Dáil Éireann debate -
Tuesday, 31 Mar 1992

Vol. 417 No. 9

Private Members' Business. - Tallaght (Dublin) New Hospital: Motion.

Mr. R. Bruton

I move:

That Dáil Éireann condemns the decision to again postpone the commencement of the Tallaght Regional Teaching Hospital; requests that the Kennedy Group complete an Interim Report on Tallaght Hospital at the earliest possible date; and resolves itself to be of the opinion that the necessary capital should be set aside to commence building work in 1992.

The urgency of this motion arises from the fact that the Minister for Health will shortly finalise plans for the expenditure of over £40 million during 1992 on hospital services, investment in new capital projects for hospitals and health care. It is vital that the Minister includes the £5 million necessary to get Tallaght Hospital under way in this allocation, and I hope the Minister will give an indication of his commitment to do this in the House tonight.

The people of Tallaght are no strangers to official foot dragging. They have had to wait for third level education facilities and fight all the way to get them; they have had to wait for shopping facilities and they are still waiting for effective transport services. It is unacceptable that they should still be waiting, 12 years later, for a basic health service.

I do not know, a Cheann Comhairle, if you are familiar with the history of this project, which goes back a very long way. The board, who were first appointed in 1980, had a planning brief drawn up which was completed in December 1983 and accepted by the Minister. They held an architectural competition in March 1984 and the winning design was announced in July 1985. The Department of Health gave their approval to the commencement of the detailed planning in March 1986 and this was completed in December 1987. The Department gave their approval to the commencement of the stage 4 planning process, the builders' drawing stage, in June 1988. In early 1989 the Minister for Health announced that he wanted to see the project accelerated; in an unprecedented move, he wanted to see stage 4 and stage 5 drawn together and completed together. This was done during the autumn of 1990. Tenders were then ready to go in November 1990, but sadly, that is where the matter has rested since then. That state of readiness to go to tender was submitted to the Department of Health in November 1990 but there has been no response to date.

Tallaght hospital was overlooked in the capital programme for 1991, and there is a very real danger that Tallaght will be overlooked yet again in 1992 and that the £5 million necessary to get the hospital under way will not be made available. This is why Fine Gael believe this motion had to be brought to the floor of the House. I am very pleased that the Labour Party and the Democratic Left are supporting this motion and I hope that there will be all-party support for it.

Obviously to the 80,000 people in the Tallaght area this project is crucial. As we know, this community has suffered unusual economic hardship during the past ten years, having the problems of economic recession piled high on them. The unemployment level in some parts of the area is extremely high, up to 70 per cent in some cases. This project is of importance not only to the people of Tallaght but also to a much wider catchment area of some 300,000 people which it will service.

The project has been referred yet again to the Kennedy group, despite the 12 years of preparation. The Kennedy group have laid extreme emphasis on the importance of an integrated service which should have at its heart an acute hospital which would provide a comprehensive range of services. I should like to quote briefly from the earlier work of the Kennedy group which gives a clear illustration of their thinking. In talking about the problems in our health services, as presently constituted, they say:

The present structures are notable for the fragmentation of the health service, the confusion as to roles and responsibilities of the various agencies and the lack of an effective overview of the interaction of services at levels of planning or delivery. The difficulties arise from the scale of the area and population to be served, the operational autonomy of most of the acute general hospitals and many of then non-acute agencies in the city, the fact that the geographical areas which apply in the organisation of community care services do not generally coincide with the configuration of the populations served by acute hospitals, and because of relative isolation of the more than 800 general practitioners in the region from the rest of the health care system, the present structures facilitate a lack of co-ordination and provide no proper basis for resource allocation or for performance review.

That is a short summary of the deficiencies they identified in our health services. Nowhere in the city of Dublin are these deficiencies more stark than in the Tallaght region where acute hospital care is entirely divorced from the region. The Meath Hospital, the Adelaide Hospital and the National Children's Hospital and the Naas hospital on the other side of the region are a long distance from the core populations who have to be served. We expect some of the most deprived people in Dublin city to attend acute hospital facilities long distances from their homes and to do so without a proper transport service.

At the core of the Kennedy group's recommendations for restructuring health care in Dublin is the idea that there should be five regions with integrated and comprehensive services which would be capable of being supported by a given population and would be provided locally to that population. Those are the key elements of the report. As the Minister knows, they go on to say that one of the key areas was to be the Tallaght region, centred on the Tallaght Hospital. It was to serve a population of 250,000 people, under the section "the south west region". The Tallaght Hospital and the development of a comprehensive range of services is at the core of the Kennedy group proposals. It has already been established by that committee what they want to see in the way of development of health services for the population to which I referred.

Against that background people have been rightly dismayed at the recent suggestion by the Minister for Health that the Adelaide Hospital should be kept open. That would involve the splitting of specialties and would leave some key specialties not available as part of a comprehensive service to the people of Tallaght and the surrounding region, known as the south west, which takes in part of Wicklow and Kildare as well as the south west regions of Dublin. It is disturbing to hear the Minister making these announcements. It is hard to accept he is acting in good faith in commissioning and urging the completion of this report when he makes suggestions like this which are not only ill-thought out but cannot be seen as anything but put together to prejudge a conclusion which is likely to emerge from the Kennedy report based on their existing work, mainly the recommendation, as a matter of urgency, that we go ahead with a comprehensive service in Tallaght, drawing together all the elements of care now split between the fragmented services of the existing hospitals.

People in Tallaght and the surrounding regions must rightly feel aggrieved that they are being turned into a political football after the long history, which I described, dating back to 1980 when this project was being brought painstakingly through the different stages of development, that a new committee has been appointed at the last hurdle to investigate afresh the functions, scope and scale of the hospital.

Despite being concerned as to whether the review is in good faith and not just a stalling tactic, I accept that since 1980 there have been significant changes in the approach to hospital care and in the needs for bed complements relating to different specialities. I accept — as do the board of Tallaght Hospital — that the changes in health care have also changed the balance between in-hospital stay and day care which should be provided for in the Tallaght Hospital project. However, they have been acutely conscious of that throughout the design stage, they have not been living in an ivory tower divorced from these trends; they have been acutely conscious of those trends and have designed a hospital explicitly to have that flexibility to convert stay care into day care in a way which can respond to the emerging needs and process of effective health care which is developing.

