Tá mé an-bhuíoch díot go bhfuil an seans seo agam labhairt ar an ábhar seo agus tá mé buíoch den Aire freisin go bhfuil sé anseo chun éisteacht liom. At the outset I want to make it quite clear, lest my words might go astray, that I am opposing completely the closure of St. Dympna's Hospital in Carlow. I do so, not just on sentimental grounds, but because of the facts that I will produce as I go on with my speech. There is an idea abroad and I saw it in the papers that some of the shock that was talked about when the announcement was made was hyped up and that it was artificially created. Coming from Carlow I know exactly the genuine shock that was felt. It was not just organised by political groups; it may have been helped perhaps, but it was quite genuine. I was at a meeting within 24 hours of the announcement and I saw one of patients who was not put up to anything reacting in a way that was quite genuine. I regard Carlow as a special case, not again because of sentiment, but simply and solely because it was the one hospital that was not earmarked. The other hospitals were told four or five years ago that they were being replaced or being amalgamated. Some that were closed had alternative arrangements in accommodation. Carlow has not got that. We are being pushed too quickly too soon. It is not possible to put the cart before the horse and make progress.
It is well known that community-based care has been discussed but it is not ready in Carlow. This is the big problem. If it was ready there would not be a problem. While I cannot speak officially for the staff I know from speaking to them that they were all geared towards community-based care and they are quite willing to put it into practice. Carlow has a special case. If we look at the staff-patient ratio in Carlow it is the best in the country and I have been told it is the best in Western Europe. That figure will probably be disputed but that is the figure that has been given to us. The staff itself has been integrated years ago. Long before integrated staff became a bone of contention in many hospitals, Carlow was using integrated staff in the wards.
The reference to these walled-up buildings being an anachronism does not apply to Carlow either. The walls were gone in Carlow long before it was thought to remove them in many other hospitals. It has been a community hospital for years. It may not be community-based in the sense that the patients were still in the hospital but the community were in there; I played football there 25 years ago and so did many other better footballers. It was a short cut for people for many places. The patients were being allowed to mix; the walls were down and there were beautiful gardens. The whole scene was one of modernisation. The staff cannot be faulted for the fact that community-based care had not come into action. From a cost point of view the hospital must be giving great value. The maintenance staff who look after St. Dympna's Hospital also look after our district hospital, the maternity hospital and the district hospital in Bagnalstown. That is fair value for money from one maintenance staff. The kitchen staff provide meals for all of those except the district in Bagnalstown and they also provide 100 meals a day for St. Laserian's Special School for the Mentally Handicapped.
We hear a lot about planning for the future and community-based care so that these people should not be in hospital but should be out as much as possible in the community, either with their own people or in hostels and flats. Carlow has started that; they have their hostel across the road from the main hospital and they bought a house last summer. That is still there. They have not the wherewithal to put it into action. They have been setting up a pre-hostelling course to train the patients who would have to go out into ordinary life again. I was surprised to find that you would have to train people to plug in kettles — simple jobs like that — people who have been in hospitals and unable to cope. The preparation of the patients is a very slow process; it takes a lot of time and it needs a lot of care. If people are pushed out into the community after being in hospital they do not fit in. A psychiatrist in another area told me that it took three attempts by one patient to settle down in the community. He went to live in a house with a few more; he came back into the hospital. He tried it a second time and he failed; he came back into the hospital. The third time he managed to settle down. Even patients who are willing to take part in community-based care are often not able for it when it is available. They are used to being hospitalised and they have a relationship there with the staff.
The patients have to be cared for and trained. The staff have to be trained also; many of them are used to working in hospitals for a long number of years; they are used to the routine of wards. They have to be updated in training to get them used to the whole question of managing in the community. When we talk about community-based care we must also talk about the community. If the community are inundated with people that appear to be dumped out without any preparation we can have more trouble. The Minister will know this from what psychiatrists have said. They have given examples of other countries where all kinds of trouble arose simply because the transition scheme was rushed. For that reason alone it is not possible to close Carlow hospital as it stands now. The people are not geared to come out unless we throw them out into the community and say; "There you are sink or swim; there is nothing wrong with you". That cannot be done.
