Dáil Éireann debate -
Thursday, 13 Jun 1991

Vol. 409 No. 8

The Royal Hospital, Donnybrook (Charter Amendment) Order, 1990: Motion.

Minister for Health (Dr. O'Hanlon)

I move:

That Dáil Éireann approves the following Order in draft:

The Royal Hospital, Donnybrook (Charter Amendment) Order, 1990,

a copy of which Order in draft was laid before Dáil Éireann on 18th December, 1990.

This is a small technical amendment to the charter of The Royal Hospital and, as indicated in the explanatory memorandum which accompanied the draft order, the application to amend the charter of The Royal Hospital, Donnybrook, was made by the board of management of the hospital. Section 76 of the Health Act, 1970, gives power to the Minister for Health to make an order on the application of the governing body of a hospital to amend a charter or private Act relating to that hospital, subject to consultation with the Commissioners of Charitable Donations and Bequests, who have been consulted in this case and who have approved of the proposed amendments to the hospital's charter and to a draft of an order which it is proposed to make being laid before each House of the Oireachtas. The section stipulates that the order shall not be made until a resolution approving of the draft has been passed by each House.

Following consideration of the amendments to the charter and supplemental charter put forward by the hospital's board of management, I agreed to make an order incorporating the amendments to their existing charter, which was granted to the hospital in the year 1800, also to the supplemental charter, which was adopted in 1886. This order in draft was laid before Seanad Éireann in December 1990 and was approved by the Seanad.

The main purpose of the amendment is to make new provisions for the appointment of governors and to bring up to date certain other clauses that are regarded as outmoded. The memorandum circulated with the draft order explains the various amendments.

I believe that the House will welcome the amendments to outmoded clauses. But it is only fair to the board of The Royal Hospital to say that the outdated clauses have not been applied in practice for many years past.

I wish to take this opportunity to thank the board of The Royal Hospital, and the medical, nursing and other staff of the hospital, for the excellent work they have performed over the years in treating a great number of long-stay patients and, more recently, in developing rehabilitation services. I feel sure that this good work will continue and will be further developed to meet the changing needs of the hospital's catchment population in south Dublin.

I ask the Dáil to approve of the draft Royal Hospital, Donnybrook (Charter Amendment) Order, 1990, which has been laid before the House.

Mr. R. Bruton

I should like to support the amendment. It is very timely that a charter originally drafted in 1800 under the pen of King George III should now be amended. I am sure the Minister is proud to be making history that dates back to the Act of Union.

Even within more recent times the change is overdue. The board of governors has for a long time sought changes, it is a pity it has taken so long to come to fruition.

As the Minister says, much has changed and there have been dramatic improvements in The Royal Hospital since 1800, when it was described in the charter as the hospital for incurables. It is now a bright hospital providing excellent care, rehabilitation and returning people to the community. The hospital is excellently run and is a tribute to its staff and board of governors.

The changes involved in the amendment to the charter are also welcome. They will bring new blood into the board and will bring forward representation from groups such as the health board, which obviously have a major contribution to make in the running of the hospital. The amendment also brings to an end the notion of life governorships. As Members of this House I suppose we would all like to have that concept established a little more widely, but it is appropriate in this day and age to do away with such anachronisms. I commend the Minister for bringing the measure to the House.

Mr. Ferris

The Minister will be pleased to know that there will be no acrimony in this health debate. There will be agreement across the floor of the House of the motion now before us.

In this debate it is opportune for all of us to pay a compliment to The Royal Hospital at Donnybrook for the services they have rendered through the centuries. Many people were in real need when the hospital and its charter were set up. The hospital carried out a very useful function and, even to this day, it has a very important function in relation to the hospice movement that is being promoted throughout Ireland. The hospital fulfils a particular category of need that can be easily forgotten at times by many people. This is one of the most sensitive and important aspects of nursing — the care for those who are terminally ill, those who would have been called "incurables" in the old days. That is a very important role played by specialised nursing carers throughout the country. The Royal Hospital in Donnybrook has a long history in that regard.

In recent years the hospital has carried out an essential service in the treatment of geriatrics. All of us know how important that service is for our old people who are unable to get long-stay care in many of the public institutions, whether geriatric hospitals, sub-acute district hospitals — many of which are closed now — welfare homes or whatever. Over the years the hospital has provided 220 to 230 beds for geriatric patients, who have benefited from the quality of service provided by the hospital. The hospital also have day-care and rehabilitation wards. All of the work of the hospital is very commendable. I have no doubt that the Department of Health have assisted the hospital by way of special grants made under the 1970 Health Act.