The continued delay is pushing that future — where there is flexibility between stay and day care — further and further from our grasp; that is the reality. The delay means that the old Nightingale wards in the Meath and other hospitals will continue. It is hard to credit that the Meath Hospital is 270 years old and that the Adelaide Hospital is 150 years old. Conditions in those buildings cannot result in the sort of modern care which I know the Minister wants to see delivered. Tallaght Hospital is there to fill that gap. We all know that it would be a total waste to see money being sunk into an attempt to patch up these hospitals and to keep them going to a date long beyond when they can provide the sort of services that either the staff working there or the patients have learned to accept. It is like the old story of the roads network, we have seen to our cost that this patchwork of putting a small amount of money here and there is a total waste of money and leaves a service which is structurally unsound in the long run. We must arrest that possibility in this instance by not having continued delay in regard to this project.

People were also dismayed at the Minister's recent suggestion that some sort of municipal loan would be the basis on which this project would stand or fall. I do not know who the Minister thinks he is fooling by suggesting that a municipal loan is some way of resolving the problem of finance for this project. We do not have to go to the United States of America to learn how to borrow money, this country is better than any at borrowing money. We are borrowing money this year to give the Minister £42 million to provide capital for his hospital programmes and his health investment. To talk of some mysterious US loan as being the answer is just pie in the sky and the Minister must know that. It cannot deliver an effective solution to this problem because the Minister for Finance, who sits beside the Minister for Health at the Cabinet table day after day, has made it crystal clear that he will not sanction more borrowing for health purposes; he will not go beyond the £42 million which he has made available. The net issue here is not a new loan to divert attention to a different area of work, the issue is whether the Minister and his colleague will make available from the £42 million the sum of £5 million to build the Tallaght Hospital.

I look forward to the Minister's response because people want him to prove he is not engaged in a stalling tactic in the various suggestions he has made and that he is committed to starting work on the project which emerges from the review by the Kennedy group. As I understand it, the Kennedy group will, very shortly, be in a position to give an answer in regard to the sort of service they envisage as suitable for serving the people of the south west of Dublin. The manoeuvring and political brinkmanship in regard to the Tallaght Hospital must come to an end. It is not as if the money is not there, that is manifestly untrue; not only is there £42 million available this year to be spent, since the sod was first turned on the Tallaght site in 1986, the Government have spent a colossal £350 million on hospitals and yet Tallaght Hospital did not get the go-ahead. That sum would have built Tallaght Hospital three times over and more no matter what estimates are given of the cost of the project. If the Government had the will, that project would now be underway. However, it seems that the Government do not have the will.

I should also like to refer to the issue of costs. The Minister and his colleague, the Minister of State, time and again repeat the estimate of £118 million as if that was the proposed scale of expenditure planned by the hospital board at present. That is not the case, the sum of £118 million was based on a 600 bed hospital which the Tallaght board are not pressing at this stage. That sum involved three phases of their plan and, at the request of the Department of Health, they abandoned those three phases to provide this extra scaled-down service. The real project does not run to £118 million but could be financed for under £100 million. It is significant that the Government seem to be putting up the figure to make it seem more difficult to solve this problem.

We would have to draw attention to the fact that a Minister in the present Government voted against his own party in order to secure the survival of Limerick's third hospital, a city with a much smaller population than Tallaght. The Tallaght-Clondalkin area which as the Kennedy report stated is the second largest region and has two Ministers representing it in the House tonight, is still denied a hospital.

In this area incomes are low and people do not have the option of paying for care elsewhere. I am convinced that these people are going without health care and the disadvantage of low income and unemployment they already suffer is compounded. I have spoken to many people directly concerned, our party councillor, Councillor Michael Keating and Senator McMahon, and they have testified to the enormous problems these people face. Picture if you can, a single parent with three or four children trying to cope with the children as well as having to attend an accident and emergency unit, who has to flag down a bus, perhaps in the rain, to make her way into the inner city for hospital care. It is unthinkable that that is the level of service we are providing in such a large area, and it compounds our scandalous neglect of the area. It is a shame that we should continue to neglect health care in this area.

If the Minister goes ahead with his proposal to split the project the Tallaght Hospital project will be seriously damaged. There is not only a clear desire to see the Adelaide approach to care in the Tallaght Hospital and providing the Adelaide with a modern setting, but it is vital that the many excellent consultants in the Adelaide should not be relegated to the second division serving an area which is already adequately served by the existing major hospitals. It would be sad to see the Adelaide Hospital relegated in that way — as the Minister suggests — which is against the tone and approach of the Kennedy report.

There were other suggestions that gave rise to concern. When the Minister talks about looking to other sources of funding for this hospital, I fear that this is some sort of code for private funding. We all know from our experience of privately funded hospitals elsewhere that they are hungry for private patients and their main driving force is to maximise the level of private business in order to generate revenue. It would be very serious if there was any suggestion that the proposed Tallaght Hospital would not be a public hospital committed to the care of public patients as their primary function who, according to the Minister's statement, make up 85 per cent of the patient throughput. It must be clear that the Minister is committed to public care from the outset and any suggestion that we would row back from that commitment and opt for a privately funded hospital that would have different priorities would be damaging.

We must also examine the types of services to be provided in the proposed Tallaght Hospital. It is important that the Minister's suggestion of splitting the project and leaving certain elements, such as the Adelaide Hospital and some of the children's hospital, out of the Tallaght project must be addressed in this debate. I hope the Minister recognises the wisdom of the Kennedy approach where it is clearly proposed that the paediatric speciality would be a core part of the service. What is really needed in an area where there are a great many children is a strong acute hospital with paediatric services and I hope the Minister will confirm that there will be no attempt on his part to row back from the concept of a comprehensive health service in Tallaght. By splitting the project and taking some of the specialities away from the proposed hospital, the Minister would be undermining the concept at the heart of the proposal to develop an effective care service for the people of Dublin.

Tallaght lies within the greater Dublin area and has a population of 250,000 plus. The Kennedy report recommended that an acute hospital be situated in the centre of the area which would build up relationships with the general practitioners and the community care services in the area. That is at the heart of what we want to see developed in the Tallaght area and I hope the Minister will not row back from this.

With your permission, a Cheann Comhairle I wish to draw my comments to a close so that I can share my time with Deputy Fennell.