To provide all the back-up services for community-based care there is money needed. I am well aware of the cost of the medical services. I am a member of the health board. We had a meeting last Monday and there was a cut of £6½ million. I have to admit publicly I was not able to contribute much even though I had the escape that I am on the community care section of the health board and that was the one section where we were asked not to cut back, if at all possible because of the demands of that service.
If the money is not provided by the health board perhaps, through the Minister, to set up a system nobody can go anywhere. This is what I find difficult to understand, how we can just announce the closing down of a hospital and find that the staff are there. I would be appalled if all it meant was that we were going to start transporting older patients, those who are institutionalised through no fault of their own; they are in the hospital for years. There are 155 of them who are over 60 years of age and 108 of them over 65 years of age. These are not people who will settle down too well in any other place that they do not regard as home. They do regard St. Dympna's as their home. Again, speaking to an independent psychiatrist — in the sense that he had no connection with Carlow — I asked him what was the real position, how could one close St. Dympna's in a short space of time. He said it was not possible. He said there was probably 80 patients who could be lined up for community-based training to go out into the community. If you were lucky 60 of them might succeed. There are 340 patients in Carlow. That means one is left with 280 patients. These are the older patients, the patients who are institutionalised, no matter what we feel about it. If I had my way I would have every hospital closed, including general ones if that were possible. But we cannot talk about that. People have to be in hospitals and we cannot do anything about it.
The uncertainty in Carlow is causing problems for the patients and indeed for the staff, because the patients feel that they are going to be thrown around. I certainly do not want to see an exodus from St. Dympna's Hospital to other hospitals in neighbouring counties or to see a fleet of ambulances or mini-buses taking the old patients out of St. Dympna's. I do not want that and I hope we will not come to that stage. The older people there deserve to finish their lives in the surroundings they know. I think it would be most unkind, ungenerous and inhuman on our part to decide that they are going to be told: "We are taking you to Enniscorthy, Clonmel or St. Canice's in Kilkenny". Maybe it can be done but certainly I am opposed to it. I hope the Minister does not want to do it either. I am appealing to him to make sure it does not happen.
Everybody who had any connection with the mental hospital at all was geared towards a phasing down of St. Dympna's. Long before the announcement came we had asked about the effect that this community-based case would have on the hospital and we were told then that there would be a phasing out of St. Dympna's. Nobody objected to that. That is part and parcel of the process of advancement. We cannot oppose what is good for patients. The staff are not opposed to that. They welcome the whole idea of modern methods and it would not affect them in the slightest because they would be dealing with the patients. It would be dreadful to think that we would just simply, overnight, decide to tell these people to go, let them sink or swim. I really do not want that.
We have another bad position as well as regards the RMS. What is going to happen about the filling of posts following this announcement. Will it wear itself out by degrees because we have not got the staff? In that process there will be no care there, and we will have an accusation then that the patients are not getting proper care in the hospital.
I want to refer at this stage to the dreadful film that was made by RTE when they came down to do a feature on St. Dympna's Hospital in Carlow. I am sure it shocked people who did not know St. Dympna's. I can assure you it shocked the people who do know St. Dympna's. The way St. Dympna's was depicted that time was a scandal. I am quite sure it has influenced people who saw that film and concluded that it was a dreadful place. I do not blame people who saw the film and did not know St. Dympna's. It was a completely unjust portrayal of St. Dympna's Hospital. I hope that the Minister and his officials who have since met at least once with the South Eastern Health Board officials and discussed the future of the hospital, will continue these talks. A lot more can be achieved in these talks than in much of the political posturing that goes on.
I have to refer at this stage to Lanigan's ball in the Seanad this morning. I put down this motion as soon as I knew about the closing of the hospital. I was genuinely interested in the saving——
