We have lost some time. I suggest that Deputy Harney take ten minutes and the Minister take the remaining five minutes.
Adjournment Debate. - St. James's Hospital, Dublin, Services.
I would like to thank you, a Cheann Comhairle, for giving me the opportunity to raise this matter on the Adjournment this evening because it is something very serious and worthy of attention in this House.
The cancellation of all routine admissions to St. James's Hospital in Dublin both yesterday and today highlights once again that our public hospitals, particularly in Dublin, cannot cope with the number of sick people requiring hospitalisation. Now only accident and emergency cases can be admitted to most of the public hospitals in Dublin. Patients are either left until they become emergencies before they can get a bed or are becoming emergency cases in order to get a hospital bed.
The problems that arose in St. James's Hospital when they were on call last Monday night are not unique and have occurred several other times this year. In order to facilitate admissions while the hospital was on call the management had to use the 12-unit day care bed centre to facilitate the patients who came in that night and required hospitalisation. This resulted in that ward not being made available for the many long planned investigative cases including at least six colonoscopies and in 25 people having to be sent home yesterday morning. It is appalling that patients who had already begun the preliminary procedures required before entering hospital for these treatments should be treated in such a way. Sick animals would be treated better than this; it would be easier to have a sick dog attended to in Dublin than a sick person.
Last summer when problems arose in the accident and emergency services in Dublin the Minister established a committee, one of his famous 21 committees appointed since he assumed office, to review the situation and to report to him. That committee, consisting of representatives of the public hospitals and of departmental officials have, I understand, submitted their report to the Minister. I understand they confirmed that there is a serious shortage of beds in the public health system in Dublin. I would like to ask the Minister to comment on this report and to say whether he will make its contents available to the public.
The problems in Dublin arise from the fact that the Minister has closed both Dr. Steevens's and Baggot Street Hospitals without making any provision to replace the beds lost. Approximately 1,000 beds have been taken out of the public hospital system in Dublin since Deputy O'Hanlon took office. This Minister has adopted a policy of cutbacks without setting in place the necessary management procedures to ensure that there is not an undue delay and that hardship is not being caused, particularly to public patients.
Over 75 per cent of all the beds in the Mater Hospital are now at the disposal of the accident and emergency services. In the Adelaide Hospital's annual report for 1988, published last week, they confirm that they cannot now do any elective work. Over 100 beds at St. James's Hospital are designated for emergency cases; obviously, this number is quite inadequate for the demand, given what happened on Monday night last. The taxpayers have already spent over £70 million on the building of two new hospitals in Dublin which have been lying idle for up to two years. One such hospital is at St. James's and the other is at the Mater. The Minister refuses to give any date for the opening of these new hospitals and I am now calling on him to give these dates and, in particular, to say when he intends to open the new hospital at St. James's. Already £5 million has been borrowed to equip this hospital. I would call on the Minister and the Government to do whatever is necessary to ensure that these facilities are used.
Our hospital services are now in a very serious position and the immediate future looks very bleak indeed. As the year progresses the problems that came to light this week at St. James's Hospital will become far more serious and far more common as the hospitals begin to run out of money. The Minister must act now and stop hiding behind health boards and hospital managers. It is Deputy O'Hanlon's responsibility to ensure that the public have access to hospitals when they require it. It is not good enough that 25 people had to be sent home yesterday from St. James's Hospital, and may be more today, because the day ward was otherwise occupied. If such a serious situation could arise on a normal Monday night in Dublin, what would the consequences be if we had a major catastrophe such as happened at Hillsborough recently? Would our hospital system in Dublin, or indeed in the country, be able to cope? It is no longer good enough for the Minister to simply wash his hands of his responsibility and to pass the buck and blame others. It is now his clear-cut responsibility as the Minister for Health to come clean and tell us whether it is a lack of funding or bad management that is causing the problem. It has to be either of these or a combination of both. The Minister should take whatever action is necessary — and in doing so he would get the support of this House — to make sure that public patients in particular have access to a much needed hospital system when they require it.
I apologise to the Deputy for calling her by a wrong name. It was a slip of the tongue. Of course, I should have said Deputy Mary Harney.
Firstly, I would like to assure Deputy Harney that it is neither lack of funding nor bad management that is responsible for the problem that arose in St. James's Hospital on the night before last. On the question of funding, St. James's received an allocation of £36.628 million in the current year compared with £34.2 million in 1988. That sum of £36.6 million is well over half the sum the North-Eastern Health Board received to run four acute hospitals, two major psychiatric hospitals, six hospitals for the elderly and a whole range of community care services. Certainly, lack of funding is not the problem.