An Ceann Comhairle

For obvious reasons, it would have been more appropriate if that request had been made at the commencement of the Deputy's speech. However I am sure this House will agree to the Deputy's request. Is that agreed? Agreed.

Mr. R. Bruton

This is a very serious issue. As I am sure the Minister knows, there are very active committees which are committed to ensuring that this project starts, and they rightly recognise that Tallaght has a history of neglect, but this must not be allowed continue. Even if the Minister agreed today to start this project, it would be five and a half years before the first patient would be admitted. Therefore, I urge the Minister to support our motion which seeks a commitment to start work this year and I look forward to hearing his response.

May I commend the Minister on his suggestion to site an outpatient facility in the area as a matter of urgency? While we would like to see that, we do not want it used as an excuse to put off the commencement of this project which is long overdue. We hope this is not the thin edge of the wedge to set up a hospital that would be less than the comprehensive service envisaged in the Kennedy report which sould be at the core of an effective treatment centre for the population of 250,000 in Dublin south-west.

Mrs. Fennell

There is a sense of déja vu about this debate. It is similar to the Shannon controversy which keeps cropping up; it appears to be solved but nothing happens.

The proposed Tallaght Hospital was raised in numerous questions, during grievance time and on the Adjournment. This area is close to my own constituency and I am very familiar with it. Indeed, the proposed hospital would serve part of my constituency.

From reading the Official Report of the debates, one would feel sorry for Deputy Flood, who represents this constituency and is Minister of State at the Department of Health. As a local Deputy, he had to bat for the Minister and repeatedly he has had to read scripts and amended scripts which say the same thing but with the words juggled a little, to soothe the frustrations of Opposition Deputies who run out of patience on this long drawn-out and cynically manipulated measure. I would feel very sorry for the Minister were it not for the fact that on this matter my sympathy goes to the people of the area — the 200,000 citizens who are being left without this very urgent service. Considering the political representation in the area, there are two Ministers of State serving that area, one is surprised that nothing has happened and that there is such a stalemate. One is led to believe that hospitals, highway buildings and road building tend to be decided on geographical representation of Ministers. I am sure the people of Tallaght feel very frustrated in view of the fact that they have such good, strong representation and yet nothing has happened.

We are talking about a vast area — Clondalkin, Rathcoole, Firhouse, Brittas to Ballyboden, west Wicklow and south Kildare. The people out there are being let down and they are the people for whom this motion speaks. When this hospital was first proposed in 1968 it was for a moderately developed suburb of Dublin which still had features of its rural past. Maybe there was not the same urgency for a hospital when it was first suggested and certainly not for a hospital of the scale that has laterally been decided upon.

The need now, as for many years past, is chronic. No other region in the whole country can be more deserving or more desperate for a hospital complex for the following reasons, there is a grave need for medical care in the central Tallaght area for surgery, treatment, preventive medicine, out-patients. This is an area which is as large as many of our cities in population. Second, it would be a source of employment and, therefore, the development of the community. No area can have a greater need for development. This community has been starved of resources. Effectively, people were dumped out of the town, put in small boxes away from the city with little or no development. How can people, who are already disadvantaged both socially and educationally, survive when deprived of basic needs and facilities such as schools, shops, transport and medical facilities?

Was it any wonder that over the years we saw such bad newspaper headlines about Tallaght given their geographical isolation, their 50 per cent unemployment rate and the lack of community amenities? Of course, one cannot expect community development and proper community growth when you feed people on promises with no follow up action. That leads to disillusionment and to disdain for us politicians in Leinster House. We promise to build roads, schools, hospitals and to drain rivers, yet those who make those promises know there is very little hope of fulfilling them. We saw that kind of cynicism from Fianna Fáil in 1989. There was a promise in 1989 that the hospital building would be brought forward to 1990. I quote from an advertisment by Fianna Fáil which was put in the media in 1989:

Building of the massive new Tallaght Hospital in Dublin which was to have started in 1991 has been brought forward to next year.

The Chairman of the Tallaght Hospital Board, Professor R.T.W.L. Conroy said that Health Minister, Dr. Rory O'Hanlon has agreed to accelerate the development programme. It is now hoped that work would be underway in about 15 months time.

The advertisement continued as follows:

By voting Fianna Fáil on 15 June you will ensure that the improvements which are taking place will continue.

That is the kind of cynicism that makes people lack belief in politicians.

The new Minister for Health, Deputy O'Connell, is trying to grasp all the very difficult problems — nobody underestimates the job he has to do — and given his style, energy and approach to the job he will want to leave his mark in all these areas. I hope he will be honest and set down his aims and objectives for the Tallaght hospital and stick with them. I would ask him not to say something that cannot be delivered on: it would be wrong that that should happen in an area like Tallaght. The project has been deferred, postponed, and the people strung along relentlessly. We have been told there is to be another report and more proposals; I feel these are unnecessary but perhaps they are necessary for administration purposes or for the Department's procedures. When one goes out and sees the glorious turned sod or monument, one has to feel very sad for the people of Tallaght that they do not have an amenity, which is so necessary for growing families, close to their community.

The proposal is that a children's hospital should be part of the new hospital. We have to think of the needs of the children in that huge built-up area where there must be more children per street than in any other area. Parents have to struggle with a very bad transport system, take their children into the city centre to hospital and depend on an unreliable bus service to visit them. It is particularly regrettable for parents, who value their children, just as the rest of us do and want to have the best for them, but it is made very difficult for them because of the difficulties of getting into town. Everybody in hospital deserves the best and most up-to-date treatment they can get and they should have it closer to them than is the case at present.

What can these people do? They have made their protest, they have made their submissions, they have been polite and have complied with all the necessary requests. They deserve realistic answers and to have their expectations met. People in this House who do not live near Tallaght and who, perhaps, were never in Tallaght, would sympathise very strongly with this case and would want to urge the Minister to take action and to do something. I support the proposer of this motion and ask for support from all sides of the House. I would ask the three Ministers present, but particularly, the Minister for Health, Dr. O'Connell, to give considered commitment to this project and to give a clear message to the people of Tallaght and to stick to it because the people living in Tallaght deserve it.

Minister of State at the Department of Health (Mr. Flood)

I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"welcomes the commitment of the Government to the Tallaght Hospital Project and supports its initiative in commissioning the Dublin Hospital Advisory Group to review and make recommendations on the functions, scope, scale and funding of the proposed Tallaght Hospital."

