Dáil Éireann debate -
Tuesday, 12 Mar 1991

Vol. 406 No. 3

Adjournment Debate. - Dublin Dental Hospital.

Mr. J. Higgins

I thank the Chair for choosing my question and I thank the Minister for coming in to take it. The Dublin Dental Hospital was built in 1897. At the time it was purpose built for the conditions of the day and to cater for 2,500 patients per annum. Today it caters for between 70,000 and 80,000 patients per annum.

The hospital consists of two buildings, one the hospital proper and the other the administrative and library facilities. To call the structure a hospital is a misnomer. The existing buildings and facilities have been condemned by official visitors representing the competent authorities for both Ireland and the UK as outmoded, cramped, hazardous and unacceptable. There are more patients treated every fortnight than was initially intended as the overall complement for the year. The building is a multi-storey fire hazard. Despite repeated warnings from the fire officer and despite the installation of fire doors and alarms, it is an extremely dangerous structure. Having seen it I am convinced that it is a potential inferno should a fire break out.

A former secretary of the Higher Education Authority described the hospital as the worst facility in third level education. That is no exaggeration. Following a threat by the UK General Dental Council to withdraw recognition of the Dublin Dental Degree, the Government promised in 1963 that a new hospital would be completed by 1967.

I visited the hospital today. Up to a dozen people were administering dental treatment in rooms of only 200 square feet. Those awaiting treatment are actually looking at treatment being administered to other patients. The patients are queueing in annexes and corridors. In the X-ray department patients have collapsed during busy sessions due to overcrowding. There is no central sterile supply area, an essential feature given the hazards of cross infection in such conditions. Because of the nature of many dental procedures, extreme care has to be taken in relation to such ailments as AIDS and hepatitis. There is no lift in the building and wheelchair patients have to be carried up a narrow stairway to the top storey for treatment. The isolation of the Dublin Dental Hospital from general hospital facilities results in patients and staff having to attend eight centres around Dublin for certain types of treatment. There are very limited back-up facilities in case of emergency.

Successive reports from visitors sent to inspect the training programme and facilities of the Dublin Dental Hospital have all condemned the building as being unacceptable. While the programme has been complimented, the institution has been referred to as "hazardous, a slum, a rabbit warren". One group of visitors from the British and Irish Specialist Advisory Committee for Higher Training in Dentistry described the laboratory facilities as barbaric. Large parts of the building are reeking with dry rot. The masonry on the front of the building is extremely dangerous and the replacement cost is estimated at £100,000.

I pay tribute to the staff at the hospital and indeed, to the undergraduates there. Sixty per cent of the patients treated there are medical card holders. Treatment includes orthodontics, oral surgery and oral rehabilitation. The staff provide dental treatment for prisoners in all six Dublin penal institutions. This is quite taxing as there is a high HIV infection level among prisoners, particularly among those who are intravenous drug abusers. Staff provide treatment for patients from drug rehabilitation units. The hospital is a referral centre for dental and maxillo-facial problems for the entire country.

It is quite obvious that the Dublin Dental Hospital is a vital and integral part of the dental service of the nation, yet it is expected to exist in what can only be described as atrociously sub-standard conditions. Each year the hospital trains between 35 and 40 dental surgeons. It also provides courses for undergraduates in dental science, post-graduate degree programmes, training programmes for the Dental Fellowship Examinations of the Royal Colleges of Surgeons of London, Dublin, Edinburgh and Glasgow, a diploma programme training dental teachers and public dental officers for developing countries. It trains dental nurses and dental technicians to the highest possible standard. It continues to push out the frontiers of research in all areas of dental science.

It is incredible, when one sees the generally high level of third level institution at RTC, DIT and university level, to understand how the Dublin Dental Hospital has been permitted to languish in such squalor over such a considerable period of time particularly when one considers the enormous saving to the State in the provision of dental treatment to over 80,000 patients per annum, many of whom are treated by students.

