the Minister to make or for the Government. It would.....

The decision now rests with the Minister of State present. Indeed the picture portrayed by the words of the paragraph I have just quoted will be appropriate if the Minister of State washes his hands of the position obtaining in Castlerea. I call on him as Minister of State and as a Deputy for Roscommon, to take the necessary steps to ensure that the future of St. Patrick's Hospital, Castlerea is assured until such time as alternative services to cater for the patients there are provided in the community.

Deputy Desmond has five minutes available to him.

I thank Deputy Naughten for the opportunity to contribute to this debate. It is now three years since the publication of the report entitled Planning for the Future. The work put into the preparation of that report by senior officers of the Department of Health, notably the present Secretary, the retired Assistant Secretary, Seán Trant and the Minister's colleague present this evening, Frank Foley, was quite extraordinary. Within 12 months of the publication of that report in March 1985 we proposed to change radically the whole structure of St. Patrick's Hospital, Castlerea and St. Dympna's Hospital in Carlow. It is worth recalling here the criticism heaped on Deputy Naughten by the present Minister of State at the Department of Health in the local newspaper, when he called on Fine Gael Deputies to realise that they were being sold down the river by what he described as the “so-called socialist Minister for Health”. Equally I recall Deputy Doherty, as reported in the Roscommon Herald of 7 February, as having said that the people of Castlerea were in a state of absolute shock, that he could not describe the shock felt among the patients, staff and local community, contending that the then Minister and Fine Gael Deputies had no concern whatsoever for the patients in the hospital. That kind of stuff was hurled across the House. Indeed in addition, in the debate on 12 February, Deputy Doherty went on record as being of the opinion that the then Government was a junta Government rather than a democratically-elected one, describing their actions as crude and cruel. In some ways one could maintain that the hands of the clock have turned—

Full circle.

Yes, full circle. The reality is that not only have the recommendations of the report Planning for the Future not been implemented by this Government but they have taken from the Western Health Board the resources which would have enabled them to do so.

I might add that the allocation for the Western Health Board when I left office amounted to £112 million, on the outturn for 1986. It is now down to £108.4 million for the year 1989, a major reduction. The prospect of the provisions of that report being implemented throughout the west has been substantially impeded by drastic reductions in the basic allocations to the Western Health Board. It was never the intention that these hospitals would close on the basis of financial stringency alone. Rather was it the intention that they would be closed on the basis that, over the best part of a ten to 15 year period, we would have a much better model which would involve substantial capital expenditure on hospitals and community care of mentally handicapped patients transferred from those hospitals. It was predicted that the transition would cost the best part of £50 million over a 15 year period. The capital allocation of the Department of Health has been cut from £57 million when we left office to £46 million this year.

I thank Deputy Naughten for having given me the opportunity to point out to the Minister of State their hypocrisy, their blatant baulking of a serious effort on our part to radically transform the delivery of psychiatric care which we found to be on its knees in 1982 when we assumed office, there having been no change whatsoever over the years. When we tried to change things we were impeded every inch of the way. I now call on the Government and the Minister, and indeed Deputy Doherty, to implement this decision of the Government in a sensitive and caring way and to ensure that the resources are made available to the Western Health Board to enable this to be done. It is long overdue that the Fianna Fáil Party in Government should face up to their responsibilities because they blatantly and flagrantly refused to do so between 1982 and 1987 when they were in Opposition.

The provision of psychiatric services in County Roscommon is a matter for the Western Health Board. Nevertheless, in his contribution to the budget debate in 1986, the then Minister for Health, Deputy Barry Desmond, announced that a number of hospitals were to close, among them St. Patrick's Hospital in Castlerea. A time scale of less than six months was proposed for the closure. There had been no prior discussion with the health board or with the staff of St. Patrick's Hospital in Castlerea.

In notifying the health board of their allocation for 1986 the proposed closure was formally notified. The closures and the manner of their announcement were strongly resisted by my party at the time. We were concerned that the decision had been taken without regard to the consequences for patients if proper community services were not in place and for the staff since there had been no discussion with them on matters which vitally affected their future. The basis put forward for this decision was the report, Planning for the Future, which set guidelines for the development of the psychiatric services. The recommendations in that report were accepted by the great majority of people involved in the service. It recommended a range of services in the community to replace the mental hospitals. It is clear from the report that these facilities must be in place before the change can be brought about. It was unrealistic to suggest that St. Patrick's Hospital should be closed in six months and that has proved to be so.

In the course of discussions between the Department and the health board the various facilities to be provided in County Roscommon were set out. Most of these are not even now in place three years later. It was suggested also that a portion of St. Patrick's Hospital should be redesignated as a geriatric unit to cater for elderly people in the hospital but that has not been done.

