Seanad Éireann debate -
Friday, 22 May 1992

Vol. 132 No. 14

Adjournment Matter. - Adelaide (Dublin) Hospital.

Mr. Ross

With the agreement of the House I would like to share my time with Senator Cosgrave and Senator Norris — not in equal proportion I may add.

As a member of the Church of Ireland, I could be accused of having a vested interest in this motion or certainly a denominational interest. I must confess to the House, in raising the issue of the Adelaide Hospital, that my father has been a member of the board for 30 years and I suppose that should be disclosed. Having said that, I will make the case as quickly and as clearly as possible.

The position of the Adelaide Hospital at the moment is a critical one. It is possibly best summed up by the Archbishop of Dublin in an interview in The Irish Times today where he says:

The Adelaide Hospital is the flagship of the Protestant community's involvement in health care in Ireland. From its foundation 150 years ago it has always been very strongly supported by The Church of Ireland, North and South. It is our wish that whatever solution emerges, the Church of Ireland should maintain a controlling interest on the board.

What we do know is that the hospital is being starved of funds and this must not be allowed to continue. It would be grave discrimination. The Protestant community's links with the Adelaide are historic. We have seen five hospitals with Protestant associations closed. Healing is an essential part of the work of the church.

This is more than a parochial issue at this stage. It is an issue of some significance internationally for Ireland's image. The Adelaide Hospital and its liberal ethos is symbolic in how this State treats minorities. The eyes not only of people overseas but of people in Northern Ireland are focused on this issue today. It is an issue of pluralism, tolerance and liberalism. The Adelaide Hospital was given assurances in the past that its liberal ethos would be allowed to continue undiluted by this State but those assurances have now been exposed as both vague and incomplete by recent events. The Adelaide Hospital has decided that it needs to be exclusively in control of its own ethos, not necessarily of the hospital of which it is a part, but of the ethos and the tradition it represents.

In recent times, as the Minister will be well aware, the Adelaide Hospital was in negotiation with the National Children's Hospital and with the Meath Hospital but negotiations with those two hospitals broke down after 39 meetings. The Adelaide Hospital was recently given a pledge by the former Taoiseach, Deputy Haughey, that no serious financial pressure would be put on it to such an extent that it would weaken its position in negotiating its own future. That pledge has now, possibly not deliberately, been broken. Because of its present financial crisis the Adelaide Hospital is in such a weak position that it feels its future and, therefore, the future of the liberal ethos which it has practised is now in jeopardy. It will not be able to meet its bed targets this year. It is £800,000 short for the year. The long term danger of the obvious loss of independence for the Adelaide Hospital means to those who are followers of this hospital and to the board of this hospital that it will inevitably mean the loss of the individual ethos it has represented for so long.

The dangers are very acute and they were expressed well at the Church of Ireland synod this week. The dangers are that that ethos will be submerged in a new hospital and that the assurances which we have been given will disappear, or that the Adelaide Hospital will be so starved of funds that it will not be in a position which is strong enough to actually defend that particular ethos.

People often ask what is the ethos which we are talking about. Can we define it? What is so special and so different about the Adelaide Hospital? What are the practices there which are differnt from other hospitals? They are best summed by saying it is exclusively a medical ethos, and not a church ethos. The Adelaide Hospital practises, and it is unique in Ireland in this way, the supremacy of the confidentiality between the patient and the doctor. That is not the case in other hospitals. It involves issues like fertility, contraception, genetic counselling and all issues which touch the reproductive system. On these issues, the minority have got different beliefs and have got different traditions. There is no suggestion whatsoever that doctors in the Adelaide Hospital will in any way behave illegally, but they will behave in accordance with their traditions. This is a test case. What is happening now is more than an inconvenience. The eyes of the world are on the Government's attitude to this and their tolerance of pluralism.

Mr. Cosgrave

I thank Senator Ross for allowing me some moments of his time. I would like to welcome the Minister. This is a very important issue. There are two major aspects. One is the present funding situation and the other one is the deficit which is overrunning. There is a lack of money which has resulted in a reduction in beds. We require a commitment that the bed situation will be restored and that sufficient grants will be paid.

Secondly, in relation to the future of the hospital, we need the Minister to give a further clear commitment and to back it up as the Minister can do, to ensure that the fine tradition of teaching there can be continued. As Senator Ross indicated, the general ethos must be preserved. I know the Minister has dealt with this already and has spoken on it but many people are greatly concerned about this.

Mr. Norris

I extend my gratitude to Senator Ross for allowing me a couple of minutes. We previously had a debate on this issue in May 1990 to which the Minister may care to refer.