I am appealing to the Minister for Education to put the provision of a new dental hospital high on her agenda of priorities. Without wishing to denigrate the present development of Carysfort College, I honestly believe that this should have a far higher priority rating than Carysfort. I also look at rationalisation and other savings that are taking place and particularly at the reducation of numbers to teacher training colleges. What we are talking about here is a commitment of £15 million pounds to a new, modern state of the art purpose-built Dental Hospital at St. James' Hospital. The plans are there, the site is there and the need is there. The existing school has been designated by the World Health Organisation as one of the very few collaborating centres for dental education. It is in this capacity that members of staff are asked to advise other schools and Governments on education and health service matters.

Recently the International Association for Dental Research held a meeting of 1,700 delegates in Dublin. In 1991 people from all over the world will come to the Dental School meeting celebrating Trinity College's 100th anniversary. What a pity that instead of an up-to-date, functional and modern dental hospital on a par with the excellence and high standard of work carried on there, we have a building of which we can be truly ashamed.

Mr. Byrne

I would like to be associated with the comments made by Deputy Higgins and I appeal to the Minister to satisfy the demand for a new dental hospital in Dublin.

Minister for Education (Mrs. O'Rourke)

The need for a new dental hospital and school to replace the existing inadequate facilities has been accepted for a long time, indeed for 23 or 24 years. To comply with the fire regulations would cost about £2 million and those modifications would result only in a temporary solution. We would still not have a premises which was clinically correct as well as a safe facility or an adequate training environment.

The estimated cost of providing a new hospital and school on the site is £14 million at 1990 prices. This figure would include the furniture, equipment and fees but would exclude the £1.5 million already incurred on the site of the development, and the design fees.

While this project, when it comes about, will be financed through my Department, we do not make the decision on the necessity or otherwise of such a facility or on what will be in it. That is a matter for the Minister for Health. Because it is a third level facility the funding will be under my Estimate.

In 1987 the Minister for Health was asked to report on the need for a dental hospital in Dublin. The Department of Health have confirmed that they are satisfied that a dental hospital/school is needed in Dublin, both in relation to the range and nature of the specialist services it provides and the extent of its patient needs. This is where the Department of Health come in because naturally my Department would not have the expertise to deal with the matter. It is also justified by the Department of Health in the context of the desired dentist population ratio.

Approximately 80,000 patient visits are made to the hospital annually and a high proportion of these are made by medical card holders. It satisfies the needs of those who require training, out patients and those who have no other way of getting dental care. The hospital also provides treatment for haemophiliacs, HIV positive patients, prisoners and other medically and socially disadvantaged people, many of whom would not otherwise obtain treatment. The number of patients treated could be increased to about 120,000 per year in a new building.

In addition to providing training for about 200 undergraduate and post-graduate dentist students, the facility proposed for Dublin would also cater for 75 para-dentist students while the library and lecture facilities would be used by students in St. James's Hospital. It is accepted that the case for a new dental hospital is well established and, as I said, this is based on the observations of the Department of Health. However the question of providing such a facility has now to be addressed.

Deputy Higgins referred to the question of third level enrolments which have increased by almost 28,000 to a total of 70,000 this year, an increase of 66 per cent during the decade. A capital provision of £14 million for a college which would cater for 200 full-time students must be subjected to a thorough scrutiny in the context of priorities. My Department, with the Department of Health, are pursuing as a matter of urgency the question of how to address the present highly unsatisfactory situation.

The need for such a hospital has been assessed by the Department of Health.

Our provision, in student terms, is very modest compared with the provision by the Department of Health who provide a great many services each year. This matter has to be worked out carefully so that the division of costings can be done in an equitable manner. It would be odd if we were to provide from our own budget a facility which would be used in the main by public patients. These are matters which must be addressed by the two Departments involved.

I have had several meetings with Derry Shanley who has impressed me greatly by the way he has stuck with the case in very difficult circumstances. I, too, have visited the hospital and was not satisfied with what I saw. I have already spoken to the Minister for Health about the matter but we will now have to address the matter with greater urgency. I hope we will speak about this matter again in the House and I thank the Deputy for raising it.