I would like to express my appreciation to you, a Leas-Chathaoirligh for your decision to allow me to raise this important issue this evening. I would also like to thank the Minister for his attendance which I greatly appreciate.
The Royal City of Dublin Hospital was founded in 1832. For more than 150 years this hospital has provided a caring and effective hospital service. To the great credit of the hospital board the service and facilities were continually updated so as to provide patients with the best diagnostic facilities, treatment and care. Patients from an area roughly covered by the constituency of Dublin South-East constitute the largest geographical group of those attending the hospital. The cardiology and pulmonary units have given the hospital a national function.
At this stage I would like to briefly outline the activities of the hospital. In 1986 some 6,352 patients were admitted representing 19 per cent of an increase over a five-year period. The average length of stay for patients was less than eight days which compares very favourably with other general hospitals. Over 17,000 attended out-patients and specialist clinics in 1986. The attendance at the hospital's casualty department during 1986 amounted to over 22,000. Later, I will refer to the casualty department aspect of the hospital. During the same year the number of X-ray examinations carried out amounted to 33,000. I quote these figures briefly to show that the hospital has served the community well over the past number of years. I believe the closure of the hospital would be a mistake.
The 1989 plan was part of an overall package that presumed in the first instance that St. James's Hospital would be in a position to accommodate and provide for all the services that were provided by Sir Patrick Dun's Hospital, Mercers Hospital and Baggot Street hospital. That is not the case. The timetable at St. James's is out of line and it will not be in a position to meet the projected delivery of services in 1989. From the outset the plan for 1989 is very much off course.
The trustees of the board and staff directly involved, and the broader community which saw the closure of Mercers and Sir Patrick Dun's hospitals, were partly reassured that on the closure of Sir Patrick Dun's many of the facilities for the community would henceforth be carried out at the Royal City of Dublin Hospital, Baggot Street. I am now extremely worried about the imminent and possible closure of Baggot Street hospital because of the substantial reduction in money allocated by the Department of Health.
The trustees of the Royal City of Dublin Hospital have submitted a proposal to the Minister. The board is anxious to develop a community hospital to provide secondary hospital care closely integrated with the community services in the area. This type of hospital would meet the requirements of the people of the area for general, medical and surgical services on an out-patient and in-patient basis. It would be ancillary to the major hospitals with high tech specialties. I understand this proposal was submitted to the Department of Health earlier this year and was followed by discussions between representatives of the Department and the hospital. I understand the Minister stated he was not in a position to respond at that time but would put the proposal on the table for further discussion.
The reason I have raised the matter on the Adjournment this evening is to find out the Minister's thinking in regard to the community hospital aspect. Living in the area I know, understand and feel that there is a clear need for a secondary hospital like the hospital in Baggot Street to provide back-up facilities and to take patients out of the acute expensive beds who do not need to be there in the first instance, thus preventing acutely ill patients from getting the kind of specialist treatment they require. The area need the retention of a local community hospital which at present the Royal City of Dublin Hospital provides. The south east part of Dublin city is often regarded by many as an area where people can provide for their own medical treatment. Many of those in the catchment area of Baggot Street hospital are not affluent, Many are on a low income. One of the striking features of that area is that a large portion of the population is over the age of 65 years. There are statistics to back up the fact that people on low incomes have a higher incidence of certain kinds of illness. We are then talking about a community that needs a hospital as an absolute necessity and not a luxury.
Subsequent to the submission of the hospital's proposal to the Department of Health, the Department have now advised the hospital of its financial allocation for this year. The allocation was 18 per cent short of the 1986 and 25 per cent short of 1987 figures. The hospital was advised of its allocation in April which effectively left eight months to achieve the necessary savings. Since then services in the hospital have been severely curtailed. Half of the wards have been closed since 1 July 1987. It was necessary to let go 40 temporary and locum staff. Following a series of meetings with the Department of Health, the board has been advised by the Minister that he intends to transfer the services at present maintained there to St. James's Hospital as soon as possible. Indications are that a transfer will take place before the end of this year.
On the proposed transfer of services, the Department of Health asked the board of the hospital to discuss with the Eastern Health Board the possibility of providing bed facilities for long term patients on a temporary basis until 1 April 1988 and also with regard to providing a health centre in Baggot Street hospital for a period of two years. In approaching the board with this proposal, it is clear that the Department of Health have put a knife to the hospital board's proposal in regard to a community hospital to serve the medical needs of the community, a hospital that could provide in-patient, out-patient and casualty services.
I must outline to the House my recent experience of casualty services. My young son injured his hand playing football. His finger appeared to be fractured. Even though I only live one mile from Baggot Street hospital I knew there was no point in bringing him there as the casualty service closes before 6 o'clock due to the cutbacks. When I arrived at St. Vincent's Hospital I was informed that the casualty service for the catchment area in which I live was being provided that night by St. James's Hospital. Luckily I had transport and was able to drive from St. Vincent's Hospital to St. James's Hospital, — if I had been without transport I would have had to take about three buses from St. Vincent's Hospital to St. James's Hospital. When I arrived at St. James's Hospital at 8.10 p.m. I paid the required fee of £10 and I was shown into a waiting room. It was not until 12.25 a.m. the next morning that my son saw the doctor and it was 1.30 a.m. before we left the hospital. I had to get a taxi home. If I were unemployed and could not afford a taxi I just do not know how I could have got home from St. James's Hospital to where I live.
I make this point because it has been pointed out that the new provisions at St. James's Hospital will provide the necessary services for that catchment area. Here is an instance where, sadly, the service is being provided after a long wait. For the first time that night I had a glimpse of what I have now come to understand in Irish society as a two-tier medical system, those who can afford private medicine and those who have to depend on the State.
Hospital staff in all categories are affected by the changes which are taking place in Baggot Street. It is a major concern of the board to ensure that their interests are protected. It is very sad for them to see the acute services which have been developed in this hospital over many years and which were working very effectively and economically and are now being dismantled and transferred elsewhere, and shortly Baggot Street will cease to be an acute general hospital.
It is most regrettable since the board of the Royal City of Dublin Hospital believe that the hospital can be developed into a community hospital providing high quality and cost effective secondary hospital care for the south inner city. Because of its historic character and location it is uniquely qualified to do so. In addition, the development of the Royal City of Dublin Hospital as a community hospital provides an opportunity to explore the integration of primary and secondary medical care which would lead to an improvement in the overall quality of primary care, together with a reduction in the rate of hospitalisation.
In view of this, I ask the Minister to reconsider his decision on Baggot Street hospital. I further understand from a question the Minister answered in the Dáil, that the Eastern Health Board will take responsibility for the provision of the finances to allow Baggot Street hospital to continue a service in its new role. Would the Minister point out what that service and role will be? I hope that he will not say that it is just a possibility of providing some beds for long term patients on a temporary basis until next April and a health centre for the next three years. The catchment area of Baggot Street hospital deserves and expects more.
