Seanad Éireann debate -
Wednesday, 6 Mar 1991

Vol. 127 No. 16

Adjournment Matter. - Ennis General Hospital.

Mr. Howard

I wish to share my time with Senator Honan who is equally concerned about this issue. I will be happy to give her at least five minutes of my time or perhaps longer.

I thank the Minister for coming in to respond to this matter this evening.

The overcrowding in the General Hospital at Ennis is simply another crisis in an ongoing series of crises at the hospital since the acute bed complement was reduced from 130 approximately to 78 two years ago. Ennis General Hospital serves County Clare which has a population of over 93,000. The present number of beds are totally inadequate for the needs of the county. During November and December, overcrowding at the hospital occurred on 24 nights. From Christmas through to mid-February over-crowding was regularly of the order of 20 people per night.

Monday, 11 February, was a typical day at the hospital. On that day I visited the hospital at the request of a distraught parent whose child was on a trolley in the casualty unit. In a hospital that is staffed to accommodate 78 beds, the casualty emergency unit was full, the two beds were occupied, the five trolleys were occupied and a child who came in as an emergency was being treated on a table. No further beds or trolleys were available that day in the casualty unit.

On that day also, the day unit had 17 patients, male and female. They shared that day unit which has accommodation for six patients. Therefore, there was virtually three times the capacity of the unit there that day. The intensive care unit was full and the three available wards were full. The fourth ward with 26 beds was closed. It has been closed for over two years. Elective surgery has been cancelled since early February. The waiting list before then for elective surgery was four to six weeks delay. I do not know how long it is as a result of that cancellation but I am sure the Minister has that information on his file.

Since November 1990 the Ennis General Hospital has been functioning as a 100-bed hospital. Enormous problems are being created for the nursing, medical and other staff there. I want to put on record that these staffs are performing a duty far beyond the ordinary call of duty. That relates to doctors, nurses and the general staff there. I believe the situation there is an abuse of their dedication and integrity and we are putting demands on them that are quite unreasonable.

In addition to that, the situation there does not allow the patients the dignity they deserve. Males and females share the same wards, the same toilets and the same washrooms and this deprives them of the privacy and dignity that is their right. A system that enforces such conditions on the sick, the old and the people who suffer great pain is a disgrace in a civilised society. Unfortunately, the Minister presides over this system.

We have overworked nurses and staff who are hassled and harassed by concerned relations of patients because there is no one else there on whom they can vent their outrage. Sick people are being put into a day unit that is equipped and staffed to accommodate but one-third of their number on many days. Tonight — I have checked out the situation — there is one male accommodated in the middle of the female ward and there are three male patients accommodated in a room off a full female ward and they have to share the toilets and washrooms. As long as there are only three wards operating in the general hospital men and women will have to be accommodated in the same ward. The opening of the fourth ward is absolutely essential there because by having the fourth ward you would have two medical wards and two surgical wards. Therefore, it would be possible to accommodate men and women in separate wards.

During the crisis of February 1990, the Minister promised that a geriatrician would be appointed for the Clare area with ten additional beds at the Ennis General Hospital and the opening of Unit 7 in St. Joseph's Hospital on a permanent basis. One year later, on 22 February 1991, I understand the post was finally sanctioned. I want to draw the Minister's attention to the fact that the 1991 financial allocation to the health board does not include funding for the appointment of the geriatrician and the back-up staff required there.

I am aware that the Minister responded to the situation at the Ennis General Hospital in reply to a question in the other House on 12 February. In relation to the mixing of male and female patients, he said that from time to time with the extra demand for beds, male and female patients may have to be accommodated in the same area, but that every consideration is being given to provide them with privacy. That is simply not true and I do not wish to be told the same story again tonight. As I have outlined, there is not privacy. The dignity and privacy of patients is being continually infringed upon by this situation there. It is an unreal, unnatural and unacceptable situation. At the end of the day, the Minister has responsibility in the matter and I look forward with interest to his reply.

The Minister also stated that the number and type of beds to be provided at the Ennis County Hospital are matters for the Mid-Western Health Board. That is irresponsible of the Minister, I might even go as far as to say it is cowardly of him because by putting across that message he is simply sheltering behind the health board. At the end of the day responsibility for an adequate health service in this country rests with the Minister alone. The buck stops with him and the provision of a hospital service in Clare has to be his responsibility alone. I cannot accept that the Minister can just stand back and pass the buck, as it were, to the health board when this indignity, pain and hardship are being inflicted on patients who attend the Ennis General Hospital. If the health board in general are found to be incapable or incompetent in providing an adequate hospital service in this country the responsibility comes straight back to the Minister.