Once again I am pleased to have an opportunity during the course of Private Members' time to talk about the Tallaght Hospital project. Since becoming Minister of State at the Department of Health I have given much time and thought to this complex issue.

Mr. Rabbitte

I hesitate to interrupt the Minister but I would like to inquire if a copy of his script is available?

Mr. Flood

Certainly, if it is not available I would ask that it would be made available.

Mr. Rabbitte

Perhaps we have it already?

Mr. Flood

I think not. In the meantime I wish to confirm that we have had many meetings and discussions with local community groups, professional groups and interested individuals with a view to progressing matters. Before I proceed further I wish to respond to a number of specific points raised by Deputy Bruton. I think it is important to briefly outline the major developments that have taken place in the acute hospital scene in recent years.

As Deputies will be aware, we have been engaged in this country over the past 15 years on a major and expensive development programme in our general hospital system. This has resulted in the upgrading of many hospitals and the development of a number of major new hospitals throughout the country.

Going back to 1968, the Fitzgerald report set out how acute hospital services should develop in Dublin. In designing the future plan for hospital services in Dublin, particular attention was paid to the movement of the population in the urban and suburban areas. As Deputies will be aware, this has shown a shift towards the suburbs and a marked decline in the inner city areas. The hospital needs of the new expanding suburbs were the critical consideration in shaping the plan that ultimately emerged.

That plan provided for six major hospitals for the greater Dublin area — three on the north side, Beaumont Hospital, the Mater Hospital and Blanchardstown Hospital and three on the south side, St. James's Hospital, St. Vincent's Hospital and a new hospital at Tallaght. The plan also provided for the relocation of services of a number of older hospitals to enable the new developments to come on stream.

We made great progress on the rationalisation of hospital services throughout the eighties. It was imperative that such progress was made, not only in the interests of eliminating avoidable management and maintenance overheads but also in the interests of improving the quality of patient care.

In 1984, Mercer's Hospital was the first of the city hospitals to transfer its service to St. James's. In 1986, Sir Patrick Dun's also transferred to St. James's. In 1987, the Richmond and St. Laurence's transferred to the new hospital at Beaumont. Also in 1987, the services of Dr. Steeven's Hospital and the acute services of Baggot Street Hospital were relocated in the Meath, the Adelaide and St. James's.

Deputies will agree, therefore, that we have made progress, very significant progress, in the implementation of the original plan for acute services in Dublin. Indeed, with the recent commissioning of the new block at St. James's, the jigsaw is almost complete. The only major developments still to be put in place is the Tallaght Hospital which will serve Dublin South-West, south Kildare and west Wicklow.

The Tallaght Hospital project, costing an estimated £118 million, is the largest health capital project ever proposed in this country. The constuction period involved is about four years, following which a further period of about 18 months would be required for commissioning.

The intention is that the Meath, the Adelaide and the National Children's Hospitals will move from their existing sites in the city centre to Tallaght where they will operate as a single entity under one management. Already through their coming together in the MANCH hospital group, the unity and cohesion of their services is being forged and this augurs well for the future. For example, all the consultants' contracts in the three hospitals are held by a single authority — the Federated Dublin Voluntary Hospitals. This was done in anticipation of the move to Tallaght so as to ensure that when the hospital was built there would be no delay in having it fully operational.

The Meath, Adelaide and National Children's Hospitals, through their representatives on the Tallaght Hospital board and on its various projects groups, have been fully involved in the planning of the Tallaght Hospital. At this stage I would like to publicly thank the members of the Tallaght Hospital board for their dedication and commitment over the years and to congratulate them on bringing the project to tender stage without any undue delays.

In planning and architectural terms, the modular design of the new hospital will, I understand, ensure an efficient working unit, built to high technical standards. Visually, the design and lay-out of the proposed hospital will greatly enhance the Tallaght area. Most important, however, and foremost in the board's thoughts at all times were the needs of patients and staff, the people who will be actually using the facility. Again, I compliment the Meath, the Adelaide and the National Children's Hospitals for their contribution to the development to date.

As I mentioned earlier, I have been pursuing this matter vigorously since I became Minister of State. It is clear to me that in organising the future development of hospital services in the Dublin area particular importance has to be given to the needs of Tallaght which has a core population of about 70,000 people and a wider catchment population of about 260,000 people.

In comparison with other Irish towns, Tallaght is a very significant urban community and its lack of a vital amenity such as a modern hospital obviously has to be remedied. I have spoken publicly on the issue many times. Indeed, both the Minister, Deputy O'Connell, and I have been criticised by some Opposition Deputies for seeking innovative solutions to the problem. For instance, in relation to the size of the hospital, we have questioned the need for the bed provision originally proposed. That question has been conveniently misinterpreted and misrepresented as a scaling down of the hospital project. That is clearly not the case and let me explain why.

Bed norms for planning purposes were originally produced by the Department in the seventies and there was a revision of the norms in 1981. These norms were essentially derived from norms in use at that time in other countries, particularly the United Kingdom. Since then, there has been a considerable international trend towards day surgery and day activity of all types as a substitute for traditional in-patient care. For example, medical literature now indicates that up to 50 per cent of all surgery can be undertaken on a day basis.

Deputy Bruton made the point that practice has changed and that the original number of beds proposed need not necessarily stand fast and can be re-examined. I welcome that statement by Deputy Bruton tonight. I should add that others have made similar statements. For example, the general practitioners in Tallaght have said at one public meeting that I have attended in Rathcoole that the number of beds proposed need not stand fast at 600 or 700, that we could start out with 400 to 450, which would be quite acceptable to them. That is the type of contribution that was made at a public meeting in Rathcoole recently in this matter.

In addition, the duration of stay in hospital has fallen significantly and may fall still further as a consequence of more intensive utilisation of beds, five-day wards, programmed investigation units, new technology and new drug therapies. All these major changes have taken place since planning for the Tallaght Hospital first commenced and clearly they point towards a reduced need for acute hospital beds in the future.

The Minister and I have had recent meetings with the Tallaght Hospital Board, the Tallaght Community Council and the Tallaght Regional Hospital Action Group and we have explained the position in some detail. I think it would be fair to say that there is an acceptance all round that in the light of rapidly changing medical practice it would be possible to provide adequately for the hospital needs of the people in the catchment area with fewer beds than originally envisaged, but precisely how many beds should be provided has yet to be determined.

