Do I take it that Senator Connor would prefer to have the Minister here for the Adjournment matter?
Adjournment Matter. - Castlerea (Roscommon) Hospital Closure.
Yes. I do not know if the Chair has the power to send a message.
I have no machinery. It is not my job. I suggest you talk to your own Whip.
How long am I allowed to wait until the Minister attends?
I do not know.
I am wondering about your patience.
I am safe, thank God.
Is the fact that the Minister is not present an indication of the lack of concern on the part of the Government in relation to this motion?
That is not fair, Senator.
On the Order of Business today, the time given for the Adjournment Matter was 4.30 p.m., or earlier. It is understandable that the Minister may have felt that the debate on building land and on the other matters we discussed today would have gone the full length of time allotted to them.
The onus is on the Leader of the House, not on me. There is nothing I can do about it.
Is there any indication whether the Minister is coming?
No, but he actually will come now.
I raise this issue of St. Patrick's Hospital in Castlerea in the light of the recent announcement to close it at the end of 1986. First of all, I am delighted that the Minister for Health is present. Senator de Brún and myself are both public representatives who live in the area. I am delighted the Minister is present to hear our point of view as to why this hospital should not be closed. At the outset, I would like to say that this is a totally unacceptable proposal and I hope in the course of this short submission and strong assertion of mine to show why the hospital should not be closed and I hope to make the point well for its continued operation.
St. Patrick's Hospital in Castlerea is incidentally the newest psychiatric hospital in the country. It was built in 1943. Like most hospitals, it is located in a most pleasant wooded parkland. It is well away from the local town of Castlerea and the local roads system. In every way its ambience and location give it a very appropriate setting for such a hospital. It is probably one of the most appropriate settings for a hospital that one could find anywhere in the country. This can be seen as part of the therapy of treating people with mental illness.
At the moment, there are about 233 patients in the hospital. Through the community care system operated by the hospital and the general admissions, patients who come and go during the year, in those two categories, there are approximately 700 people linked directly or indirectly to or dependent upon this institution.
St. Patrick's Hospital, unlike many of our psychiatric institutions, has operated a very enlightened and progressive policy in relation to patient rehabilitation by the medium of community placement. At the moment, there are about 100 patients being looked after in the four day centres and one day hospital operated by St. Patrick's. The day centres are at Roscommon town, Strokestown, Boyle and Ballaghadereen while the day hospital is located in Castlerea itself. In addition, there are at least 15 patients who are allowed home to their relatives under a very flexible time arrangement. Some of them may stay for weeks with their relatives. Some may stay for a day or days or whatever is appropriate. This is an enlightened approach by the hospital authorities in the way they allow patients the freedom to come and go where they know there is proper relation care, and it is also sensitive to the needs of relations in that it is flexible about the time. Patients can come back to the hospital at weekends and they can stay several weeks if that is appropriate.
St. Patrick's was one of the very few hospitals in the country which speedily carried out a full survey of its patient population. Broadly speaking, this survey arrived at the following conclusions. About 100 of the patients were deemed to be capable of or have a potential to be placed outside the institution in community care. This, of course, would be a very slow process. About 33 of the patients are mentally handicapped and they would be better placed in a hospital or in an institution with better facilities for looking after mentally handicapped people. There was a small number who might be capable of being placed in a conventional geriatric home. The remainder, well in excess of 100 patients were deemed to be psycho-geriatrics. They would be unsuitable for moving because of their age — most of them are over 65 years and some are in their eighties — and because of their identification with the hospital as their home. This is very important. Those people, because of their long stay in the hospital, have no home within their memory other than St. Patrick's. Disturbance of these patients would have to be seen as an unacceptable proposal because of the trauma this would bring to these unfortunate people. One has to be very sensitive, and no doubt the Minister fully recognises this, especially in the way psycho-geriatrics are handled. They are very vulnerable and naturally very sensitive to the slightest changes in their lives. Even a small change in their lives can have a deleterious effect on them.
Of course, we cannot lose sight of the fact either that moving those patients would cause major hardship upon their relations. As I say, many of these people are old; their relatives are also old, and it is often with great difficulty that they can get, I may say infrequently, to Castlerea to visit them. If they were to be moved to Ballinasloe or Castlebar, both towns are at least 40 miles away and for most relatives that would impose that extra distance in terms of travelling to see them. I would submit to the Minister that this would be a totally unacceptable imposition and hardship both on relatives and on the patients themselves from the relative/patient point of view.
