I have notice from Senator Nuala Fennell that on the motion for the Adjournment of the House today she proposes to raise the following matter: the need for the Minister for Health to respond to the many allegations regarding conditions at Temple Street Hospital, Dublin.
Adjournment Matter. - Temple Street Hospital, Dublin.
An Leas-Chathaoirleach
I should like to thank the Leas-Chathaoirleach for permitting me to raise this matter and I should like to thank the Minister for attending the debate realising the heavy schedule he has. I am glad the Minister is present to answer the criticisms made about the conditions at the hospital and hopefully to make his case. The problems at the hospital came to light about the end of September when newspapers carried reports of the views of Professor Niall O'Doherty, a professor of paediatrics and a senior consultant at the hospital. All the national newspapers, the radio and television, carried reports of his criticisms. Professor O'Doherty's criticisms were very hard-hitting. He said that children at the hospital were being forced to spend long hours lying on trolleys in the casualty department and that the situation was chronic. Indeed, he made many more hard-hitting comments.
Everybody felt that Professor O'Doherty was deeply concerned about his patients but how did the Minister respond to his criticisms? I am sorry to say that he responded in an unacceptable manner. The Minister accused Professor O'Doherty of scaremongering, an accusation which has been contradicted. Is it not a case of shooting the messenger because the Minister does not like the message he brings? There is a number of questions I should like to pose about the conditions at the hospital and the way hospital personnel make representations. Do they have access to the Minister, to senior officials or to those who can talk about human conditions and human problems as well as about finance? I regret that the Minister made the accusation about scaremongering on the "News at One" on radio on Sunday. However, it is not my intention to lecture the Minister. I accept he has a difficult job to do and that there are some instances of complaint without cause. My objective this evening is to outline the grave position about which Professor O'Doherty spoke and to try to discover what the Minister intends to do to rectify them. This is not a complaint without cause. Indeed, all the consultants at the hospital are united in trying to have conditions improved. I spoke with them today.
In clear terms, what is the position at the hospital? The hospital caters for north Dublin children numbering 150,000 under 15. The hospital operates an open door or open ward policy for casualties, 24 hours daily, seven days per week and 52 weeks per year. That puts it apart from many of the other hospitals who operate a rota system for casualties. Last year 56,000 children attended the casualty department but not all were admitted. At present the hospital admits an average of 18 children per day. Last year the hospital operated their own cutback programme by shortening the bed-stay of children from five-and-a-half days to three days, by postponing a number of non-acute operations on eyes and ears and some orthopaedic surgery that could be postponed. Indeed, that was the only way that their reduced budget, from £8.5 million to £7.5 million, would cover their needs. Bed numbers were cut from 169 to 111, a drop of one-third, and that meant that the number of staff in the associated areas was cut.
The consulting and nursing staff have reached the limit of their endurance and that is why they are speaking out. They have the responsibility for child patients and they take that responsibility very seriously. If anything regrettable happened to any of their child patients, directly or indirectly, because of the conditions they would feel that they had been remiss for not shouting "stop". The responsibility for any mishap now rests with the Minister. I should like to assure the Minister that nobody wants to be involved in a controversy over such an emotional issue. The only avenue open to the consultants was to speak out.
I appeal to the Minister to take action now, to accept the position as outlined and take action to resolve the problems at the hospital. I hope the Minister will deal with this issue on its merits. It will be regrettable if this issue becomes a matter of principle for the Minister because of the publicity in the media. There can be no winners or losers in the battle for the health services. Savings should not be made at the expense of child welfare. The morale at the hospital, it has been stressed to me, is extremely low. Nurses are working at a frantic pace. They must spend long hours in the hospital without breaks and there are too many sick children on their hands. There is a genuine concern that the pressure of work may, despite their commitment and best efforts, lead to mishaps.
When the hospital recently advertised for theatre nurses, they did not receive one response. Obviously, and this is interesting, nobody wanted to work in the poor environment in the hospital. The question we must ask is, what do the consultants and the nursing staff want; what do they need? They need extra beds for valid acute admissions through the casualty department. Staff are required to cope with acute services. Hospital cutbacks have been felt throughout the country to a greater or lesser degree but they are causing serious problems in some areas, particularly where patients may not be as articulate or vocal about the bad conditions. Into that category I would put the elderly and children. Those groups are bearing a disproportionate degree of suffering. Temple Street Hospital is one indication of that.
I suggest to the Minister that he establish an advisory committee consisting of those who command trust and on whom he can rely on, and in whom hospital authorities would have confidence, to segregate complaints about the affects of cutbacks. Some complaints are valid while others are not but the former deserve a practical response. I suggest that the complaints about Temple Street children's hospital are valid.
I should like to thank Senator Fennell for raising this important issue this evening. It gives me an opportunity to clarify the issues involved and to comment on statements made in recent days. Senator Fennell said that I had made a statement to the effect that there was a certain amount of scaremongering in this. I stand over that statement. One of my reasons for it was because the allegations caused undue anxiety for parents and the older children who attend the hospital. However, Senator Fennell did not say that on radio I said I was extremely concerned at the allegations made and that because of that I had asked the chief medical officer of my Department to meet Professor O'Doherty. I can understand why the Senator did not refer to that because the media did not carry that statement. A point has been made about the board of management and I should like to tell the House that to date there has not been a request from them, arising out of these allegations, to meet me or my officials. The Senator will be aware that nobody can accuse me, or my officials, of refusing to meet people.
I should like to say that I accept that there are some problems in Temple Street Hospital at present but I do not accept that there is a crisis or that children's lives are being put at risk, as has been suggested. Neither do I accept that the solution to the problem is, as was the case in the past, simply one of throwing more money at it without examining the underlying causes.