Deputy Barry Desmond, as Minister in February 1986, stressed in this House that his decision in relation to Castlerea was not only his own conviction but part of a collective Government decision. It was an inevitable consequence of that decision that the necessary arrangements be made in regard to the welfare of patients and staff and funds provided for a range of services but this was not done.

Saint Patrick's Hospital in Castlerea has a history, going back over the past 20 years, of progressive care for patients. Some would say this is the price of the progressive activities of psychiatrists and nurses in that hospital. It is a record that cannot be endangered. Evidence of it can be seen in the fall in patient numbers as the total of those in community care has grown. This is not only in accord with the policies set out in Planning for the Future but shows that St. Patrick's Hospital was already operating to the highest standards even before that report was issued.

Patient numbers in 1972 were just over 400. By the end of that decade the number was down to 300 and it is now down to 124 patients. This has been achieved without any reduction in the quality of care, rather the opposite. When we spoke on this debate in 1986 the number of patients was over double the present complement. At that time I expressed deep concern — I stand over the statements I made in the House then — that no provision had been made by the then Minister, Deputy Barry Desmond, for the patients who would be ejected from St. Patrick's Hospital in Castlerea.

We are concerned that future developments will be of the same high standard. For this reason the Minister, Deputy O'Hanlon, will meet with the chairman of the health board, my colleague, Deputy Seán Doherty, and the chief executive officer, Mr. Eamonn Hannan, next Wednesday to discuss this matter. I will be also in attendance at that meeting. I would not wish at this point to anticipate the outcome of these discussions.

As Deputy Naughten has referred to the debates of 1986 I would also like to remind him of his contribution at that time. He warmly welcomed, in a sense, the general thrust of the decision of the then Minister, Deputy Desmond.

As I did tonight.

The Deputy said:

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.

That is in the Official Report of 12 February 1986, column 2517.

That has nothing to do with——

Let us not have any interruptions, please.

I do not think there is any conflict between Deputy Naughten's view and mine on this issue. The decision taken by the Minister and the Government in 1986 was premature. No provision was made at that stage for the patients who would be removed from the hospital within six months of that decision. The decision to close St. Patrick's Hospital was not made by the Western Health Board in 1986 but by the then Minister, Deputy Barry Desmond, as a result of a collective Cabinet decision. I am aware that the then Taoiseach — I made this point at the time — disowned the Minister's activities in Roscommon soon afterwards which I thought was grossly unfair as it was a collective decision.

That is not true.

I would also like to point out to Deputy Naughten that he voted in this House on 12 February 1986 to close St. Patrick's Hospital in Castlerea. That vote is recorded at columns 2541 and 2542 of the Official Report.

I voted for the provision of community services in Roscommon, services which the Minister has not provided in the meantime.

I and my colleague, Deputy Doherty, voted Níl at that time to prevent the closure of St. Patrick's Hospital in Castlerea.

Now you are bolting the door.

To put the situation in context, the chief executive officer of the Western Health Board and his staff have recommended a certain course of action, bearing in mind that in recommending the proposal to close St. Patrick's Hospital in Castlerea he is requesting an allocation of £520,000 of capital expenditure for the development of a psycho-geriatric centre in the Sacred Heart Home in Roscommon, for the high support hostel in Roscommon and for other supervised hostels at locations to be determined. At this stage it is appropriate——

That money was available in 1986 and 1987 and you obstructed it every inch of the way.

Order, please. Deputy Naughten and Deputy Desmond had a very good hearing, devoid of interruptions. The Minister has only a few minutes left to conclude his remarks. Let him do so without interruption.

I have read through the files and I am quite au fait with the decisions made by the former Minister, Deputy Barry Desmond, at the time. I am well aware of what transpired at that stage. There is a very strong case to be made for the retention of St. Patrick's Hospital in Castlerea as a high support, psycho-geriatric hospital.

The Minister did not say that in 1986.

I did. I said in 1986 that it should be retained as a psychiatric hospital.

He did not say it in 1987 either.

At this stage the Minister, Deputy O'Hanlon, is meeting the chief executive officer and the chairman of the health board for discussions. I would take this opportunity of saying to the members of the health board that it is primarily their decision. A meeting of the board will take place on 6 March and they can assess the situation at that stage and decide to retain——

The Minister is shifting responsibility to Deputy Doherty.

——St. Patrick's Hospital in Castlerea as a high support psycho-geriatric hospital. I would be very pleased if that is the decision they make at that stage. They are, in a sense, trying to remove the responsibility back to the Department when in fact they are the designated and delegated authority to ensure that the services are provided in the Western Health Board area.

The responsibility rested with the Minister in 1986 as it does today.

The Minister is acting like someone caught drinking after hours.

The Dáil adjourned at 11 p.m. until 10.30 a.m. on Thursday, 16 February 1989.

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