Dáil Éireann debate -
Thursday, 22 Oct 1992

Vol. 424 No. 2

Ennis (Clare) General Hospital.

Mrs. Taylor-Quinn

I thank you, a Cheann Comhairle, for allowing me to raise this very serious matter on the Adjournment.

It is with great regret that I again stand in the Dáil this evening to raise the matter of the crisis that exists in Ennis General Hospital. At that hospital there are now the unprecedented circumstances of only 66 beds being provided in a hospital that had 128 beds in 1987. The complement of beds is just over half what it was five years ago. The result of the reduction of beds is that the people of Clare are faced with the serious problem that they are not receiving a proper hospital service within their county because there are not adequate beds to provide that service. Terrible hardship is being imposed on people from all over the county. Some of those who get to the hospital have to stay overnight in casualty — some on beds and some on stretchers — because there is no bed available for them in Limerick. There seems to be some kind of a hidden agenda to get as many people from the Clare area into hospital in Limerick. I hope that the Minister is in a position to clarify those apparent health board tactics. I would be grateful if he could clarify that aspect.

The people of County Clare find it most unacceptable that males and females are mixed together in accommodation in the male medical ward. Absolutely unbelievable conditions exist in that ward, with sick men and sick women occupying the same ward.

In addition, because of understaffing at the hospital, the staff are overstretched. I do not know whether the Minister is aware that industrial action was planned for this week. At the last minute that action was called off because negotiations with the health board were taking place.

Conditions at Ennis General Hospital are at a critical point. I do not understand the way in which the Government can stand back from the problems in such a cool, removed fashion. The Minister for Health must be aware that in 1989 his own party and the Progressive Democrats gave a firm commitment to the people of Clare that if they were elected to Government they would provide 100 acute hospital beds in Ennis General Hospital. The kind of rhetoric now coming from the Department of Health and the health board stating, as the Minister stated in reply to a Dáil question put down by me this week, that the hospital will continue as an integral and important part of the general hospital service in the Mid Western Health Board area is not satisfactory. I should like the Minister to elaborate on that statement. What kind of integral and important part will the hospital continue to play? Do the Minister, the Department and the Mid Western Health Board believe that the provision of 66 beds is an important and integral part of that service? I put it to the Minister that the people of Clare do not believe that to be an important and integral part of the general hospital service; in fact, they know it to be a completely inadequate service.

I know that the Minister visited the hospital recently. Unfortunately, in the course of that visit he was very carefully steered in certain directions by hospital personnel who accompanied him. I ask the Minister to visit Ennis General Hospital unexpectedly some evening or some morning. He should let no one know he is coming and just walk in through the back door of the hospital. Just walking around the Minister would see something that he would not believe could possibly be happening. I speak particularly of the people in casualty staying overnight on stretchers and of having males and females mixed in one medical ward, which is completely unacceptable in 1992.

During the week the Mid Western Health Board released a press statement which advised that the board were seeking the provision of a new health centre, an acute psychiatric unit and a new outpatients' department established around the existing hospital. Right now the people of Clare are not interested in that kind of detail. What the people of Clare are interested in is the provision of 100 acute beds in Ennis General Hospital.

I appeal to the Minister this evening to deliver on the promise made by his party, by the Progressive Democrats and indeed by Fine Gael before the 1989 General Election. The only difference is that Fianna Fáil and the Progressive Democrats are in Government; Fine Gael are not. The Minister is in a position to deliver on those beds. I appeal to him, as a Minister with knowledge of health, to recognise the crisis at the hospital. County Clare is a very large county with a huge hinterland. Some people live as far as 70 miles away from Ennis. For those people to get to hospital in Limerick they have to travel up to 90 miles. The situation is completely unacceptable and I ask the Minister to have the position reviewed and to tell the House this evening when the 100 acute beds will be delivered in Ennis.

Dr. O'Connell

I am very glad that Deputy Taylor-Quinn has raised this matter. I am happy to be provided with this opportunity to allay any fears people may have in relation to the acute services at Ennis General Hospital.

The position is that bed management is an important feature of hospital resource management and involves the closure of beds at times of the year when demand is lower and when many staff take holidays. That practice is not unique to Ireland; it happens in many countries. It is a feature of many hospitals. As part of planned seasonal closures, Ennis General Hospital reduced its bed numbers to 68 in-patient and six day-beds with effect from 1 July 1992. Arrangements were put in place whereby any patients requiring hospital admission which would result in that number of beds being exceeded were referred to Limerick Regional Hospital. I am informed that the number of people whom it was necessary to admit to Limerick Regional Hospital has been quite small — on average, two a day. Some of these patients would, I understand, have required admission to Limerick Regional Hospital in any case.

During the summer, the pattern of admissions changed from that in previous years and the closed ward was re-opened on a number of occasions. This coincided with the peak annual leave period. As a result, expenditure for July and the number of temporary staff required for the summer were considerably higher than had been projected.

The situation in relation to the reopening of the female medical ward in Ennis is being kept under review by the health board on a daily basis, having regard to the demand for medical beds both in Ennis and the regional hospital, Limerick. Based on past experience of patterns of demand, it is anticipated that it will be necessary to re-open the ward in the coming weeks. This will bring the bed complement to 88 in-patient and six days beds, a total of 94.

Staffing levels at Ennis General Hospital were arranged to coincide with the number of beds open. I understand that nursing personnel threatened industrial action earlier this week. However, I am happy to inform the House that agreement was reached between the health board and the unions concerned. A joint review group will be established to consider the nursing requirements of the hospital in relation to the resources available to the Mid-Western Health Board.

I would like to further state that it is the policy of the Mid-Western Health Board that the mixing of patients of different sexes in the same area should be avoided where possible — I indicated my disapproval for mixed when I was in Clare — except in those departments which have been designed to operate on this basis; these are the intensive/ coronary care unit, the elderly care unit and the day unit. These are expensive units and I can understand that it would not be possible to have two in every hospital. Occasionally, however, the urgent demand for beds for one of the sexes exceeds the number available and it may become necessary to accommodate patients of both sexes in the one area. I have to confess I disapprove of it. I have been assured that this is kept to an absolute minimum and that every effort is made to respect the dignity and privacy of patients and to ensure that any mixing takes place for the shortest period necessary. The ward areas in which patients of both sexes are accommodated from time to time have recently been upgraded and refurbished. This work included increasing the bathroom and toilet facilities. The beds are individually curtained.

Finally, in relation to the future of Ennis General Hospital, I would like to emphasise that in 1988 the Mid-Western Health Board approved a strategy for the future of the acute hospital services in the region. This included, inter alia, a decision that Ennis General Hospital would continue to provide acute medical and surgical services. There has been no change in this strategy.