The Minister of State at the Department of Industry and Commerce said earlier tonight that something like £1,550 million would be spent on the health services this year. How long more does the Minister intend throwing money at a system that cannot deliver? Why do private hospitals, and indeed private health care, appear to be growing more prosperous while public hospitals and public health care appear to be at the point of disintegration?

There is a further reason the Minister cannot dodge responsibility in relation to the Ennis General Hospital. Through his party written guarantees were published in the local paper. They were in documents handed in to every house in County Clare during the 1987 general election, guaranteeing a 100 bed complement for the Ennis General Hospital. The Minister went further. His party ran a Fianna Fáil hospital candidate based on that pledge.

Ms Honan

That is untrue.

Mr. Howard

Candidate Michael Guerin. I want to accommodate Senator Honan in the time that remains. The question is, will the Minister deliver on his pledge to the people of Clare to provide a 100 acute bed hospital in Ennis? Will he ensure that the patients who attend the general hospital have adequate facilities available to them? Will he ensure that the excellent staff who work there are enabled to discharge their duty to their patients in suitable and satisfactory conditions? Will he direct that the closed ward in the Ennis General Hospital is opened or will he, on the other hand, and I hope not, again seek the cover of telling me that the responsibility is not his but that of the Mid-Western Health Board? At the end of the day, the responsibility for an adequate health service in this country rests with the Minister and with him alone. I await his reply with interest.

Ms Honan

I would like to thank Senator Howard for giving me a few minutes of his time.

I would like to pay a tribute to the staff of the Ennis General Hospital for their extraordinary dedication and commitment at this time, and indeed always. I regret the maternity unit was moved out of Clare General Hospital. When people in recent times — I am not referring to Senator Howard — decide to play politics with a hospital it is very dangerous.

A meeting took place recently between all parties on the panel and all the nurses of the hospitals. It was the most responsible meeting that I have attended. The attitude of the nurses in the general hospital and in St. Joseph's Hospital was extraordinary. No politics were involved. I would like to put that on the record of the House. In fairness to Senator Howard and other people there are sensible people serving in public life and one does not play politics with health.

When one talks about £1,550 million in respect of health that is taxpayers' money a colossal amount of money. I agree with Senator Howard. Perhaps the Minister will have to consider this. That is the kind of money the Government are allocating to health.

We have a problem and the geriatrician has been appointed. I accept that the delay with the Comhairle should not have happened when the Minister had cleared the geriatrician for us but he is now in place. Let us take a look at what that means. Nobody recognises this better than the staff in the general hospital. With a geriatrician who may be in place immediately or in a very short time on a temporary capacity, comes the ten beds we all want and the ten to 12 extra nurses. The Minister has given that commitment. I believe him when he says something. Senator Howard has acknowledged that the geriatrician is in place now,.

The public have a tendency to go on a rampage in response to the downgrading of a hospital. I had my two children in that hospital 34 and 32 years ago. We have now lost that maternity service. I was worried when this matter was being hyped up politically one and a half years ago. Senator Howard will know the time I am talking about. I am a long time serving in public and a long time associated with health boards. I met a certain person in the car park one day who said to me that if somebody belonging to him was ill in the morning he would not let that person into the general hospital. That was the day I worried about the general hospital. Certain people were creating that atmosphere at the time and they were not politicians. There may have been some but they were not the politicians present here.

For years temporary nurses have been working in our hospitals and they cannot be appointed. Nurses who go on maternity breaks, career breaks and job-sharing breaks are not being replaced. Ennis General Hospital is short of four permanent nurses at the moment. I would like the Minister to take a look at why we have nurses in temporary positions for eight to ten years, some with unbroken service.

I hope the hassle of the general hospital is behind us. I agree with a lot of Senator Howard's sentiments which relate down onto the corridors of these hospitals. Senator Howard stated that the money has not been put in place for what has been cleared by the Comhairle. I ask the Minister to see that that is corrected.

I would like to pay tribute to the extraordinary dedication of the staff of the general hospital. We are talking about a service for 91,000 people. While I am alive, no Minister will downgrade or close the general hospital in Ennis.

Minister for Health (Dr. O'Hanlon)

I am glad of the opportunity to come into the Seanad and speak about the situation in Ennis hospital. First, I would like to refer to the point made by Senator Honan about the sheer size of the allocation for the health services in the current year, almost £1,550 million, the largest sum ever provided by an Irish Government. I agree with Senator Howard that it is very important that we get value for money. The Senator will be aware that the Government have laid great emphasis on value for money over the last number of years. We are eliminating any waste that might have been there. The health boards have made a major effort over the last number of years to come to grips with the fact, which is a fact in every developed country in the world, that there is not sufficient money to meet demands.

