I wish to thank the Cathaoirleach, through the Leas-Chathaoirleach, for allowing me to raise this matter and also to express my regret that I should have to raise it again so soon, that is, the question of the continued delay by the Government in issuing a circular to general hospitals to ensure that homeless people are not discharged from hospital onto the streets.
This is, in fact, the third time I have raised this issue in Seanad Éireann. It is interesting that the first time I raised the issue the opening words of the Minister of State were: I wish to refute the suggestion that there is not adequate concern. We have made a lot of progress since then and I hope this will be the last time I have to raise this matter.
The last time I raised this matter was on 18 June and the Minister of State at the Department of Social Welfare, who was here then, endeavoured to explain to me why a circular which the Department agreed to issue on 29 May 1984 had still not been issued. He promised the House that it would be sent out as soon as possible. The number of times I have heard that statement since I came into this House has made me very sceptical about that particular phrase.
Let us remind ourselves, the record and the House what we are talking about. I am referring to a very well documented practice that some hospitals have of discharging homeless people direct from hospital onto the streets without arrangements being made for their after care. It is worth remembering that homeless people tend to use hospitals more than other categories of people because of the appalling medical consequences of being abandoned by society to live on the streets in overcrowded and usually unhealthy hostels and shelters.
It is worth remembering that there could be no greater contrast between the warmth, concern and individual intention, the food, the heating and the care in a hospital and the isolation, cold and desperation of living on the streets. It is worth remembering also that the point of discharging somebody from a hospital provides a unique opportunity for the caring institutions to provide care for vulnerable and destitute people to ensure that their health and social welfare services, etc. are looked after and to ensure that there is adequate accommodation available for such people.
In May 1984, the Department accepted that homeless people were being discharged onto the streets, that they were not receiving adequate after care service and that measures should be taken to deal with the situation. They rightly decided to issue a circular instructing all hospitals not to discharge a homeless person unless a 16 point check list was complied with, including such matters as the arrangement of accommodation, clothes, convalescence, letters for the labour exchange, medical condition stabilised, money arrangements and so on. To lay people all this will sound eminently reasonable and I am perfectly sure to both the Minister and the officials of the Department of Health all of this will seem perfectly reasonable. It would be a quite clear basic safety net.
The promised circular was not issued until April 1985 as Circular 6/85 and it applied only to psychiatric hospitals. In February 1986 the Department of Health renewed their commitment to apply the circular to general hospitals. In June the Minister of State repeated his commitment to issue the circular and discharge list, as I said, as soon as possible. In fact, I was going to make a two word speech tonight, which would be unusual for me. I was simply going to say: "Well, Minister?" and sit down, but I will not because I think the subject merits a little more reflection than that.
The facts are that the case for the circular is not in dispute. The need for it is not in contention. The urgent requirement that homeless people should not be discharged onto the streets is accepted, as far as I can see, by most of the bodies involved at national level. So the question is: what has happened to the circular which has been promised now for 30 months? The question arises: is somebody blocking the issue of the circular? I know it is not the Minister, neither this Minister, nor the Ministers who were here, nor any other Minister I am aware of. I know, too, that it is not anybody among the officials in the Department of Health who, I know, have been more than helpful in this issue. Nor is it the voluntary organisations who have been blocking the issue of the circular. I am fairly satisfied it is not the social workers dealing with homeless people or working in the hospitals who I know have welcomed the principle of the circular as a start towards the provision of comprehensive after care for homeless people. The only conclusion I can draw is that the obstacles and objections to progress must rest either in the senior levels of health board management or in the senior management of the non health board hospitals, the voluntary hospitals.
One wonders if these are the people responsible for blocking what is accepted by most people to be a necessary reform in this area. It would be particularly and supremely ironic if the caring institutions — perhaps I should in this context put "caring" in inverted commas — are the bodies preventing a service of care from developing. It is difficult to understand how bodies who are in many cases statutorily committed to the care of patients could stand in the way of a system that would provide care.
I cannot understand what possibly could motivate caring institutions to be worried about an obligation to ensure that clothing would be provided for homeless people, that accommodation, proper convalescent services, follow up medical visits, day care, a letter to a GP were available to a homeless person and that community care agencies would be notified. These are the things that should be involved and the circular agreed they would be involved.
It is astonishing that one is forced to the conclusion that it is the caring agencies who are objecting to having an obligation imposed on them to ensure that these obvious things be done before a homeless person is discharged from a hospital. It is very little to look for, for the poorest of our citizens. It is quite clear that you cannot define hospital care as some sort of abstract, pseudo-scientific thing called medicine. You are talking about people who have all the needs of a human being and not some sort of detached abstract organism which has an illness which is cured and is then dispatched onto the streets to live in isolation from the care with which he or she was provided.
I will conclude by saying to the Minister that, if it is these so-called caring agencies who are holding up progress — and that is the only conclusion I can draw because he or his officials or the voluntary organisations who were to be consulted cannot have held it up — I hope he will do what he has shown great willingness to do in the past, that is, to remind them of their responsibilities and what their primary function is. It is not to run large organisations or big plants; it is to care for people and, in a particular way, to care for those people who, while least able to demand their services, are most in need of those services. I look forward to the Minister's reply and to an indication that the circular will issue promptly and efficiently.