The health services are one of the largest items of Government expenditure and it was only logical that they should take some share in the expenditure savings which were necessary to put the economy on a stable footing once again. Nevertheless, I made certain that the level of spending on the health services would be maintained at an adequate level and the level of spending this year at £1.3 billion has been approved by the vast majority of the Members of both the Dáil and this House. The reduction in expenditure, however, meant that the health system as a whole and in particular the hospital system had to be evaluated critically with a view to achieving the necessary rationalisation and re-organisation so that maximum efficiency and effectiveness would be obtained.
Members of this House will be aware of the review process which I initiated last year. I am happy to say that most of the initiatives which that review indicated are now in place and working satisfactorily. That is not to say, however, that everything is fully satisfactory since I am not happy that we are getting the fullest co-operation, co-ordination and integration between the various hospitals and other health care agencies and, of course, it is necessary to have this in order to maximise the use of resources. This is of particular importance in the area of the expensive high technology medicine.
In the Dublin area we have three specialist children's hospitals at Temple Street, Harcourt Street and Crumlin and children are also treated in other hospitals such as the maternity hospitals and the Royal Victoria Eye and Ear hospital. It is clearly very difficult to provide a cohesive and unified service unless there is a very high degree of co-ordination between the various institutions.
For example, I have had complaints that children have had to be moved from one hospital to another for CT scans. It is just not possible to have CT scanners in all hospitals and indeed, even if we could afford it, it would be wasteful to do so. This also applies to other high technology expensive equipment. Consequently, we just have to look at alternative arrangements which will enable us to overcome the difficulty inherent in a multiplicity of units under separate managements.
Apart altogether from the overall organisation of the services we must also maximise efficiency and cost effectiveness so that we get the best possible value for money spent. At this very time a major study of this nature is under way in one of the children's hospitals and the results of this study will be available shortly. In the light of what is happening in Temple Street, it is imperative for me to undertake immediately, an analysis of what is being done for the £7.3 million given to that hospital.
While I am on this point I might just say for the record that the financial allocation to Temple Street in the current year is £7.3 million, which includes a figure of £150,000 for the child abuse unit which I established there last year. This is a substantial sum of taxpayers' money and it behoves all of us to ensure that it is spent in the most effective manner. Two general hospitals with 258 and 234 beds respectively are managing to provide a wide range of services with allocations of £6.5 million and £5 million in the current year. I do not know where Senator Fennell got the figure of 56,000 attending as out-patients in 1987 because the figure is actually 39,811 children attending as out-patients in 1987.
Various specific allegations have been made in relation to the situation in Temple Street both here in this House tonight and in the media generally over the past week. In particular a number of serious and worrying allegations were made by one consultant working in the hospital. I asked the chief medical officer of my Department to examine the situation in Temple Street. The chief medical officer accompanied by senior officers of my Department visited Temple Street this morning and discussed in some detail the various allegations which have been publicised.
I have just received a copy of the report of this meeting and I would like to clarify the issues involved. Essentially there were four main issues raised and I would like to deal with them. First, it was alleged that it is only a matter of time before a child died or was left with severe brain damage because of the unnecessarily squalid and primitive conditions in the casualty and admission area of the hospital. The chief medical officer in his report of his discussion with the consultant involved was unable to elicit anything which would substantiate that allegation.
It was also stated that children are left on trolleys overnight due to cutbacks and ward closures. Unfortunately this has actually happened on a few occasions and this is regrettable. This highlights the need for greater liaison arrangements between the three children's hospitals in the city so that this situation could be avoided and this is a matter which I intend to pursue as I indicated earlier. There was also a suggestion that those children which had to be accommodated on trolleys were left unattended but this is just not so and again I would like the general public to be assured on this point.
It was also alleged that it is dangerous to transfer patients to other Dublin hospitals but it now appears that what was intended here is that there is a risk of ambulances being involved in traffic accidents while transferring patients. This risk is extremely slight and there are on occasions good medical reasons why patients should be transferred to a hospital which may have more appropriate facilities to treat a particular condition.
A particularly serious allegation was made that children with suspect bruising may be sent home to possible violent abuse because there are insufficient beds. The chief medical officer was unable to obtain any evidence that this has actually happened and I am confident that no member of the medical profession would expose a child to this danger no matter what the circumstances. At this stage, I would again like to mention that one of the two units in Dublin for dealing with child abuse is located in Temple Street. This unit was established and staffed by funds which were made available by my Department. The unit became fully operational early this year and I am pleased to say that it is working extremely satisfactorily. The hospital authority and the staff in the unit have been most helpful and co-operative and are providing an excellent service in a quiet and professional manner. Consequently I am fully satisfied that no child who might be the subject of abuse will be neglected or unattended at Temple Street hospital.
I accept that there are difficulties caused for those providing accident and emergency and out-patient services by the age and conditions of the building, and I am considering how these difficulties can be overcome. The resolution of the problems may lie either in the development of a new out-patient department at Temple Street or siting the paediatric hospital on the campus of a general hospital.
I do not deny that Temple Street has problems but I absolutely reject the notion that they are of a scale or are as serious as has been portrayed in the media lately. I will be taking immediate steps to explore the underlying causes of these problems along the lines indicated and in the meantime I want the public at large to be reassured that, should it be necessary to bring a sick child to Temple Street, he or she will be treated in a competent and professional manner.
The last number of years have been difficult for the public service because of the critical financial situation. Despite these difficulties, all those working in the health service, nurses, doctors and ancillary staff, have continued to provide a high quality service comparable with other developed countries, all of which are facing similar problems at the present time.
I can assure the House that I am concerned at the public unease and the essentially unfounded allegations which were made. I will continue to monitor the situation and I will take whatever action is necessary to ensure that an adequate and proper paediatric service is maintained.
The Seanad adjourned at 6.20 p.m. sine die.