I should like to go back to the more general and particular reasons that are germane in my argument for keeping this hospital open. To say that the hospital population fell from 388 in 1971 to 215 now and to use this as a good reason to close it, is in my opinion, spurious. All mental hospitals in that decade and a half had the same experience of a falling population because of the move away towards community placement and so on. The number of people and patients linked to and dependent upon this hospital is greater now than it was in 1971 because the catchment area in which St. Patrick's Hospital operates has a population of about 48,000 people in it. This area has the highest incidence of mental illness found anywhere in the country, and, many experts say, anywhere in Europe as has been proved in a number of surveys. If we had total figures, it might be one of the worst black spots for mental illness in the whole world. We do not know. It is a significant statistic. It is a significant fact that this hospital is located in an area with this particular unfortunate statistic about it. That is a high incidence of psychiatric illness.
I have been speaking in laudatory terms about the back-up service which Castlerea has operated but, of course, I have been speaking relatively. It is very good when compared with the community back-up service operated out of other psychiatric institutions in the country. The fact is that the community care services out of this hospital are, like everywhere, greatly underdeveloped and in many cases inadequate. For that reason the closure of the hospital could not be contemplated or cannot be contemplated until a proper community care service is built up with buildings, properly trained staff, transport and all that that entails. That would take not months but at least years.
Let me look at the four centres which operate from St. Patrick's. The centres at Strokestown and Ballaghadereen are about adequate for what they have to do. The numbers that have been placed in them are relatively small as yet but they are just about adequate. They leave a lot to be desired but they would be, in the general description, about adequate. The centre at Boyle is regarded as being barely adequate. There is a new centre at Roscommon which many people believe and, indeed, I would agree, is not adequate or suitable. It is the old gate lodge of the county home in Roscommon. It is in the wrong location. This has been reconstructed but it is not the right kind of centre because there should have been a suitable new building in a much better location provided in Roscommon town.
The Senator is getting away from the motion.
I have to suggest that I am talking about St. Patrick's Hospital, and the day centre at Roscommon is a spoke, if you like, going out from the hub of St. Patrick's Hospital in Castlerea.
It is not being closed.
It is not being closed but I am talking about the fact that it is inadequate and before you could talk about closing the hospital you would have to provide an adequate service in Roscommon because Roscommon is the largest urban centre in County Roscommon which has a natural drawing effect to a very large proportion of the population of County Roscommon.
Another interesting fact about St. Patrick's Hospital is that in recent years. out of the capital programme — I think you call it the small capital programme — provided by the Department of Health and operated by the Western Health Board for improvements in this and other hospitals there have been several significant improvements carried out in this hospital. In the speech on Tuesday night in the Dáil by the junior Minister the point was made about inadequate toilet facilities and I think inadequate kitchen facilities in St. Patrick's. That cannot be true because a significant amount of money has been spent in recent years on providing new toilets and new kitchens adjacent to each ward in St. Patrick's. Surely if these things were well planned, they should not be described as unsuitable now. It is also interesting that recently 300 new windows have been replaced in St. Patrick's, no doubt costing tens of thousands of pounds. One must surely question the wisdom of spending in recent years sums of money that must have run into at lest six figures on upgrading the hospital from a structural point of view at least and now it is proposed to close it down. Surely there is great lack of policy and great lack of any kind of foresight in that kind of thinking and certainly in that kind of action.
There is also a relatively new industrial therapy unit at Castlerea. That was opened in 1975. That is also an important part of the service which is offered by St. Patrick's Hospital. I am aware that I am already more than 15 minutes into my time and I have to allow some time for Senator de Brún. I have not had time to make all the points I would like to make to the Minister about the matter. No doubt my colleague will have more to say. I appeal to the Minister because I see no good case for closing this hospital. It has operated well and efficiently. Granted, it is one of the smaller hospitals in the Western Health Board region but that does not necessarily mean that it should be closed for that reason. When people talk about its 250 patients and say there is a relationship between the number of patients in the beds in the hospital and the number of staff, that are around one-to-one, it is not a fair comparison because you have to think in terms of the total patient population which is related to, linked to or directly dependent upon St. Patrick's Hospital and that figure is more like 1,000 than 250. There were about 400 admissions — people who were coming and going — in the 1985 to St. Patrick's Hospital. The amount of manpower that it takes to look after that kind of activity is quite large.