When I came into Government in 1987, 18.7 per cent of what the Government were spending was on health. This year it is 22 per cent. That is an indication of the Government's commitment to ensure that we maintain a very high standard of health. It is disappointing to hear Senator Howard undermine his own hospital in Ennis. I agree with him and with Senator Honan about the great staff in Ennis hospital. That can be applied to our health care staff generally in Ireland. We are particularly fortunate in the quality of our nurses, doctors, para-medical, catering, administrative and all the staff that go to ensure that a hospital functions effectively. We can be very proud of that in Ireland. Ennis is no exception. I have been down there and have seen it for myself.

The level and scale of services to be provided at Ennis hospital are matters, in the first instance, for the Mid-Western Health Board. The Health Act 1970, spells that out quite clearly. As regards responsibility, Senator Howard had a lot to say about my shirking responsibility and being cowardly. I am delighted to say — I will be Minister for Health for four years this week — that there is not one day that I walked away from my responsibilities in any way. If I had to take unpopular decisions in the interests of the nation I did. My predecessors did not. As a member of a party that was in Government before us Senator Howard should not talk too much about responsibility in the health services. The first problem that plagued me was an overrun of £55 million that was incurred by that Government.

Mr. Howard

There were 130 beds in that hospital.

Dr. O'Hanlon

If that Government were still in power there would be no hospital in Ennis. The Senator can thank the Minister for Defence and Senator Honan who kept up the pressure to ensure that we would not allow happen what would have happened if the previous Government were still there.

Mr. Howard

There were no cutbacks in our time.

Acting Chairman

I will suspend the sitting if Senator Howard keeps interrupting. Allow the Minister to speak, please.

Dr. O'Hanlon

In March 1988, the Mid-Western Health Board adopted the policy that Limerick would be the regional hospital for the area with St. John's hospitals at Ennis and Nenagh, providing complementary and supplementary roles in continuing to provide acute hospital services for the region. That is what we are committed to.

The board considered in detail the question of hospital services and decided that Ennis General Hospital should continue to provide acute medical services for its present catchment population. In determining that level of service the board took into account the population of the area, its characteristics, the number of patients who travel outside the area for hospital services and the relationship which exists between Ennis General Hospital and Limerick Regional Hospital. Following assessment of all the relevant factors the board decided that the appropriate number of beds for Ennis hospital was 84. These beds are divided as follows: general medical 40, general surgical, 32; intensive care 60 and day beds 60, a total of 84, not 78 as Senator Howard says. He also referred to the fact that the night of 1 February was a typical night. It was not a typical night. The first time there were 100 patients in the hospital during this year was 11 February.

A total of 3,957 in-patients were treated in 1990 and 17,383 were treated in the casualty department, an increase of 9.6 per cent on the previous year. In addition, there were 13,414 out-patient attendances and 1,359 day patients treated last year. They got good treatment in Ennis hospital and it is a tribute to the staff. It does not become anybody to come in here and tell this House that it is only private patients who get service in this country. That is not fair to either the staff or the patients of this country.

Mr. Howard

Private hospitals are thriving as a result of this.

Dr. O'Hanlon

At present there are seven consultants employed in the hospital. These include two physicians, two surgeons, two anaethetists and one radiologist. There are also 12 non-consultant hospital doctors working with the consultants. Over the last five years, £1 million has been spent on a range of important improvements to the facilities at Ennis General Hospital. These schemes include a new X-ray department; operating theatre refurbishment and the new equipment for the intensive care unit. The male surgical ward was operated at a cost of approximately £70,000 in 1990.

Senator Howard raised the issue of over-crowding in Ennis General Hospital. I understand from the board that there has been a degree of over-crowding at Ennis General Hospital in recent weeks. The Mid-Western Health Board have taken a number of measures in order to cope with the increased demands being made on the hospital. Non-urgent planned admissions have been postponed and I understand that additional beds have been opened and extra nursing staff have been employed. Furthermore, some patients, where appropriate, have been transferred to the Limerick Regional Hospital and St. John's Hospital.

I am satisfied that the health board have responded effectively to this temporary increase in demand and that patients are receiving the necessary care and treatment they require. I do not think it should be necessary to point out in this country or, indeed, in any other country, that changes in the level of demand at different times of the year are a feature of all acute hospital systems. This country is no exception. There is no way you can predict the number of patients who will turn up for admission to hospital today, tomorrow or the next day. Hospitals must be flexible and respond.

