The matter on the Adjournment this evening is the need for the Minister for Health to review the decision to close the Royal City of Dublin Hospital, Baggot Street, the Adelaide Hospital and the Meath Hospital. I would like to thank the acting Chairman and through you, the Cathaoirleach for facilitating me on this Adjournment to discuss the rationale 12 years later of the Government's decision of 1974 in relation to the Dublin hospital plan. My intention is to exhort the Minister and his Department to review certain elements of it and in particualr the intended closure of the Royal City of Dublin Hospital, Baggot Street, together with part of Dr. Steeven's Hospital in 1989 and in 1992 the closure of the Meath, Adelaide and the remaining part of Dr. Steeven's Hospital.
This debate comes a short period after the closure of Sir Patrick Dun's Hospital and not long after the closure of Mercer's Hospital with the loss in the south city of 296 beds. The total losses in the south will be 1,142 beds in 1992 or thereabouts. I am pleased the Minister for Health is here this evening to reply to this debate and I hope he will view my contribution as one of concern for the future health services in this area and take the opportunity to have a close look not just at the adequacy of acute hospital beds in the south city and county but also at the wider health care function which his Department are expected to provide. I hope that he will not just involve Comhairle na nOspidéal in this review but seek to ensure that those involved in the day-to-day care of patients in the community are at one with the plan and its timetable and whether the spending and scarce resources are best allocated to the plan at present being implemented.
There are two principal areas for response. The three catchment area hospitals in the south, that is, St. James's, St. Vincent's and the future Tallaght Hospital are to cater for a population of 830,000. Before the closure of Sir Patrick Dun's and Mercer's, there were 2,506 acute beds in this region whereas in 1992 there will be a loss of 141 beds as a result of the closure of six hospitals. These have been engaged in the provision of medical and surgical facilities for generations. On the north side the three catchment areas of the Mater, James Connolly, Blan-chardstown, and the future Beaumont will have, as soon as Beaumont is opened, a bed complement of 1,898 for a population of 550,000. There is a clear imbalance here with a mere 212 beds provided for the 280,000 extra people. The plan has, as far as I can determine located more resources in acute beds and sizeable proportion of specialities in the north while services have been reduced in the south. I am speaking of the catchment areas which include those beyond the Dublin County border and stretch into County Wicklow and parts of Kildare and Meath.
There is a growing concern that 33 to 40 per cent of all acute beds are occupied by the elderly and the development of community care in the south has been to date underprovided for. The growth of the elderly population in south Dublin is 4 per cent per annum of those over 75 and 2 per cent per annum of those over 65. This is the region with the highest proportion of the elderly. The elderly living alone are 15.1 per cent of the population, yet, inexplicably, there are 14 extended care public beds per 1,000 of the population in the north, nine in the west and only four in the east, indicating a clear underprovision once again. It is, therefore, not surprising that, as the Minister is well aware, this is the area of the private nursing homes although resources have recently been allocated to the Royal Hospital, Donnybrook, and to some little extent elsewhere in the region. This is why I am concerned about the future of the three hospitals I have listed in today's motion. This concern started as early as 1974 with the publication by the Comhairle of the discussion document on the role of smaller hospitals.
I could also go back a little bit earlier to the Fitzgerald report of 1968 which talked about community health centres providing inpatient services backed by diagnostic facilities and a more comprehensive consultant outpatient organisation. However, the bulk of my quotations this afternoon come from the discussions document on the role of smaller hospitals published by the Comhairle shortly after the Government approved of the Dublin hospital plan. In 1974 the Comhairle stated in its discussion document at page 1, section 1.4:
That in the future, where acute medical and surgical services would be concentrated in fewer and larger hospitals centres with a full range of supporting facilities, it is essential that the maximum utilisation of such services is achieved. It is most important that patients should be accommodated in these centres only for such period as they require the extensive facilities available there. Coupled with this consideration is the desirability of reducing as much as possible the inconvenience to both patients and relatives inherent in the provision of fewer centres. In meeting these requirements the Comhairle considers that the smaller hospitals have an important positive role in the reorganised hospital system.
Successive Governments and I make this point because the public seem to think that the only person involved in the closure of any hospital is the Minister for Health, Deputy Barry Desmond. The plan was approved by Government in 1974 and there have been a succession of Governments since from all sides of the House. Successive Governments and those responsible for health services planning have ignored this publication and its implications. Later on in the document the Comhairle develop the community hospital idea. In paragraph 3.2 is states:
the provision of in-patient facilities for the population of the area, together with same day hospital treatment could, however, be provided in community hospitals which could provide services complementary to the general hospitals and the community care services.
It goes on to suggest in paragraph 3.8 — and this is the kernel of the matter but not the kernel of the entire case I hope I am making this afternoon which has to do with the imbalance of population as between north and south — the kind of patients who could be given care in a smaller hospital. It states that patients who might be appropriately transferred to the community hospital after assessment in the general hospital include: (a) those who need treatment and rehabilitation as in-patients but who no longer require direct access to the full diagnostic and treatment facilities of a general hospital; (b) those who have not responded or who are unable to respond to treatment or rehabilitation and who need nursing or medical care beyond which the family, helped by the community care services or a welfare home, can be expected to provide; and (c) patients normally cared for at home who need short-term hospital care in order to give temporary relief to their families. I suggested that there was a large number of elderly occupying beds in acute hospitals. I do not need to mention at any great length to this House, to the Minister or his Department, the numbers of older people who find they are occupying beds longer than the hospital can contain them.