This order provides an opportunity to remove what is an ancient, outmoded and outdated charter. The only reason that The Royal Hospital at Donnybrook succeeded to operate in recent times under such an old charter is that they have managed to ignore the old charter, to their eternal credit. Compliance with the old charter would have inhibited the hospital's continued progress. The order abolishes the old provision for life governors, people who paid a fee of 20 guineas to become life governors. The sum of 20 guineas was quite a commitment to invest 200 years ago in order to become involved in the running of a hospital that provided a service which was possibly not then available. It is to be hoped that, by excluding outdated sections of the charter, it will be moved into line with more every day events in the health world, whether nominated by local authorities, the professions or the Department. It is appropriate that the hospital be given the change they have sought. The Minister has the power under the Health Act to confer the change if the order passes through both Houses. The other House has already passed it and, with its passage through this House, the requests of the board of management and the governors will have been met. They will also have the ability to borrow and enter into contracts for the purchase, sale or leasing of property and anything else that is necessary today if they are to obtain advantage in the commercial world.

People are prepared to invest money in hospitals which give a hospice type service. They are prepared to make gifts and requests in their wills. I would suggest that the Minister consult with his colleague, the Minister for Finance, to ensure that any finances made available by direct payment from taxpayers to this type of concern which is caring for our seriously ill old people would be considered to be a charitable donation and deductible for tax purposes. That would be an incentive to people who have money available to give gifts and make wills in favour of such institutions. As the charitable trusts have dealt with this hospital in the past, that is possibly still legally binding. That option may continue to be available to people who want to make gifts to the hospital.

It has taken the Minister some time to bring a non-contentious order before the House though he was sure of support from all sides. It would be inappropriate for anybody to hold this order up. I and the Labour Party support it fully.

Mr. Byrne

We in The Workers' Party equally support the changes proposed by the Minister. Those of us who sit on Dublin City Council are conscious of the role of the hospital because we have three nominees on the board. One of them, Deputy Doyle, is present and I am sure he will give us an insight into the role of a governor of the hospital board.

I have glanced at the Charter of the Hospital for Incurables which was written in 1800. I feel the charter is in need of more radical upgrading than what the Minister is proposing. I would argue that it needs to be completely upgraded and restructured. One only has to look at the opening lines to realise that. It says:

GEORGE III, by the Grace of God, of Great Britain, France and Ireland, King, Defender of the Faith, and soforth,

To all whom these Presents shall come GREETING.

WHEREAS we are informed that our right trusty and well-beloved Counsellor, Arthur, Lord Baron Kilwarden, Chief Justice of our Court of King's Bench, in our Kingdom of Ireland, our right trusty and well-beloved Counsellor.....

So it goes on. It is a language of the past.

An Leas-Cheann Comhairle

We will not speculate as to which party they belonged.

Mr. Byrne

In fairness to them it was a charter and did give recognition to the voluntary activities of those who were concerned about the social conditions prevailing in the eighteen hundreds. We should recognise that there were good people about then as there are today.

The title, "hospital for incurables" is equally an outmoded and improper title. I do not think any hospital now or any section of the medical profession would ever use the term "incurable", even in the area of hospices for the dying, because in many cases people go into those places and come out again feeling better. That, therefore, is a terminology that is improper and should be abolished as quickly as possible.

We are happy to support the proposed changes in the Charter of The Royal Hospital. These changes are clearly necessary and long overdue. The charter of the hospital is a relic of another era when both the health problems and the social structures of Irish society were quite different. It will clearly present difficulties if a hospital has to rely on a charter which was drafted in 1800 and a supplemental charter which was drafted in 1886. I do not think the proposed changes go far enough. Perhaps the Minister will tell us in a few minutes that he recognises that the charter is so ancient as to be in need of complete upgrading.

It is quite ludicrous that a person could become a governor of the hospital by simply paying a fee of five guineas per year; this clearly could create all sorts of organisational difficulties. One wonders if there might not be a case for totally updating the charter to take account of modern conditions.

Anyone who has visited the hospital can only have been impressed at the manner in which it is run. The regime is a very progressive one and, despite the problems created by the continual shortage of funds, the patients — all of whom are suffering from severe disabilities and many of whom are elderly — are treated with great care and attention. It is important to record that here.

Unfortunately, we need more places like The Royal Hospital. I mentioned the social concern of people in the eighteen hundreds when they went about providing these services. Equally in 1991 we need more of these services for the elderly and the incapacitated. There are many elderly and incapacitated people who should be receiving institutional care and attention, but who are unable to find places, and are living at home with their families. This is a very severe problem today. There are many elderly whose families wish to place them in hospitals and who are finding it extremely difficult to get beds. I refer not to hospital beds but to long-term care beds. There is a crisis in the Dublin of 1991. We need more facilities, more places. I am a bit disturbed that the carer's allowances which was brought in to assist those caring for people at home——

An Leas-Cheann Comhairle

Deputy Byrne, we have to refer specifically to what is in the motion. I will not say you are abusing the position but you are straying beyond what is pertinent and approrpriate to the motion before us.

