I am not attempting unrealistically or from a sentimental point of view to oppose the closing of Dr. Steevens Hospital even though this is an institution with a very ancient, venerable and distinguished history in serving the needs of the poor of the city of Dublin. I think it is worth looking a little bit at the history of this hospital because it is one of the voluntary hospitals. It emerged during a period of our history when there was a polarisation between those who had access to some degree of medical services and those who did not and I might, for the Minister's enjoyment and erudition, quote from a very exhaustive history of Dr. Steevens Hospital something I am sure he will wish to bear in mind to communicate to his Cabinet colleagues. I refer to page 4 of the History of Dr. Steevens Hospital where the following passage occurs:
For well-nigh 200 years these institutions have given to the poor shelter and assistance in time of sickness, have helped to enlarge the boundaries of our knowledge, and have done much to alleviate the catastrophies resulting from the mistakes and ineptitude of politicians.
It would seem to some people that there has been at least a degree of ineptitude in the way in which the fate of this hospital has been handled. What I wish to do during the 20 minutes allotted to me is to demonstrate a principle I have consistently sought to uphold in this House, that is, that the underlying philosophy regarding cuts, which may very well be necessary, is an important duty of politicians to ascertain and to lay down these guidelines for those involved in implementing any such cuts. I do not believe, and I am certainly not convinced by the evidence that has been presented to me, some which I have with me tonight, that this has been done in this case. Certainly the public and the media do not seem to feel that this has been the case. I refer to an inch high headline in the Evening Press of Thursday 24 September “Government U-turn Means Hospital Reprieve”. It may or may not be a U-turn. A U-turn may be an emotive title but it does come from a paper that is not noted for its trenchant criticisms of the Government party. It is less surprising to find in the Irish Independent of the following day, 25 September, a short report concerning “Department `blunder' over hospital”, the first paragraph of which reads:
The decision to allow Dr. Steevens Hospital, in Dublin to remain open for three months more, just a week before it was due to close, showed up a complete lack of planning by the Department of Health, it was claimed last night.
It is to this apparent lack of planning that I shall address my remarks and I hope the Minister will address his remarks to the same subject at least in some detail.
It is particularly appropriate that this debate should have been called for this evening because this very day, 30 September 1987, is the day on which the hospital was scheduled to close and yet a reprieve has been granted for three months. Whatever about the details of the political inter-play, the medical politics involved — and I recognise that this whole area of medical politics is very much a minefield — it seems that there has been some confusion. Certainly I would feel that the interests of patients must have suffered because they have been left in a very indecisive state. It seems to me that it is a test, and a very important test, of a civilised society to determine how it treats those who have the misfortune to be sick and vulnerable.
I should like, in parenthesis, also to say I recognise that this is only one of a number of hospitals that has had to close. There is some concern about the fact that the era of the voluntary element in hospitals appears to be drawing to a close, this amateur aspect of hospital life which many people feel had a positive social value. With regard to that I would like to say — and I hope this will be communicated to the Government — how very disturbed I was to hear last week reports on Radio Éireann broadcasts of the closure of what was described as a Protestant hospital in Cork. I am very sorry indeed that there should be Protestant hospitals or Roman Catholic hospitals. I note that part of this process of the closure of Dr. Steevens Hospital is part of a process towards a centralisation, towards a rationalisation, towards a concentration of medical resources on behalf of the whole community. I look for an assurance from the Minister that, in this process of concentration, when these great new hospitals at Beaumont and Tallaght and so on are established they will be established for all the people and that no such intolerable excrescences as ethical committees which preclude citizens of this country from a legitimate medical procedure will be tolerated at the expense of the taxpayer.
I should like to go through a brief history of what I understand has occurred in the matter of Dr. Steevens Hospital. In 1978 in concurrence with the report of Comhairle na nOspidéal it was decided to locate as much federated hospitals orthopaedics in Dr. Steevens Hospital as possible. The document, "Development of Orthopaedic Services — A Discussion Document" concludes on page 12 that there are plans to centralise elective orthopaedics in one centre, namely, Dr. Steevens Hospital. For the benefit of those who like myself until recently were not quite sure what elective orthopaedics might entail, as I understand it, it means hip replacements, treatment of backs and so on, in other words non-traumatic, nonlife threatening procedures. At the same time it would be unwise to regard these as not serious because my information is that if this report had been fully followed through and if the orthopaedic unit at Dr. Steevens Hospital had been made what it very well could have been, the best and most centralised site for this kind of work, it would have been possible to turn round somebody who had a serious back ailment inside six months and return them to work instead of as at present taking longer than two years. My information is — and I could back this up statistically — that somebody who is out of work for over two years with serious back pain is very unlikely to return to productive work. So there is a loss to the economy by virtue of the fact that our procedures are not sufficiently efficient in this regard.