I look to the Dublin Hospital Advisory Group for guidance on this point. The advisory group, as Deputies are aware, was reconvened in December last and was asked by the previous Minister for Health to examine and report on the proposed new hospital at Tallaght in the context of the following terms of reference:

(i) To review and make recommendations on the functions, scope and scale of the proposed Tallaght Hospital, having regard to the previous reports issued by the group on the organisation and delivery of hospital care, so that the hospital needs of the catchment population can be met in the most appropriate manner;

(ii) In the light of (i) to consider and make recommendations on possible methods of funding for the building of the new Tallaght Hospital.

The group was asked to report before the end of June.

The group, which is under the chairmanship of Mr. David Kennedy, is comprised of senior health services medical, nursing and administrative personnel who are experts in their particular fields. The group have proceeded to meet with a broad range of community groups and interests as well as the hospitals mainly concerned. This consultation process is almost complete. The group are also currently actively exploring funding options.

The Minister for Health, Deputy O'Connell, made the point to Professor Kennedy's group, that those in the Tallaght area who wished to put forward their views on the project should be accommodated as early as possible. As far as I am aware the Kennedy group have met with most of the organisations in Tallght and have heard detailed submissions from them.

Mr. Rabbitte

What does "funding options" mean?

Mr. Flood

That will emerge in time. I do not wish to pre-empt the work of the Kennedy group at this stage. I am prepared to wait for a few more weeks to see what the Kennedy group have to say, taking into account the brief given to them and the submissions from the groups I mentioned.

Indeed when the Minister met the group on 27 February last, he asked that they report back quickly and in advance of the June deadline, if at all possible. I know that the group have been extremely active in the meantime and I understand they hope to be in a position to submit their report in about six weeks time.

On receipt of the group's report, the Minister and I will have the recommendations considered as a matter of urgency in the Department with a view to bringing it before Government at the earliest possible date. We have already indicated to a number of groups in the Tallaght area that once we receive the report and consider it we will submit it to the Government without delay. I am talking in terms of days, not weeks or months. That will be welcomed by those in this House who have an interest in the Tallaght Hospital project.

Mr. R. Bruton

Are the Department keeping some money so that they will be able to start it as soon as the report is on the Minister's desk?

Mr. Flood

Deputy Bruton raised that point in the course of his contribution and made a suggestion regarding this year's allocation. I will return to that later.

I would now like to refer to the role to be played by the Adelaide in the Tallaght project. I welcome the firm assurances given by successive Ministers in regard to the preservation and continuation of the Adelaide's distinctive traditions and ethos in the new hospital at Tallaght. It is right and proper that we should use opportunities such as we have this evening to specifically reaffirm those assurances. The Adelaide is a hospital with a splendid history and has been responsible for many significant developments in medicine in Ireland. More than 130 years ago, it introduced the first dermatology clinic. It was the first to introduce gynaecological clinics, psychiatry clinics and organised social services.

Anyone who has had an association with the hospital, can testify to its exceptional record in the area of patient care. This is in no small part due to the quality of its nurse training. In this regard, I am particularly pleased to repeat the categorical assurances given by previous Ministers that this tradition will be maintained in the new hospital at Tallaght and that 40 places in the new nursing school would be reserved for nurses from the "Adelaide" tradition. The Government respect and value the tradition of the Adelaide and are committed to ensuring its continuance.

The Minister for Health made it clear, in answer to questions in this House last Thursday, that he was not pre-empting the outcome of the Kennedy group report so far as the Adelaide is concerned. The Minister merely suggested that if the Adelaide wish to stay where they are he will ensure the protection of their interests and ethos. The Minister made it abundantly clear also, that should the Adelaide wish to move to Tallaght he would ensure that they would be fully facilitated.

Mr. Rabbitte

The Minister said he thought it would be a good idea if they stayed where they were.

Mr. Flood

That is not true.

Mr. Rabbitte

The question was mine.

An Ceann Comhairle

We shall hear the Minister. There is a time limit to this debate.

Minister for Health (Dr. O'Connell)

Was the Deputy present?

Mr. Rabbitte

Of course I was.

An Ceann Comhairle

There is a time limit in this debate. Interruptions are unwelcome. The Minister without interruption, please.

(Interruptions.)

An Ceann Comhairle

Deputy Rabbitte, I said there is a time limit on this debate and interruptions are particularly unwelcome if not disorderly.

Mr. Flood

If the Adelaide decide to remain where they are, the Minister and I will facilitate them but if they wish to move to Tallaght under the management structure and proposals that will emerge from the Kennedy group they will be facilitated. I am glad of the opportunity to repeat that commitment tonight as the debate on the Adelaide project has been misinterpreted. That is unfair to the Adelaide——

Mr. R. Bruton

What opened that debate?

Mr. Flood

We simply put it on the table.

Mr. Rabbitte

It was the Minister who did it.

Mr. Flood

We simply put it on the table but there was no direction. Deputy Rabbitte misinterpreted what was said. It was for them to decide and both options were made clear.

Mr. Taylor

There was never any question of them not participating.

Mr. Rabbitte

What kind of planning is that? The Minister cannot issue some kind of diktat as if he was some kind of backbencher.

An Ceann Comhairle

Please, Deputy Rabbitte.

Mr. Rabbitte

I apologise.

An Ceann Comhairle

The Deputy will be afforded an opportunity later.

Mr. Flood

It was a matter of putting one's idea on the table. Many individuals and groups I referred to have presented their proposals to the Kennedy group. I do not know what they said nor does Deputy Rabbitte. Some groups may be making a particular point about one or other of the hospitals. They are entitled to put forward their ideas and no harm is being done to the Adelaide Hospital. They can make their decisions in their own good time.

Mr. Rabbitte

There is no harm in it——

Mr. Flood

Then Deputy Rabbitte should leave it where it is.

Mr. Rabbitte

——but it does not indicate that the Department know what they said.

An Leas-Cheann Comhairle

Aire Stáit, we cannot have this tete-à-tete argy bargy or whatever it is. The Minister of State should address the Chair and he will get a more sympathetic audience from the Chair than he will from Deputy Rabbitte.

Mr. Briscoe

Listening to Deputy Rabbitte anyone would think it was his constituency.

An Leas-Cheann Comhairle

We will proceed and have a proper debate.