I ask the Minister to reconsider his proposal in this case very carefully. There are the economic side effects for the town of Castlerea which I know the Minister for Health is not directly involved in but believe me it is a major economic blow to the community there. I will not go into it because I am talking to the Minister for Health. I am making the point purely for good health reasons and good psychiatric health care reasons that the hospital should not be closed. There is a widespread feeling abroad that this hospital is being closed to allow resources to be released to open the new mentally handicapped centre at Swinford. I submit to the Minister that that is an unacceptable proposal also.
Naturally, we want to open the centre at Swinford. I fully agree that we should move the mentally handicapped patients in Castlerea to a centre like Swinford because it was specially developed and built for that purpose but the long stay patients in Castlerea are entitled to have their hospital there. The hospital has gone along with modern trends in psychiatric treatment and has evolved along the community care idea. It has operated a very flexible policy in the way it looks at its patients and in allowing them home and so on. I hope the Minister's decision is not a final decision. To close this institution is wrong. It is not based on the right facts and I sincerely hope that it is not based in any way on any economic fact of having to close one hospital to open another.
Senator de Brún.
I should like to say, first of all, that I had a gentlemen's agreement with Senator Connor that he would allocate me 50 per cent of his time. I do not think he has done so but, however, I hope the Cathaoirleach will be lenient with me in my contribution.
I am glad to have an opportunity to support this motion calling on the Minister for Health and the Government to reverse the decision to close St. Patrick's Psychiatric Hospital in Castlerea. I need hardly say that the Minister's announcement to close this hospital came as a profound shock to everybody. The manner in which it was announced was both insensitive and offensive, in my view. It is inconceivable that any Minister or Government would come to such a far-reaching decision without prior consultation with the various agencies responsible for the administration of the hospital, namely, the Western Health Board, the chief executive officer of that board and the senior psychiatric person at the hospital. No such consultation took place. This unilateral action by the Minister is surely without precedent. It also shows a total disregard for the unfortunate patients, especially patients afflicted with mental illness.
As one who lives in Castlerea I sincerely assure the Minister and his Government that the patients have not yet recovered from the shock of learning over the airways, that their hospital was to be closed. Some of them are there for 30 years or more and regard the hospital as their home. To be told that they are to be transferred to other institutions or even sent to community care must be a traumatic experience. It is an experience which they will not easily overcome.
There are three elements inherent in the closure of any hospital. One, the patients, two, the nursing staff and general workforce and, three, the economic consequences to the community in the environs of that hospital. Obviously, the most important of these is the well-being of the patients. What is best for them must be the primary consideration of all. But the staff and workers also have rights and they must be given serious consideration. They chose mental nursing as a career and have dedicated themselves to caring for the most vulnerable section of our community.
A closure of the hospital will entail redeployment and disruption of homes established for quite some time. These are considerations that must be respected and considered. The economic consequences to Castlerea which would result from the closure of the hospital need not be elaborated on. It would have a crippling effect on that town.
There are many cogent reasons why Castlerea Hospital should be retained. It is a comparatively new hospital, built for psychiatric treatment only 45 years ago. It is a very fine building of cut stone and will bear examination to that effect any day of the week. The catchment area for which it provides has the highest incidence of mental illness and schizophrenia in Europe. A varied programme of mental treatment is operated there. That programme includes an industrial training centre, a reform training centre and a centre for dealing with the treatment of alcoholism.
The senior psychiatric consultant at the hospital has advanced the view that the hospital should be retained as at present and in view of the circumstances in the catchment area it could be gainfully developed as a research unit for psychiatric treatment generally.
For all the foregoing reasons, on behalf of the patients, the management and the staff and the people of Castlerea — in which town I live — I strongly protest at this totally unjustified decision to close Castlerea Hospital. Accordingly, I call on the Minister and the Government to reverse this decision which is a grave injustice to the most vulnerable section in society.
It is heartening to know that I am not alone in making this demand. I am aware that there is general opposition by Oireachtas Members not only to the closure of Castlerea hospital but also to the closure of St. Dympna's Hospital in Carlow.
As of now neither the Minister nor the Government are empowered to close hospitals. This requires new legislation which will, presumably, be introduced in due course. When that time comes I hope the Members of the Oireachtas generally opposed to the closure of these hospitals will demonstrate that opposition by voting against the proposed legislation and by so doing defeat the decision to close the hospitals. I hope, particularly, that Senator Connor will act similarly when a more composite motion relating to the closure of the Castlerea Hospital will be brought before this House in the very near future. Have I exceeded my time?