I should like also in passing to remark on the fact that investment in this hospital was apparently continuing until very recently indeed. I can produce some facts and figures which will demonstrate that this is not just some academic speculation of my own but actually does have substance. For example, over the past ten years a casualty facility was provided costing £300,000; new operating theatre costing £1,250,000; a physiotherapy unit, £200,000; a burns unit, £150,000; an intensive care unit £100,000; ward renovations, £500,000. In other words, £2½ million of public money was invested. It seems to me that it was remarkably poor housekeeping to invest this kind of money if there was a long term intention to close down this facility.
This seems to be something on which the Department have never been sufficiently clear. This is made manifest by the fact that it is precisely this kind of problem that they addressed belatedly in a letter dated 22 September 1987 to the Chairman of the Board of Dr. Steevens Hospital. The Secretary of the General Hospital Services Division, Mr. Phelan, stated:
It is now clear that the capital works needed to receive the services at St. James's and the Meath/Adelaide will not be completed until late November/early December.
It is rather late in the day to discover that when the hospital is supposed to close on 30 September. It took them until 22 September to discover that the facilities intended to receive these patients at the other hospitals to which they were to be directed would not be ready for at least three months. My information is that it is very likely to be considerably later than that. There is evidence here of some degree of U-turn.
The report of Comhairle na n-Ospidéal also suggested that it would be improper procedure to have one elective orthopaedic centre for the entire system of Dublin, the population being so large. They recommended, and this was not contradicted by departmental information, that there should be two such centres, one on the south side and one on the north side. It is also clear from the figures that the cost of treating a patient in Dr. Steevens Hospital represented a very efficient factor. I do not wish to spend too much time reading too many statistics into the record but figures are available to prove that. I have before me figures which show that Dr. Steevens Hospital were very efficient in their handling, in a financial sense, of the patients under their care. In January 1987 there was a meeting with the Department of Health which confirmed the continuation of orthopaedics at Dr. Steevens Hospital until the Tallaght Hospital was built. I have confirmation of that in a series of letters, particularly one of 26 January 1987 from J. O'Dwyer, Assistant Secretary of the Department of Health in which he stated:
The role of Dr. Steevens as the nucleus of a regional orthopaedic unit pending transfer to Tallaght, including clarification of the number of beds in the medium and long term, should be determined as soon as possible. A small team representative of the hospital and the Department should assess the implications and develop an outline plan for implementation once the role has been clarified. We will take the initiative on this matter.
No such initiative was taken. The letter continues:
Planning of facilities for the nucleus of the regional orthopaedic unit at Dr. Steevens, or one of the hospitals to be vacated circa 1993, might proceed on the basis that it will remain in service for about 20 years.
Therefore, at the beginning of 1987 the Department of Health certainly appeared to give Dr. Steevens Hospital a tentative assurance at the very least that the forward planning was that for 20 years these facilities were going to be concentrated, improved and made excellent on the site of Dr. Steevens Hospital pending a transfer somewhere in the nineties to the new hospital at Tallaght which, as we know, has not commenced.
In April 1987 the allocation to Dr. Steevens Hospital for the year was reduced by 18 per cent which, in real terms, taking into account inflation and some other factors, comes to about 25 per cent. Hospital boards consist of responsible people and it is not possible for them to continue providing services for the community on this kind of basis. In other words, they were instructed to trim their sails and there were very clear conclusions to be drawn from the method in which their sails had to be trimmed. In May 1987 the board wrote to the Department saying that accident and emergency units would have to close in order to keep inside the budget as directed by the Department of Health. In June 1987 the accident and emergency services were transferred to the Meath Hospital.