Mr. Flood

The two other hospitals involved in the move to Tallaght — the Meath and the National Children's — have also contributed in a significant way to the development of Irish medicine.

The Meath, which dates back to 1753, is recognised internationally for its contribution through physicians such as Graves and Stokes to the development of medical education. Whatever else we do, we must ensure that the excellent record of the Meath in relation to education and training, patient services and first class medical and nursing care is continued in the new Tallaght Hospital.

In a similar manner, the National Children's Hospital, now at Harcourt Street, has an unbroken tradition of providing care for children since 1821. It is the longest established children's teaching hospital in these islands. It has, while being small in size, played an important role over the years in a paediatric medical and nursing education and training. Moving to an area with a large child population will provide a new challenge and, as in the past, I am sure this will be met and dealt with in the same caring and professional manner.

As I said on many occasions, the challenge which faces us in relation to the arrangements for the management of the new Tallaght Hospital is to ensure that all that is valuable in the traditions of the three hospitals is successfully transferred.

When Deputy O'Hanlon was Minister for Health he was concerned that arrangements for the management of the new hospital would be agreed in advance of the development of the hospital. He was anxious to ensure that all possible obstacles to the speedy transfer of staff to the new hospital would be removed. He did not want to see a completed hospital lying idle while management were sorting out staffing arrangements. To this end, with the agreement of the Meath Hospital, Adelaide Hospital and National Children's Hospital, he established an ad hoc working party under the chairmanship of Mr. T.D. Kingston to consider a management structure which would respect the traditions of the three hospitals.

The working group were asked to consider possible future management arrangements for the new public voluntary teaching hospital, with nursing school, at Tallaght. Specifically, they were asked to consider the following management options: a management board established under the Health Corporate Bodies Act, 1961; a management board established under primary legislation providing for the establishment of a new public voluntary hospital; a management board operating under an adapted Adelaide Charter or a management board established under the Companies Acts.

The group were asked to base their proposals on the premise that the traditions and emphases of the three hospitals are valuable and must be given expression in the management arrangements for Tallaght as must the existing links with Trinity College and other teaching institutions. In particular, the position of the Adelaide as a focus for Protestant participation in the health services and its particular denominational ethos was to be provided for in Tallaght.

The report of the working group was submitted to my predecessor. While it was never the intention to publish the report, I can say that there was a broad measure of agreement on many of the management issues. There were, however, some matters on which it was not possible for the working group to adopt an agreed position. We will be asking the parties concerned to address these outstanding issues in the context of the Government's decision on Tallaght subsequent to the submission of the report of the Dublin Hospital Advisory Group.

Deputy Bruton suggested that the £40 million available to the Department of Health in 1992 for capital works should be used in part to fund the Tallaght project. He should know that the funds have already been committed to projects which are at various stages of construction. A large proportion, for example, has been spent on the new Ardkeen Regional Hospital in Waterford which will be completed in the next two years. We do not have the option to cancel any contracts.

Mr. R. Bruton

The Department could not provide me with any details. They had not decided the allocations.

An Leas-Cheann Comhairle

We cannot let this debate develop into a duologue. This is not Committee Stage. We cannot entertain interruptions if we are to achieve anything worthwhile.

Mr. Rabbitte

The interruptions are very illuminating.

Mr. Flood

We simply do not have the option of utilising any of that £40 million on the Tallaght project because it is already committed to projects under way elsewhere and contracts entered into.

Mr. R. Bruton

It indicates the Minister's priorities.

Mr. Flood

There is no point in trotting out for consumption by the people of Tallaght the message that there is an easy solution. That is giving them a misdirection. We do not have that facility. Consideration by the Kennedy group of the project and of the funding is the best way forward. We will then seek options and solutions to this very complex problem of the large amount of capital which will have to be put forward.

Mr. Rabbitte

In 1992?

Mr. Flood

People, including Deputy Rabbitte, have attended meetings in Tallaght and talked about sums of up to £6 million needed in a year. He knows from his experience of dealing with trade unions and so on that when you enter into a contract you have to see it through.

We may be talking of a figure of £118 million but whatever the figure is we will have to see it through.

Mr. Taylor

I thought the Minister said he is committed to seeing it through. Where is the problem?

Mr. Flood

Of course we are. Our commitment is a lot stronger and means a lot more than the commitment made over four and a half years by the Government which Deputy Taylor supported. That Government said "no" to every project.

Mr. Taylor

Every year that the Labour Party were in Government money was spent on the Tallaght hospital project — up to £8 million. How much have this Government spent?

Mr. Flood

I agree. A few months before the election a few bulldozers were sent in to clear the site. It was merely a type of smoke screen.

Mr. Taylor

We spent £8.7 million in Tallaght.

Mr. Flood

No money was provided for in the Estimate when the Labour Party fell out with their partners.

Mr. Taylor

Money was spent.

Mr. Flood

There is no point in trying to mislead the people of Tallaght, to whom the Deputy was so greatly committed.

Mr. R. Bruton

What about starting in 1990?

Mr. Taylor

The Minister's party have been in Goverment for years.

Mr. Flood

Every time we talk about the four and a half years during which Labour were in Government, Deputy Taylor wants to change the subject. He cannot point to a single project in Tallaght which his Government got under way or approved. I challenge the Deputy to name one. There is no regional college, no Jobstown community, no Whitestown industrial estate, no road infrastructure and no tenant purchase scheme.

Mr. Taylor

What about the hospital?

Mr. R. Bruton

When you are in the driving seat do not spend your time looking out the back window.

Mr. Flood

If Deputy Taylor wants to make points about how good his party will be to Tallaght, I have to remind him about the history of his party's involvement in Tallaght and their failure to deliver on certain commitments.

Mr. Taylor

Talk about the commitment to the hospital.

Mr. Flood

I will continue to say that and the people of Tallaght will continue to be aware of it. The availability of funds is the crucial issue. Anyone in this House who ignores that fact is living in cloud-cuckooland.

Mr. R. Bruton

The Minister has put £350 million through his hands and Tallaght did not get any of it.

Mr. Flood

When we came into office in 1987 all the capital allocations for the next five or six years were already committed by contracts which Deputy Bruton's party in Government entered into. They could not be broken.

Mr. R. Bruton

Why promise to start in 1990 if that were the case?