I am glad to say that the management in St. James's is, in my view, particularly good. The problem is that on this occasion the hospital was on call for the south side from 5 p.m. on the previous evening and 38 people required admission to hospital that night. There has not been a similar occurrence for 12 months and the hospital simply was not geared for it. I am sure Deputy Harney would be the first to complain if any hospital in this city was to keep beds available on the offchance that 38 patients would turn up for admission. The usual number admitted to hospital at this time of the year is 12 patients a day and that is the reason this problem arose in St. James's Hospital.
I can appreciate the anxiety and the upset experienced by the people but, as I have said, the extraordinary numbers requiring attention that night could not have been anticipated by those who organise the service. There is a general consensus that this was an unusual occurrence. As I have said, a similar situation occurred only once in the last 12 months and was dealt with in exactly the same way as on this occasion. Problems such as this arise from time to time because of the difficulty in predicting the number of emergency cases likely to be presented at a hospital in any period of time. I am sure the Deputy will appreciate that you cannot organise hospital services or the number of people who turn up at a hospital in the same way as you would organise an air flight across the Atlantic where seats are booked a fortnight in advance.
It is unreasonable and unfair to select isolated incidents such as this and to cause unnecessary anxiety to patients and their relatives. It is particularly inappropriate to do so in the case of St. James's Hospital which has shown a dramatic increase in the number of patients treated there in recent years. There was an increase of 7 per cent in the number of patients treated there in 1988 over 1989. It might interest the Deputy to know that 220,000 outpatients were treated in St. James's in 1988. Deputies then come into the House and complain that we are not providing a service.
What did the committee say?
Over 18,000 day patients and nearly 20,000 in-patients were treated at that hospital in 1988. I would pay a tribute to the staff and management of St. James's for the way they have responded to the challenges that everyone in the public service has had to respond to in the last number of years, for very obvious reasons.
On the question of the buildings in St. James's, I accept that they are not all suitable for service but I would point out to Deputy Harney that last year we provided £10 million to equip the X-ray department in that hospital and that has now been done. Funding has been provided this year to equip the general hospital but it will not be ready to be occupied until the end of this year or early next year. It is hoped to open the out-patient department later in the current year. There is no lack of resolve on the part of the Government. As I have said, we have provided quite adequate funding in the last year for the X-ray department, the out-patient department and the new in-patient block. The new accident and emergency unit is part of the phase one development and is due to be opened later this year. This includes 14 overnight beds, which should help to avoid the sort of problem that arose two nights ago. I would assure Deputy Harney that the management and the funding of St. James's are adequate to provide the necessary level of services in the south Dublin area.
On the question of the committee, I do not make apologies to anybody in this House for the fact that I set up committees. The difference between myself and the members of the Progressive Democrats is that I admit I do not have a monopoly of wisdom. I am glad to bring in experts to advise me on a whole range of subjects such as hearing aids on which I have no technical expertise. One of the committees to which the Deputy has referred deals with that matter. I also set up an advisory committee on health promotion and that is another area that is very important.
What did this committee say?
This is an ongoing committee and will be there, I am sure, for many years to come. They report to me on a regular basis. In the case of St. James's they reported that in November 1987 the total attendance at the hospital was 16,900 patients and in November 1988 it was 23,652 patients, an increase of 6,500 — and that is the service that is claimed to be run down. Those are the reports I am getting from the committee. I accept there are difficulties with the accident and emergency unit because of the large number of people who attend. As I have often said in this House, there are areas that we have to look at, such as the level of consultant staffing in accident and emergencies and the level of general practitioner service that is available in the city of Dublin after 5 p.m., the whole question of prevention of accidents, of people not taking risks, what can be done to try to avoid accidents in the home, particularly with elderly people and children, and also on the roads, in the work-place and on the farm. These are all areas that can be addressed.
What happened in St. James's on Monday night was an isolated incident. Only once before in 12 months did the same problem arise. There is no way of predicting that over three times the number of people who normally attend will turn up at accident and emergency for admission. As I said earlier, I am sure Deputy Harney would be the first person to come in here and criticise me if I told St. James's Hospital to keep 40 beds available on the offchance that 40 patients would turn up. On this occasion they dealt with the matter in the only way that is possible and practical to deal with such a matter.
The Dáil adjourned at 9 p.m. until 10.30 a.m. on Thursday, 4 May 1989.