Dáil Éireann debate -
Wednesday, 4 Mar 1998

Vol. 488 No. 2

Adjournment Debate. - Hospital Services.

Mr. Gormley

I am glad to have the opportunity to debate this important issue for the city and particularly the people in my constituency of Dublin South-East. The area is about to lose three hospitals — the Adelaide Hospital, Harcourt Street Children's Hospital and the Meath Hospital. They will be replaced by the new Tallaght Hospital in June. Tallaght undoubtedly needs a new hospital, but so does the south inner city.

When the policy decision was made in the 1970s, Dublin was a different place. The planners had a different vision of what a city should be; cities were places where people worked and conducted business and people aspired and were encouraged to live in the suburbs and to commute to work. We witnessed the decline of the inner city population and the consequent spread of the suburbs. However, that vision has changed radically. The planners and politicians want to create a living city. People are now actively encouraged to live in the inner city, yet at the same time they are deprived of essential services.

Since this policy decision was first mooted the population of Dublin 8 has increased one and a half times over to 30,000, roughly the same size as that of Leitrim. Many new families are moving into the area, yet there is no hospital for them or for their children. It is a devastating blow for a vibrant and growing community, and these people are justifiably very angry about successive Governments' failure to plan adequately for the future health needs of this area.

I have no doubt that if the Government proceeds with the decision to close these hospitals it will be a very costly mistake. It is illogical, short sighted, irresponsible and even dangerous to close down hospitals in such a populated area. Have we not learned from the mistakes of the past? Tod Andrews closed down the Harcourt Street rail line and boasted about it. It seemed like progress then but now we regret that decision. Now we wish to build the expensive Luas system at enormous cost. We built Ballymun flats and now we wish to demolish them. This decision falls into the same category and I urge the Minister to think long and hard before closing down these hospitals, particularly the Meath. The Minister's reply will no doubt refer to the conclusions of the Working Group on the South Inner City Primary Care Needs Assessment, which was completed in March 1997. It identified the problems likely to arise following the relocation of the Meath, Adelaide, and National Children's Hospital to Tallaght. It recommended the establishment of a primary care centre and the enhancement of general practice and community services in the south inner city. The working group recommendations included the following: a minor injuries unit, an out of hours on-call centre, public health nursing facilities, anti-coagulation clinics and in-patient beds for respite care. In addition, the Eastern Health Board has identified the following health service requirements for the south inner city including a 50 bed unit for secondary rehabilitation for the elderly in particular. All of these services could be provided on the Meath Hospital campus. The recommendations of the Eastern Health Board and the working group look good on paper and some are welcome, but it states categorically that acute hospital services are to be provided only from St. James, St. Vincent's and the Mater Hospitals.

This is not good enough and is unacceptable to the people who live locally. An acute general hospital with all the necessary facilities and equipped with the latest technology is needed. How will a minor injuries unit be able to deal with a child with meningitis or an elderly person who has just has a stroke or heart attack? I ask the Minister to reassess Government policy and to intervene before it is too late. I refuse to believe that this decision is irrevocable. At a huge public meeting in the Olympic Ballroom it was suggested that if this was in the Minister's constituency, action would be taken to reverse the decision. I agree with that conclusion.

There is cross-party support at local level for the retention of the Meath Hospital. However, the buck stops with the Minister. I appeal to him given his compassion and common sense to rethink this retrograde decision.

Ms Fitzgerald

There is an urgent need to review the hospital service for the south inner city area of Dublin. There is enormous local concern about the closure of the Meath, the Adelaide and Harcourt Street Children's Hospital when Tallaght Hospital opens in June this year. The decision to close these hospitals was taken many years ago. I welcome the opening of the Tallaght Hospital, which is desperately needed. However, the impact of the closure of the three hospitals on the inner city must be urgently examined. It is abundantly clear that the health needs of adults and children in the area cannot be met if all three hospitals close completely. Local concern has been expressed by 11,000 people who have signed a petition urging that services remain in the area.