An Leas-Cheann Comhairle

I will not tolerate this. I will ask offending Deputies to leave the House. Think of what we are at. We are supposed to be having a debate but this is an argument. Deputy Bruton has made his contribution and the Minister of State is making his. I would suggest that the Minister of State should not be inviting interruptions from colleagues in the constituency. It might serve his purpose better. Deputy Taylor will make his contribution presently and I am sure he will look for the protection of the Chair to give him a proper audience. We will allow the Minister of State to conclude, making his own contribution.

Mr. Flood

We are committed to Tallaght Hospital. In fairness to all public representatives of the Tallaght area, the Minister of State, Deputy Harney, myself and our opponents, we want to do what we can to ensure that the project is brought forward as quickly as possible. I recognise that political points will be made in the heat of debate, but I am satisfied that all of us are very keen to make whatever contribution we can to bring forward the provision of the hospital. We know the area and its needs, which have been there for a very long time. The needs are greater than ever because of the growing population. Our commitment is to try to provide the mechanism whereby funding will be available, not only to start the project but to develop it into a hospital capable of providing all the services required in Tallaght and beyond. The Kennedy group are possibly the best option because they are looking at the scale of the hospital and the groups are saying quite clearly in various contributions that it is not necessary to have a 750-bed hospital with an impersonal operation. It is not necessary to start with a 600-bed hospital. The first phase, which we talked about originally, of 450 or 460 beds is the type of development with which we should commence.

If it is seen in the years ahead that a larger hospital is required, the question can be addressed then by those with responsibility. The people of Tallaght want to see a major hospital of 450 or 460 beds in operation as quickly as possible. The Minister and I are committed to finding a way to ensure that the project can start quickly. It is complex and costly in these difficult financial times. We are not saying that the money has to come from the taxpayer or, indeed, come from any particular source. What we are saying is that it would be a public hospital providing for the needs of Tallaght. In the meantime we are saying, as an indication of our goodwill, that we want to provide as soon as possible basic services in the Tallaght area, perhaps even on the site if that is possible. These services have been called for at public meetings which, as public representatives, we have attended in the past number of months.

The community is united behind this project. We are simply saying that the last issue to be resolved, which is perhaps always the most difficult, is the financial one. I would like to hear from anybody in this House who says that the issue can be easily solved. We have to be realistic because once the project starts we must be capable of seeing it through for three or four years construction and one to one and a half years commissioning and of providing whatever amount of money is required. Different figures have been mentioned but at the end of the day the project will require about £100 million or £120 million. That is the crucial question and that is the question that is being addressed by the Kennedy group. As the Minister for Health has said, he will have the report in six weeks time and, having considered it, there will be no delay in putting it on the Cabinet table.

Mr. Taylor

The Labour Party's amendment to the Fine Gael Private Members' motion proposes to delete all words after "hospital" on the second line and to insert the following: "and demands that the necessary capital be made available to allow work on the hospital to commence in 1992". I am disappointed, as are the people of Tallaght, that the Minister's contribution has brought nothing new to this debate. I had hoped some specific positive announcement would be forthcoming this evening from the Minister, which would have shown a clear intention to get this project moving at some stage this year, but that was not the case.

The Minister's speech is an indictment of the Government's response to the people of Tallaght and Dublin south west. At the beginning of his speech the Minister talked about the wonderful improvements that have been made in hospital services in every part of Dublin, in Beaumont Hospital, Blanchardstown Hospital, the Mater Hospital, St. James' Hospital, St. Vincent's Hospital and also in Ardkeen Hospital and others. The Minister said the jigsaw is almost complete. The piece that is missing is Tallaght Hospital.

Mr. Flood

We do not deny that.

Mr. Taylor

That is the piece of the jigsaw that is the concern and the need of the 260,000 people in Dublin south west to whom the Minister referred. It is no consolation to the people of Tallaght, Clondalkin and the surrounding areas to hear about the wonderful provisions that have been made on the north side of Dublin, in Ardkeen, in Waterford and everywhere else. It shows the scant regard the Minister and the Government are paying to the people of Tallaght and Clondalkin.

Mr. Flood

Rubbish.

Mr. Taylor

The people in these areas had hoped that as there are two Ministers in the area, a hospital would be provided. In gamesmanship terms the result could be described thus: Ministers, two; hospitals, nil. A much better result for the people of Tallaght and Clondalkin would have been: hospitals, one; Ministers, nil. That would have much better met the needs of the people.

In his speech the Minister quoted a statement of Deputy O'Hanlon when he was Minister for Health in which he said he did not want to see a completed hospital lying idle while management were sorting out staffing arrangements. I wish we had a completed hospital, even lying idle, with only staffing arrangements to be sorted out. However, we are a very long way down the road from that position.

Mr. Rabbitte

Five and a half years.

Mr. Taylor

It would take at least five and a half years. I had hoped the Minister would tell the House tonight that this project would be started considering, as he has said, that £42 million has been already committed to it. Supplementary budgets are introduced in this House when the occasion demands it. Would it be the end of the world if a supplementary budget of £5 million was introduced to get this project started? The Minister said that before the project starts one has to be committed to it. In statements and replies to questions over the past number of years — and it is years since this Government and their predecessors came to office — we have been consistently told that the Government are committed to the project. If they are so committed, why is there a problem in providing the initial start-up sum of £5 million? That provision would at least give some hope to the people of the area who are so frustrated. They would see that the commitment meant something and that it was not just talk. However, nothing is being done. All we are witnessing is shilly-shallying.

The amendment in the name of the Labour Party is based on the conviction that the last thing Tallaght needs is another report and that the time for action on this project is overdue. In my view and in the view of many people, the Kennedy report is just an excuse to postpone this project. There is no reality in it whatsoever. The Minister shifted from one side to another in the course of his speech from the Kennedy report to the number of beds and the financial provision for the project. If the Minister was honest he would say there will be no financial provision for the Tallaght Hospital now or in the foreseeable future, that it is not the policy of this Government to go ahead at this stage, or ever, with the Tallaght Hospital project and for that reason the matter is at a standstill. However, the Minister tried to sidetrack that fact. He referred to it briefly on the one hand while on the other hand he talked about revisions, the needs of the hospital and the number of beds it should have. I do not accept the point about fewer beds being required as a result of some miraculous, sudden change in technique and that this whole issue is relatively new on the scene, just as is the red herring of the Adelaide Hospital.