Senator Howard referred to value for money. I would expect him to be the very first Senator to come in here talking about value for money and criticising any Minister for Health who would have 20 beds opened, fully staffed and allow nobody into them on the off chance that there might be an emergency. That is not how a hospital system works. We have to ensure that we get the best value for money.

Certain periods during the winter months tend to be busy periods for the acute hospitals, just as summer months tend to be relatively quiet. The patients being admitted to Ennis General Hospital are mainly elderly. The trend is in line with other areas in the country, because elderly people account for a very large proportion of admissions to acute hospitals. This is particularly true during the winter months. The characteristic of elderly admissions to acute hospitals is that they often have a longer length of stay than the average patient. In this context, the Mid-Western Health Board have indicated that the length of stay in Ennis hospital for medical patients was ten days in January 1991. This was longer than the average length of stay in other hospitals in the region during the same period. That is an issue.

I have already outlined the measures taken by the Mid-Western Health Board to deal with the recent problem of over-crowding at Ennis General Hospital. As part of a longer term strategy the board are focusing attention on improved discharge planning and the development of a specialised geriatric service. Planning for the discharge of patients from hospital is of crucial importance in the case of elderly patients. For example, the home circumstances may not allow an elderly patient to be discharged quickly so that some intermediate step-down facility may be required.

The Mid-Western Health Board are, therefore, taking action to ensure that there is effective liaison and co-ordination between the acute hospital services, their long stay services and their community care services, so that patients do not remain inappropriately in the acute hospital setting. Of course, I accept that there are problems in the service and problems that have to be addressed.

Senator Honan referred to the fact that there are a number of temporary nurses. It is important to point out that over the last two years we increased the number of staff working in our public health services by 2,500. We have 59,000 people working in the services at present. The point that Senator Honan raised will be looked at and investigated immediately, the question what might be done about the number of temporary nurses. It is a matter between the unions representing the nurses and the health board, but in the past posts have been filled by open competition. We will look into the question raised by Senator Honan.

My colleague, the Minister for Defence, has pointed out to me on a number of occasions the value of having a geriatrician in Ennis hospital and the effect that that would have on the use of beds, where so many of the patients are elderly and there is a longer than average stay there at this time of the year. We have looked at that. We have sent an application to Comhairle na nOspidéal and they have responded recently and given the go-ahead—they have statutory responsibility for appointments, we do not have that — to appoint a geriatrician.

The Government gave an additional £5 million in 1990 to strengthen the services for the elderly at home and in the community. The Mid-Western Health Board received £455,000 of that. That helped them to make considerable progress towards implementing the recommendations of the policy report on services for the elderly. The Mid-Western Health Board are using this increased funding to expand and develop the home help and home nursing service. Speech therapy services have been made available and the operating costs of the day centres for the elderly at Limerick and Ennistymon are also being funded. The payment of additional subventions to nursing homes has also been undertaken as part of the implementation of the Health (Nursing Home) Act, 1990, which is due to be commenced later this year.

A sum of £182,000 has been allocated to the development of facilities for the provision of a consultant-led geriatric service at Ennis General Hospital and St. Joseph's Hospital, Ennis. This development will result in an increase of ten beds in the bed complement of Ennis General Hospital, thereby helping to alleviate the problem of overcrowding being experienced there from time to time. As I said, the post of consultant geriatrician was approved recently by Comhairle na hOspidéal and the post will be filled by the Local Appointments Commission at the earliest possible date. In the meantime the board intend to fill the post in a temporary capacity and will be advertising in the Irish and British press for a temporary appointee.

Again, I would like to take issue with Senator Howard. It is not true that funding has not been provided. The reality is that——

Mr. Howard

The health board denied it.

Dr. O'Hanlon

——funding has been provided for the geriatrician appointment. I want to assure the Senator that when the Department and I make a commitment we honour it. When we committed ourselves to providing a geriatrician in Ennis hospital we also took account of the fact that he would have to be paid.

I am confident that this new development of a specialised geriatric service will greatly enhance the service provided by Ennis General Hospital to the patients in County Clare. Again, I would like to pay tribute to the staff in County Clare for the manner in which they run an excellent hospital. I can assure Senators that as long as Fianna Fáil are in Government they will continue to provide acute medical and acute surgical services of a very high standard for the people of County Clare.

The Seanad adjourned at 10 p.m. until 10.30 a.m. on Thursday, 7 March 1991.