I thank the Cathaoirleach for allowing me to raise the question of the delay by the Department of Health in extending the provisions of Circular 6 of 1985 dealing with the discharge of homeless persons from hospital to cover the discharge of such persons from general hospitals. I am sure the Minister and his officials are aware that when I refer to the provisions of Circular 6 of 1985 I am referring to the check list which was a part of Circular 6 of 1985 which check list initially applied only to psychiatric hospitals.
I raise this issue because of the frustration of a number of people and, in particular, members of the Simon Community who over the years, along with other organisations, have documented the recurrent practice of a number of general hospitals of discharging homeless people into the streets with nowhere to go. For the record yet again, the case histories cited include a man sent out from a Cork hospital in 1983 with severe back pain straight into a night shelter where somebody had to acquire a board in the night to put under his mattress to minimise the man's discomfort. Another man who could hardly walk discharged straight into a night shelter had to be re-admitted to hospital in five days. This was in Cork in 1983. A woman under 20, pregnant was discharged from hospital in the winter of 1984 with nowhere to go and she slept rough. Another homeless man was discharged early due to bed shortages who still had stitches in place; his wound got infected and he had to go back to the casualty department. A homeless man in Galway, who fractured his skull was discharged and re-admitted four times. His doctor would not keep him in.
These and similar cases have been documented for years. In 1983 the Simon Community produced a document called Homeless and Vulnerable, which reported on 110 cases of homeless men and women arriving at night shelters directly on their discharge. In other words, they were discharged and came directly to night shelters. This, incidentally, was without prior notification or any contact or consultation. There could clearly be no greater contrast than that between the warm round the clock care of a hospital and the harsh reality of street life epitomised by the life of most of our night shelters.
The Simon Community made a series of proposals to the Department of Health in 1983 based on their detailed case histories. They argued that a check list should be introduced and that homeless people should not be discharged until its details are complied with. It seems perfectly reasonable, incidentally, that a hospital should not discharge somebody they know to be homeless unless they know where the person is going. It seems to me to be a basic provision of any sort of concept of proper health care that people should not be discharged from a hospital to go nowhere. It seems to contradict the whole operation and intent of hospital care.
The check list would include a number of matters which are effectively self-evident such as arrangements for accommodation, arrangement for day care and follow up services, medication, arrangement for income and a letter for the labour exchange, the most important document perhaps a homeless person can have to minimise all sorts of subsequent bureaucratic obstacles.
At a meeting on 29 May, 1984 the Department of Health agreed to issue a circular to all hospitals, general and psychiatric, which would require them to go through a detailed 16 point check list modelled on that operated by the Programme of the Homeless in St. Brendan's Hospital. Dublin. Despite that agreement in May 1984, the circular was extraordinarily slow in materialising. I never have been able to find out quite why it took so long to issue a circular given that the draft existed when the agreement was reached.
Repeated letters and telephone calls to the Department of Health throughout the summer, autumn and winter of 1984 produced no response. I got involved at that stage in making a considerable number of representations to the Minister for Health, none of which immediately produced any response. The long promised circular, promised on 29 May 1984, did not see the light of day until 23 April 1985 11 months later. Called Circular 6 of 1985 it was quite different from that which it was understood had been agreed at the meeting in May 1984. The check list applied to psychiatric hospitals but not to general hospitals. These hospitals were required only to comply with a vague and general injunction to take the necessary follow-up action, but it was deemed inappropriate for reasons that were never made clear to give them a check list or to ask them actually to check out in detail that, for instance, a homeless person would have somewhere to go upon being discharged from hospital or a homeless person would have proper provision for after care, for the provision of medication et cetera. Apparently it was impossible to give a logical and intelligent explanation as to why a homeless person being discharged from psychiatric hospital needed all these protective processes but a homeless person being discharged from a general hospital needed no such protective processes.