It is running out.
It was my intention to share my time with my constituency colleague, Senator Mullooly——
I would like to put on record my support for my colleagues, Senator Connor and Senator de Brún, in their opposition to the closure of St. Patrick's Hospital, Castlerea.
I thank the House for the opportunity to reply to the debate. The report on Planning for the Future was drawn up by professional psychiatric and administrative officers of the Department of Health and the health boards. I would urge all Senators and Members of both Houses of the Oireachtas to read that report. If one takes a glance at the references in the report they will show that there is a very extensive range of authorities quoted by them, in this country and elsewhere, who fully support their recommendations. The study group was set up a considerable time ago in 1981 and the report was published by the Government in late 1984. In their introduction they said:
What is required now is a programme to implement these recommendations in all parts of the country. This programme should be initiated without delay so that mentally ill persons can benefit from an effective and progressive service.
I strongly hold the view that for too long the psychiatric services in this country had not received the attention from successive Ministers for Health that the services merit. We had a commission of inquiry which reported in 1966. It made many recommendations. These are echoed again and further developed in the 1984 Report. In the past 20 years there has been some progress in following the earlier recommendations. I strongly hold the view that in relation to our psychiatric services — 12,000 in-patients, 12,000 beds, in 22 psychiatric hospitals — there could have been, there should be and there must be far greater progress in implementing long-awaited recommendations. My only regret is that in the past three years, due to the pressure of a great deal of work in the Department, I have not had the opportunity to devote myself — to an even greater degree — to these recommendations. I do not intend that they should suffer the same fate as previous recommendations and the recent report should start to be implemented.
I do that because in my adamant view the best interests of psychiatric patients, which must come first, require that I press ahead with the necessary changes, even in these very difficult and controversial circumstances. I intend to do so in the certain knowledge that I will introduce changes which will meet the needs of those who must be our first concern above all else, the patients in these hospitals.
Senator Connor and Senator de Brún referred to St. Patrick's Hospital in Castlerea. It was built in 1943 with separate male and female blocks. As the House knows, it was used in the late forties and early fifties for about seven years as a TB sanatorium. Then it reverted to a psychiatric hospital. The patient population in the hospital has dropped steadily over the years, from 414 in 1965 to 336 in 1975, down to 251 at the end of 1984 and now we have 226 in-patients. That is a very substantial drop; even in the past decade there has been a drop of 110, almost 50 per cent.
There is a very large number of staff involved. That point has been made. There are 273 staff. Last year the budget was £4 million. The pay side of that budget was £3.3 million and the non-pay was roughly £700,000. The breakdown of staff was eight medical, 162 nursing and allied, five para-medical, 51 catering and housekeeping, 24 maintenance, nine clerical and administrative, nine other grades of staff and five locums, making a total of 273 as of 31 March 1985. That is the situation. I hold the view, and it is not a personal view and I assure everyone here it is not a political view but it is a view advised to me by my senior professional staff, that the hospital now, like its predecessors and the TB sanatorium is in a setting where we can provide more modern and more effective treatment methods which are now available and that the hospital is not suitable for the particular psychiatric treatment model which we want to introduce.
I make the point that 75 per cent of the patients have been in the hospital for about five years or more. That is general confirmation of the point made by Senator Connor. In common with other hospitals the entire in-patient population of Castlerea was recently assessed with a view to implementing the recommendations of Planning for the Future. We had to determine the needs of patients in that regard and patients come first. That assessment is an interesting assessment, one which enables us to have very detailed discussions with the Western Health Board. As Senator Connor pointed out, there are 33 persons assessed as relating to the mental handicap services. When one looks at the figure of the 1981 census of 172 mental-handicap persons in St. Bridget's in Ballinasloe, 45 in 1981 in St. Patrick's in Castlerea and 104 in St. Mary's in Castlebar, a number of questions arise.
How and why did we, as a society, all during those years put mental-handicap patients into psychiatric hospitals? It is not good enough to say that we did it because we had nowhere else to put them. They should never have been in there in the first instance. Now I want to take some of the 33 remaining out — not necessarily all as one can have a geriatric situation equally in mental handicapped persons — and I want to bring them over to a brand new £12 million mental-handicap residential centre with 190 vacant places at the moment. We spent £12 million building it and now that I want to use it there is adamant opposition to the transfer of those patients, but we cannot have it both ways. Patients will be transferred out of St. Bridget's, St. Patrick's and St. Mary's. Not all will go but a substantial number could, in my view. There will be staffing arrangements and the budget for them must also transfer.