The Tallaght Hospital board were made up of top experts, doctors, nurses, pharmacists, professionals of every description who have been meeting on a regular basis since 1981. I was a member of that board for some years and I know the number of hours that went into the drawing up and planning of this project. Every facet of it, every need of the area and of the hospital was discussed at length. That board considered the number of beds required for geriatrics, surgery, ophthalmology, gynaecology and so on, and they knew what was needed. To hear the Minister say that the number of beds can be reduced one would imagine that the hospital needs of the greater Dublin area are up to date, that hospitals are waiting to carry out operations in the orthopaedic and other areas and that all of a sudden there is a surplus of beds.

However, the reality is that the hospital waiting lists for all departments are as long as one's arm and are getting longer, even though the Minister may be revising the lists for his own purposes and might achieve some reductions in that regard. Every bed provided in accordance with the plan for the Tallaght Hospital would be fully used. Perhaps some of them could be used to reduce some of those very long waiting lists that are such a penance, which for many people are a question of life and limb, people who have been waiting a very long time, many of them in pain, for very necessary operations. For those people the suggestion that the hospital would have a surplus of beds will sound very hollow; in fact, they will be very distressed and extremely annoyed.

The issue of funding has been mentioned. One of the briefs given to the new committee — yet another committee — is to advise on the funding for the hospital. I must confess that, in that regard, I am puzzled in the extreme. Why is the Minister for Health asking an outside committee, the Kennedy committee, to advise on the way this public general hospital, designed to serve an area bigger than Limerick, should be funded? The way to fund a public general hospital is through Exchequer resources.

The Blackrock Clinic and other private clinics may have certain arrangements for funding, different schemes, bonds and so forth — I do not know what they do — but a public general hospital is funded from the Exchequer. This idea is just another ruse, another red herring, another sidetrack.

For all of the ten years in which the hospital board existed, working hard and with dedication — including representation from all hospitals, including the Adelaide Hospital — there was never a suggestion that the Adelaide Hospital would drop out, would not participate or was not willing to be actively involved in the Tallaght Hospital project. The position of the Adelaide Hospital was the reverse. The Adelaide Hospital was keen, anxious and eager to be involved. The suggestion that the Adelaide Hospital should drop out and be retained as a smaller hospital was thrown in as a red herring. None of this has any meaning.

The planning for the hospital project was done at great length. I have seen the book of quantities, it is a three inch thick publication and the effort that went into it was enormous. The book details the smallest of items. In 1989 or 1990 when the work was done, a competition was held to provide for the hospital. We saw the magnificent drawings that came in and were developed. Everything was ready and we were prepared to invite tenders. To date, £8.7 million has been invested in that work. The Government then decided to put the project on the backburner, using such provisions for the Tallaght Hospital in the Department of Health budget for other projects.

It is not that there is not the money to build the Tallaght Hospital; there are substantial funds available to the Department of Health and if the Department, the Minister and the Government — and it is a Government matter — are minded to provide the £5 million necessary for start up in 1992, then there is no problem. I am giving a commitment on behalf of the Labour Party that if a Supplementary estimate for the £5 million were introduced, we would have the greatest pleasure supporting it. I am sure that Fine Gael and the Democratic Left also would have no problem with that.

It is a matter of priorities; it is a question of whether the Government regard the building and construction of the Tallaght Hospital as a priority. If the Government gave the project top priority, then they could and would construct it and at this late stage they would not again be shifting the matter off to the Kennedy committee or any other committee. After all of the work that has been done and all the planning that has been provided, the Government do not need to look for any other studies or reports — they are unnecessary. The work has been done, and with tremendous effort. Many specialists, GPs and hospital and nursing representatives assembled at meetings, month in and month out, and a great deal of material went into providing a very fine hospital plan, which is a very costly thing to produce. The work has already been done. It is ready on the table for the Minister if he wants to use it and start construction, which is what I hoped he would do.

Last week the Minister for Health chose to involve himself in a controversy with his rather simplistic and dangerous approach to the issue of heart by-pass surgery. That approach is all too familiar to the people of Tallaght who have been by passed for the past decade. This time no pill, even if it is sugar coated, will address the very considerable and entirely legitimate sense of grievance these people feel.

Every Minister for Health has accepted the unanswerable case put forward by the people of Tallaght for a major regional hospital. Only last December the former Minister for Health, Deputy O`Rourke, recognised Tallaght as the biggest hospital priority in her area of responsibility. Despite her recognition of that fact, she decided not to spend one penny extra. Instead, she offered to undertake two more studies. The people of Tallaght do not want any more reports or studies.

Already there are copious reports instigated by various Ministers for Health. The people of Tallaght recognise those reports for what they are — delaying tactics by a Government that, I am sorry to say, appear to have no intention of building the Tallaght Hospital in the foreseeable future. That is the nub of the issue. The Government attempt to pay little more than lip service to the people of Tallaght, on the one hand by acknowledging that there is no area in the country with a greater priority and, on the other, refusing to respond to its legitimate demands.

Ten years ago there was a proposal to establish an outpatients clinic in Tallaght. That proposal was agreed by the Department of Health in 1982. The Minister will find all the information in the files if he cares to look. The hospital was to have been managed jointly by the Meath Hospital, the Adelaide Hospital and the National Children's Hospital and was to have been funded by the Department. Now ten years later, the Minister of State, Deputy Flood, is still talking about outpatients' departments and service.

It seems almost as if time has stood still in the Department of Health but time has not stood still in Tallaght. The population of the area has grown and disadvantage has become a feature of daily life. This disadvantage has been compounded and exacerbated by the complete absence of Tallaght from the Government's list of priorities.

The Minister talks about money and providing funds, but in the 1992 budget this Government showed where their true commitment lay. In that budget the Government saw fit to reduce the top rate of income tax by 4p in the pound. That will cost the Exchequer £60 million in a full year and every year from 1993 on.

Had the Government decided to make health a priority in their 1992 budget they could have used the £60 million towards developing a full hospital service for the people of Tallaght. The Tallaght site development was initiated in the early eighties to provide essential hospital services for the 150,000 citizens of Tallaght and surrounding areas. As we know in the 1992 Health Capital Programme, there was no provision for the Tallaght Hospital. However, since 1982 when the project was originally approved, £8.7 million has been spent on the development of Tallaght Hospital.

Debate adjourned.