On 27 May 1985 the Simon Community requested a meeting with the Department of Health to discuss how the provisions of the checklist might be applied to general hospitals. Again, throughout the summer, autumn and winter requests for such a meeting were made. This is not with the Minister now, I hasten to add. This is simply with officials of the Department. Nobody was looking for a high level meeting with the Minister or indeed with any senior official of enormous rank. It was simply a request to meet the officials of the Department of Health to discuss the problem of the discharge of homeless people from general hospitals. It was hardly an outrageous request by any standards. This meeting that was sought over three seasons of the year did not finally happen until 18 February 1986.
It may have been long delayed but the outcome was quite happy. At that meeting the Department of Health stated plainly that they accepted the case that homeless people being discharged from general hospitals should be cared for in a similar comprehensive way as discharged patients from psychiatric hospitals. This, of course, was most welcome. The Department agreed to issue a new circular and send a copy to the Simon Community for final consultation. The new circular would incorporate a detailed 15 point checklist. I must say, since I have no desire to take up the time of this House talking about a self-evident requirement to make sure that homeless people are not discharged onto the streets that this agreement was most welcome, I thought it was a sign of a very positive and healthy co-operation between voluntary and statutory services.
The officials of the Department had made a detailed study of the case histories and considered them carefully and prepared as comprehensive and as administrative a response to this problem as could reasonably be done. I would like to commend the Minister and the Department of Health for their willingness to respond, to listen and, as appeared at the time, to make a positive and intelligent response to a manifestly real problem.
The Simon Community were enormously encouraged by the goodwill to help and by the co-operation extended to them by the officials of the Department of Health. It was positive, helpful and encouraging and would have perhaps led many people away from the perceived obligation to make the maximum noise about every possible issue because there was an apparently perceived route of reasonable discussion with reasonable people to achieve reasonable results. However, since 18 February 1986 nothing has happened. No circular has been issued despite a written commitment on 28 February 1986 by the Department that it would issue shortly. Since then the Simon Community have contacted the Department — it is important that this should go on the record — on 21 April, 1 May, 3 May, 8 May, 15 May, 22 May, 23 May, 28 May, 9 June, 10 June and on one further occasion.
I cannot understand why there has been no progress on this issue. Why is it that a small voluntary organisation have to spend such an inordinate time, effort and energy simply trying to ensure that a relatively small administrative issue is followed through and carried out? The purpose of the circular is to bring to an end the situation in which homeless people are sent on to the streets with nowhere to go and without any arrangements being made. It should not in a perfect world be necessary to issue a circular like that. One would have thought it would be part of the natural protective instincts of people running hospitals to ensure that people were not discharged on to the streets. The reality has been documented that it happens not occasionally but with appalling regularity.
In May 1986 Galway Simon Community reported how a homeless man in his sixties, suffering from epilepsy and respiratory problems, was sent out without any after care arrangements being made. Notwithstanding the efforts so far the need for the circular is still quite evident. This need not have happened and could have been averted. It was an entirely avoidable situation. The extension of the checklist to general hospitals is urgently necessary, I would like to hear a firm commitment from the Minister tonight to issue it now. I do not wish to hear excuses or bureaucratic explanations.
The Minister is the Minister of State at the Department of Social Welfare. On the last occasion on which I raised this issue of after care he was presented with a script by the Department of Health, the first words of which were "I wish to refute". The Minister who was present read that script in which he sought to refute all the allegations I had made about after care problems for homeless people being discharged from psychiatric hospitals.
Within four months of the Minister being presented with that script by the Department of Health, officials of the Department were accepting that, far from being capable of being refuted, the problem existed. Therefore, I do not want to hear about the problem not existing. I do not want to hear about the problem of certain hospitals because people were told that this problem had been overcome. I want to know why, notwithstanding contact in April, May and June on many occasions a circular that was promised five months ago has not yet been published. I do not want to hear about the problems or of whether I am right. I want to know why it is necessary to have such a long delay, such a history of non co-operation and such apparently insensitive intent on getting rid of the sense of enormous goodwill and of working together that the original agreement brought about. Why have we to wait so long? Why have people to be so frustrated? It is a simple problem which could be solved in five minutes literally with the attention of the Minister and a couple of his officials. I hope the Minister can explain the matter to me.