I cannot stand over a situation where the annual running cost of Swinford would be £3 million. Simultaneously, we have to spend a very large amount of money in each of the other psychiatric hospitals and in other centres in the west, in Galway, Mayo and Roscommon. I could not stand over it in terms of the rational organisation of services or in terms of having to go to the Government and ask them for additional resources of that order. That is part of the rationale behind what we are endeavouring to do. We have done the assessment and that will form the basis.
On a point of order, I was careful to stress that I had no objection——
That is not a point of order.
I do not want to miss the vote in the other House. Therefore, we will be sitting down with the Western Health Board and we will determine the appropriate placement for the 226 patients involved. We will also have to determine the future admission facilities to be made available for Roscommon. Roscommon, as well as every other county, must have and will have a psychiatric service. We will also have to determine the other facilities needed. For example, throughout the local towns, throughout Roscommon, we will have to build up day centres and day hospital places. We will have to build up supervised and unsupervised hostels or domestic residences for patients who do not at the moment, I readily accept, have homes of their own. We also have a situation of geriatric care. Four out of every ten of the patients are now over 65 years of age. In fact, looking back at the hospitals statistics to 31 December 1984, 46.6 per cent of the patients were over 65 years of age.
Therefore the closure of the hospital, as proposed, will facilitate the opening of the new mental handicap centre at Swinford — I make no secret of that — which was completed, if I may remind Senators, almost a year ago. We have to deal with a situation where the 1981 census of psychiatric hospitals — three psychiatric hospitals in the Western Health Board area — showed a total of 321 in-patients whose primary diagnosis was mental handicap. I want to reiterate that that is the situation.
I did announce my decision in Dáil Éireann and I have been criticised from many quarters about the alleged lack of consultation. Quite frankly, consultation equates rejection. That has been the experience of my office over three years. It was not just my decision; it was a decision taken by the Government after due submission by me of a memorandum to Government. It is a collective governmental decision of both parties in Government. Nobody will be permitted by me to be selective in the collective responsibility for that decision. The Government accepted my recommendation by draft decision at that time. I put it forward so that action could be taken to implement the decision in a controlled way. I have provided funding for the hospital for the next six months to enable alternative arrangements to be made. I can assure Senator Connor, and I very much share his concern and that of his colleague, Senator de Brún, that there will be no hardship imposed by me, by the Department of Health or by the health board or anybody else on patients or on their relatives. But if I had introduced a complete air of uncertainty about the prospect of a decision and if I had engaged in lengthy consultations, with all the rejection that that has entailed down through the years, nothing would have happened at all. That applies to the hospitals. If I had adopted an attitude that something might happen in 1987 or 1988 or 1989 well, again, it would simply become part of a party political manifesto because regrettably these hospital services have been personalised and politicised to an inordinate degree. That too I want, as far as possible, to bring to an end.
Finally, the staff of the hospital, and any staff involved are understandably and rightly concerned. As a member of trade union myself which organises psychiatric nurses, I can readily appreciate the concern. Every possible effort will be made to find a new role for staff, for their redeployment in appropriate positions within structures. But the policy is clear and the alternative services will be provided and I would hope to bring in, and I certainly intend to bring in the new situation as quickly as possible. For too long we have failed to take action in this area. In making a start in Carlow and in Castlerea, it is not in any way intended to be a reflection on the hospitals themselves or on the level of care. A start must be made. Traumatic as that change is, I intend to press ahead. I will keep in regular consultation with the Senators on this matter, very regular consultation. Any Senator — now that we are up and running — is more than welcome to come into my office at any time to meet senior officers in my Department on a monthly basis, on a weekly basis if necessary, and I will give all information to Senators in that regard. I, and my colleague, Deputy John Donnellan, from the health board area in the west, will advise and give all possible information to Members of both Houses. They can be assured of that. But we have had to take the decision in hand and now meet the health board. We are making arrangements these days to meet the officers of the Western Health Board. I hope that the matter will be resolved in a co-operative, constructive way. I will not be found wanting in accommodating the needs of the health boards and the members in that regard.
I thank Senators Connor and de Brún for the opportunity to clarify the position in Seanad Éireann.
The Seanad adjourned at 4.45 p.m. until 2.30 p.m. on Wednesday, 12 February 1986.