Why is another evaluation necessary? The following factors make retention of the services compulsory. The area has the largest elderly population in the entire country. There is huge concern that the elderly people with little mobility, and often little finance, will not be able to travel far outside their own area for the medical help they need. An appropriate service must be developed to meet the needs of this vulnerable group.

The local population want to retain an acute hospital in the inner city. An immediate and urgent review of the health, medical and emergency care needs of that population is merited prior to the hospitals' closure given that 18 per cent of the children in Dublin 8 are under 15, which is twice the Eastern Health Board figure. I am concerned that the closure of Harcourt Street Children's Hospital means that a huge number of families will not have easy access to emergency medical services in the area. This will impact on the most vulnerable families, given the lack of public transport and the cost of taxis to go to Tallaght. Neither Crumlin nor Temple Street Children's Hospital are in a position to respond to this, and a service for these children must be put in place in the inner city. The Minister should meet the board of Harcourt Street Hospital to discuss the type of services necessary and how those are to be provided. He must put those services in place.

If we are serious about the rejuvenation of the inner city and getting young families to move to the area — as seems to be happening given the statistics — then we must have appropriate medical care accessible to that population. If the population is to have their medical needs met, a range of services must be left intact in the inner city.

Minister of State at the Department of Health and Children (Mr. Fahey)

I am grateful to Deputies for giving me this opportunity to clarify the situation regarding the closure of the Adelaide, the Meath and the National Children's Hospital and the opening of the new hospital in Tallaght. I acknowledge the continuous representations of Deputy Eoin Ryan since I took office last July. He has been in constant touch with the Minister and me with regard to local concerns about this issue.

As Deputies will no doubt be aware, June 21 1998 has been set by the board of the Adelaide and Meath Hospitals Dublin, incorporating the National Children's Hospital as being the opening date for the new hospital in Tallaght. The state of the art facility will serve the large population in Tallaght and its surrounding areas who up to now have had, in many instances, to travel considerable distances for hospital care.

I have been assured that by June 21 the Adelaide Hospital and the National Children's Hospital will have moved to Tallaght and, with the exception of 76 beds for specific programmes, the Meath Hospital will also have moved to Tallaght by that date. It is intended that the acute psychiatric facilities currently provided at St. Loman's Hospital will transfer to the new hospital at Tallaght before June 21.

Since agreement was reached on the development of the new hospital in Tallaght, it has always been understood that the three constituent hospitals would close once the new hospital is opened. As the Deputies will be aware, the Adelaide, the Meath and the National Children's Hospital are voluntary hospitals and as such have full ownership of their sites. When the services transfer to Tallaght, the hospital sites will be sold as the premises will no longer function as acute hospitals.

My Department, together with the Eastern Health Board and the hospitals concerned, have been examining the health service needs of the south inner city catchment population following the transfer of the acute hospital services to Tallaght. A range of services for older people in the area is being provided by the Eastern Health Board. A 25 bed community nursing unit which has respite, extended care and day care facilities, is operating at Sir Patrick Dun's Hospital. A 50 bed community nursing unit which will provide similar services is due to open on Monday next, 9 March, at South Circular Road. In addition, St Monica's, a 45 bed long-stay unit at Belvedere Place in the North inner city, is due to open at the end of this month. Proposals are also being developed by the health board to provide secondary rehabilitation, extended care and day hospital facilities for older people living in the South inner city. The possibility of acquiring the Meath Hospital campus for these and other primary care services is being examined by the Eastern Health Board. More than 20,000 of the accident and emergency attendances at St. James's Hospital come from areas which will be served by the new hospital at Tallaght. This is greater than the existing accident and emergency attendances from the inner city areas at the Meath Hospital. A similar situation exists with regard to out patient attendances.

The factors which determine the levels of patient attendances at outpatient and accident and emergency departments are complex and difficult to predict with any certainty. However, I am satisfied that St. James's Hospital, given its excellent record in innovative health care planning will, in association with the other health care providers in the city, continue to meet the needs of the South inner city population following the opening of the hospital in Tallaght.