Mr. Byrne

I am attempting to draw a comparison between the love and care expressed in 1800 by the people who set up this hospital and similar people in Dublin today, an urban capital city. We could do with more of that loving care and attention from the Minister for Health by the provision of places for the equally distraught family members who are caring for the elderly at home and desperately seeking accommodation for their loved ones. I think it is a fair comparison. I will leave it at that.

There is a need not just for more full-time residential care, but also for short-term or respite beds to give families a break from the constant strain of having to care for an elderly or disabled relative.

I am concerned that of so many carers out there, estimated at 65,000, only a miserable 1,400 qualify for the meagre £45 carer's allowance. We have to put this on the record and recognise and congratulate not just The Royal Hospital but the 65,000 carers many of whom are sacrificing jobs, marriages and other prospects in life to care for the elderly.

In conclusion I would say that this is, of course, all linked to the question of adequate funding for our health services. The health services have been starved of funds by successive Governments. We need additional funds if we are to have a proper health service. It is only because of the commitment and dedication of people such as those running The Royal Hospital that the situation is not worse.

Mr. Doyle

I am very pleased to be able to speak on this motion today. I have been privileged to be a member of the management committee of The Royal Hospital for the past 12 years, representing the City Council. I hope that from 27 June this year I will be able to continue in that capacity.

Deputies

Hear, hear.

Mr. Doyle

The present by-laws are not in keeping with the practices of the hospital. It was considered by the managing committee that it would be more appropriate to develop a new set which would reflect present day needs. The structure and substance of the proposed new by-laws will concur closely with the hospital's needs for the future. Since the original charter was signed in 1800 the hospital has changed for the better in many ways. Today the hospital is quite a modern one with an excellent medical and nursing staff. The staff are supplemented by other medics who specialise in physiotherapy, which is an important aspect of hospitals that deal with the elderly, particularly a hospital which deals with long-term patients.

When speaking on the Nursing Bill here I spoke about the problems that public representatives have when they are approached by constituents about an aged parent who has suffered a stroke, who is in hospital, and for whom they are trying to find a nursing home. It is difficult to deal with these problems. The Royal Hospital plays a very important role in providing care for people who have suffered strokes. They keep them in great comfort for the remainder of their lives.

One of the most recent innovations of the hospital is that they implemented a rehabilitation service for young people. They also run a day centre which provides a service for many elderly people living in their catchment area. One of the most unique aspects of the hospital is the friendliness of the people there. Everyone in the hospital is happy. I pay special tribute to the management under the secretary-manager Mr. Jim Darlington, the medical officer, the director of nursing care and the nursing staff, who contribute to this friendly atmosphere which is essential to the running of a good hospital.

Another aspect of the hospital is the dedication of the board of management, some of whose members have served for many years and whose fathers served before them. They are dedicated people who spend many hours of their free time visiting the patients of the hospital. The Minister was generous in paying tribute to the nursing and medical staff in the hospital. I know the Minister takes a special interest in the hospital, as did his predecessor, former Deputy Barry Desmond. The hospital has been the beneficiary of generous contributions from the Department of Health in difficult times over the last number of years. I hope the hospital will continue to receive that kind of support from the Department of Health. The hospital deserves all the support it can receive. I welcome the proposal before the House and the amendment to the by-laws.

Minister for Health (Dr. O'Hanlon)

I thank the Deputies for their support of this draft order and for their praise of The Royal Hospital in Donnybrook. On the point raised by Deputy Byrne about the name of the hospital, it was formerly The Royal Hospital for Incurables, but the name was changed in 1974 and it is now officially The Royal Hospital. The hospital was founded in 1743, well before 1800 when George III gave them the charter. Since that time people have sung the praises of The Royal Hospital for their work. The hospital has 224 beds, 190 of which are long stay beds and 30 are rehabilitation beds. They also have a very good day care centre. We are in constant communication with them, the most recent time being in April this year about further development at the hospital. We hope to see a new unit for more confused patients developed there.

It is a modern hospital. The charter did not impede them from managing their hospital in a most efficient and professional way. The hospital requested this amendment to the charter. The main purpose of the amendment relates to the appointment of governors. Governors were automatically appointed on the payment of an annual or life subscription. We are amending the charter to allow the management to appoint new governors or approve applications for appointment as governor, just to give them the flexibility and facilities modern day management would have in managing the hospital. The original charter dates back to George III in 1800, but it did not impede them from doing a first class job. I have no doubt that they will continue to do that. I again thank Deputies for their contributions here this morning. I have no doubt that the hospital will be happy that the charter has now passed through this House. There has not been any delay on our part. When the application was made we had to consult with the Commissioner of Charitable Donations and Bequests and draft the order. As Deputies are aware, the order has already been laid before the Seanad and this is the final stage of passage through this House.

Question put and agreed to.