I might add that as the only member of the Eastern Health Board representative of the city of Dublin by way of my affiliation with Fine Gael — and indeed I am the only one representing the Labour Party as well — I receive not just from people who are within my own constituency but from a much wider plain throughout the Dublin region stories of people. I could line up a number of case histories that would make the point even more clear where people have had to leave hospital earlier than they were ready and arrived back into the community who were not expecting them. Very often they are living alone. There was a case recently of an old lady who within 24 hours was back in hospital having received a major fall and having fractured herself very severely in so doing. Much more liaison needs to be developed between the acute hospitals and the community services. Something has to be done to protect the elderly living alone from going home too early. As I have said there are people who do require treatment and rehabilitation but who do not require direct access to full diagnostic facilities. They do require nursing care which could be provided elsewhere rather than in the expensive operation of an acute hospital.
There is a clear need for rehabilitation, for long term treatment and for short term care for the elderly together with the development of facilities of a general nature such as consultant availability, such as some form of accident service, although the range of accident service would obviously be to some extent limited. The serious trauma case would not be delivered to one of the community hospitals but they could deal with a lot of the load that would otherwise go into these facilities. It must be possible to reduce the costs of relatively long stays in acute hospitals by giving alternative care facilities or nursing homes, community hospitals and deal much more sensitively with the sick needing continuing hospitalisation. It must be possible to provide beds in a community hospital at a reduced cost to an acute bed and in a caring atmosphere closer to relatives and friends.
I support the rationale of the Minister's programme — this is one that I picked up from the various documents that came from the Department of Health in recent times and no later than the recent debates on the closure of Sir Patrick Dun's Hospital where this particular quotation was provided by the Minister and his Department — that a lesser number of large, well equipped modern hospitals catering for the large population centres are more efficient and cost-effective than the proliferation of smaller hospitals. However, it is extraordinary that this plan can be taken so far without the balance and health provision that I am outlining. I have been a public representative catering for the interests of the people of the Dublin 8, 2, 4 and 6 areas since the inception of this plan and am a former chairman of the Eastern Health Board. I can only say to the Minister today that his reply to this debate will be treated with wide interest by the population of these areas many of whom are in a socio economic grouping who depend on public health services and who have no other alternative and have been familiar with the medical and surgical reputation in excellence and care which these hospitals provide.
I am not suggesting that the vast bulk of the people in Dublin 4 and 6 would fall into that category but if you examine closely Dublin 8 and 2 and indeed stretches of Dublin 4 and 6 there are sizeable proportions of people in that category. I am sure the Minister will not mind me contrasting this larger population with the Dún Laoghaire area which will secure the future of St. Michael's Hospital. Their dependence will be proportionately higher in these areas on the public health services than in the borough and the traditional expectation of a hospital around the corner even stronger. I appreciate that St. James's Hospital will be a very much larger and better equipped hospital when unit 1C is completed in 1992 than it is today. St. Vincent's is to have a larger complement of beds some time in the next decade. We are at an early stage in the planning of Tallaght Hospital. However, if there is to be a reprieve for some of these hospitals — I hope at least two — the sooner that is decided the better for the direction of all those involved in these hospitals towards their future recognition as medical centres.
Why cannot the Royal City of Dublin Hospital, Baggot Street, be retained as a community hospital working closely with the major acute centre at St. Vincent's Hospital and similarly the Meath or the Adelaide providing the same function with St. James's Hospital? There is a question mark against the Meath in another context in so far as there has been quite a degree of investment by the Department of Health in that hospital in recent times. We are aware of construction work going on within a unit in the complex. Of course, the stonecrusher — I do not recall the medical term for the particular piece of equipment that is gone in there — sanctioned by the Minister within the last couple of months is another indication that the Department of Health is thinking differently from what was considered in 1974.
It would be a blinkered decision to continue along the road we have been going with this plan without examining in detail the solid arguments I have made on the apparent disparity of beds in the south vis-à-vis the north and in particular the potential role of the community hospitals not least for as central a motive as cost effectiveness in the health services. The Minister has a lot on his plate. He has to contain a budget and he has to deal with the provision of services, both in hospitals and in the community. The case I have been making will in due course be responded to by him. I think the case is a strong one. As I mentioned earlier if you compare the populations north and south and in the catchment areas, it seems that there will be 280,000 people depending on 212 beds in 1992 when this plan is completed.
It has been suggested to me that people living in Killiney, and places as far afield as that, will find themselves having to travel to Beaumont Hospital because of the way beds have been provided in the north city. The Minister's response may be that it is difficult to put one's finger on the exact ratio per head of the population for acute beds. The figure given recently was 2.9 per cent with adjustments for specialities and so on. One would need to be working 24 hours per day in the hospital services section of the Department to get a true picture. However, irrespective of the calculation one uses it is obvious that there is a much greater provision for the north city. Given the population in the south of the city there is a great need to cater for the numbers of elderly in need of hospital beds. Provision for rehabilitation, extended treatment or short term care for the elderly should be made. The hospitals in question cannot be helped by a continuing atmosphere of closure. I await with interest the Minister's response.