The correspondence to which I have been given access indicates clearly that the board of Dr. Steevens Hospital were placing themselves in a negotiating posture. I have a letter from Mr. Hope, Secretary-Manager of Dr. Steevens Hospital, dated 6 May 1987, in which he said that these services should be sustained but they had been taken into the hospital's plan because funding had not been made available to sustain them. His letter continued:
In the matter of the proposal for closing the accident and emergency unit, the date of its closing would be Sunday 31 May which will be confirmed by the Governors of the hospital at their regular meeting on 27 instant.
It does not take a great deal of decoding of the kind of to and fro between hospital officials and departmental officials to realise that this was an invitation for discussion and that the decision had not been made finally. The letter stated that it was to be confirmed later.
In July 1987 a letter arrived from the Department of Health requesting the transfer of other services out of Dr. Steevens Hospital. The board of the hospital replied saying that they wished to retain orthopaedics in line with departmental policy. I want to underline that. The Department of Health, however, replied by a further cut in the allocation of £600,000 in order to pay for accident and emergency facilities to be provided at the Meath Hospital. In other words, having attempted to live inside their budget, the board of Dr. Steevens Hospital were rewarded by having implemented a further cut which made the question of survival extremely problematic.
In August 1987 there was quite a lot of fairly frenetic activity on the part of the Department to find alternative accommodation for the specialities in Dr. Steevens. It is worth nothing, in parenthesis, that Dr. Steevens Hospital represented a valuable asset in the sense that it was a concentration of specialities. By this time the Department were finding difficulty in providing alternative sites and resources. Considerable action was taken with regard to redeployment and redundancy but no provision was made until 23 September for continuing services while alternative accommodation was prepared. Doctors and patients did not know where treatment was to be continued. This is a serious matter. I speak about this with some feeling because for the past couple of days I have had a back problem. I can understand and sympathise particularly with people who are ill and are not quite sure where they are going to wind up at the end of the week. That is the position in which the Department of Health appear to have left people in Dr. Steevens Hospital.
In September 1987 the Department of Health asked the board of Dr. Steevens to continue the services until 31 December 1987 and promised to fund them until then. The officials of the Department say they are now anxious to meet the Institute of Orthopaedics to discuss rationalisation of the orthopaedic service. That has been described to me as the stable door mentality by a distinguished surgeon. I understand him to mean that this is closing the stable door after the horse has bolted but it seems more like trying to back a frightened horse in through a stable door that has been already closed. I do not think it is a particularly productive line of action for the Department of Health to be engaged in.
I should like to tell the Minister that I do not intend just to criticise cuts. I have spoken on the health cuts on a number of occasions principally from the point of view of patients and I am sure the Minister and the Government will agree that it is the interests of patients that must be served in the long term. I am not demanding that Dr. Steevens Hospital be kept open. I am not making a plea about the beautiful and famous Worth Library or the architectural merit of the building because I am sure they will be looked after, but we are entitled to a rational, coherent and consistent policy on the part of the Department of Health. The closure of the hospital is a clear example of some confusion in the Department which I hope will not be allowed to continue.
My final comment is that everything appears, in a curious way, to have been planned backwards. The planning for this development should have been decided before the decision was taken, and it was clearly taken, to close the hospital. Then, if closure was inevitable, that closure should have been taken like a military retreat, in an orderly and responsible fashion.
It is important that the Minister should meet with the Institute of Orthopaedics. This is a body representing professional orthopaedic surgeons and consultants and they must be taken into account. They are a very valuable asset to this country. The plan totally contradicts — to the layman, at least — all previous policy, including various documents which I have introduced as evidence this evening. The cost of implementing the closure of Dr. Steevens Hospital could be at least as great if not greater than keeping it open and there has been, as I have indicated, a very substantial investment in plans and equipment, particularly, for example, a sterile air unit which is necessary for hip replacement operations.
The Minister should put this plan on hold until consultations with the Institute of Orthopaedics are complete and then carry out this procedure which, regrettable as it may be, may very well be in the best interests of the health service. I would not criticise if this was done in this fashion. In the meantime, there should be an undertaking from the Minister and from the Government that the services that exist in Dr. Steevens Hospital should be maintained at an adequate level. It is a fine hospital. There is a tradition of excellent nursing and care there and excellent medical attention and as a tribute to all the medical staff and the patients who have traditionally been well treated in this hospital, it is not a great deal to ask that some degree of security should be given to those patients and some undertaking be given that adequate services in the meantime will be maintained.