Senator Ross spoke eloquently about the distinctive ethos of the Adelaide Hospital. One is naturally diffident even of giving the appearance of promoting a sectarian notion. I am against sectarianism but I am prepared to support a motion like this. There is a difference between the Roman Catholic ethos on the one hand which is seen as authoritarian and to members of the Protestant churches intrusive into the doctor/patient relationship and the Adelaide ethos on the other. I say this with the greatest respect for many fine Catholic hospitals. The ethos of the Adelaide respects totally the relationship between doctors and patients. For this reason the Catholic ethos cannot make provision for the Protestant conscience whereas the Protestant ethos can comfortably incorporate the consciences and the ethos of Roman Catholics. If this was simply a question of sectarianism, I would have no part in this debate at all.

It is extremely unusual for the Church of Ireland to come out with strong statements in these areas. It is notable that strong feelings were expressed at the Synod by the leaders of the Church of Ireland on this. I have before me a detailed statement by the chairman of the board of the Adelaide, Dr. David McConnell, a colleague of mine in Trinity. One of the statements says that the board is no longer confident that the Government will be able to honour its solemn commitments to the Adelaide. I know the Minister appreciates and understands, that he recently visited the Adelaide Hospital and that he has genuine goodwill towards it but it is worrying to read statements from a man of such eminence as Dr. McConnell who says, for example, that there is a situation of sustained and systematic under-funding at the Adelaide. This was put on the record in some detail in financial terms in the debate of 1990. As I understand it the situation has not improved since then.

I am particularly concerned by a statement of his which says the main effect of under-funding is that they have not been able to admit many patients who need to be cared for and that most of the suffering has been borne by public patients. This ia appalling. I know the Minister, as a caring Minister and as a good practising doctor himself, will share my concern that public patients have suffered as a result of under-funding. I hope he will be able to give a commitment to this House.

Professor Conroy

I understand the rules of the House do not permit me to join the debate but I would like to state sympathy with the motion on the Adelaide Hospital.

Minister for Health (Dr. O'Connell)

I thank Senators Ross, Cosgrave and Norris for raising this very important issue.

I am delighted to have an opportunity once again to reiterate the Government's commitment both to the Tallaght Hospital project and to the protection of the ethos of the Adelaide Hospital. I have stated this commitment publicly on a number of occasions and am pleased to do so again in the Seanad today.

On the question of funding, this House is well aware of the difficult economic climate which prevails, and which is likely to do so for the foreseeable future. I know that many health agencies are experiencing difficulties in living within their approved allocations. The challenge that faces them is enormous, but it is one that must be tackled on a daily basis.

I accept that the Adelaide Hospital, because of its special teaching role, would like to be in a position to use all of its available beds. Due to the overall restrictions on resources for the health services, I regret that this has not been possible in the current year. With regard to the funding of the hospital in 1992, I and my officials have met with the hospital authorities within the past few days and have agreed the parameters, including financial, within which the hospital will function for the remainder of the year. It has been agreed that the hospital will keep 150 beds open and that it will maintain activity at 1991 levels.

I am pleased to let you know that the position in relation to 1992 has now been clarified and agreed and I would like to express the hope that this will not give rise to any further problems between now and the end of the year.

I am pleased to avail of this opportunity not alone to place on the record of the Seanad my appreciation, and the Government's appreciation, of the distinctive and valuable contribution made by the Adelaide Hospital to Irish medicine but also to reiterate my commitment to ensure that the traditions of the Adelaide continue to be protected. As Senators will be aware, over the past 15 years we have embarked on a major development programme in our general hospital system. This has culminated in the upgrading of many hospitals and the building of a number of major new hospitals throughout the country.

The Tallaght Hospital Board was appointed in 1981. The board is responsible for the planning and building of the new hospital. It includes representatives of the three hospitals which will eventually move to Tallaght, that is, the Adelaide, the Meath and Harcourt Street. The Adelaide Hospital, through its representatives on the board and on its various project groups, has contributed fully to the planning of the new hospital.

The Adelaide, as an independent voluntary hospital, has a long and distinguished tradition of service to the people of Dublin. The hospital has played a major role not only in the lives of Dublin people over the last 150 years but in the lives of people throughout the country.

Anyone who has been associated or touched by the hospital thinks not just of a high level of professional medical care but of personal individual care. The ethos of the Adelaide Hospital has played a distinctive role in the development of Irish health care, not alone in its caring approach to the health of Irish people but also in training past and future generations of nurses and doctors. I trained at the Adelaide Hospital and was a patient there. I am very proud to have got first-class medical and nursing care there. I could not but pay tribute to the work of that great hospital. This is in no small part due to the quality of its nurse training. In this regard, I am particularly pleased to repeat the categorical assurances given by previous Ministers that this tradition will be maintained in the new hospital at Tallaght and that 40 places in the new nursing school would be reserved for nurses from the "Adelaide" tradition.

My motivation is, and always has been, to protect the best interests of the Adelaide. I gave that assurance two weeks ago to the hospital chairman. I know that there is concern among the Protestant Community that the hospital's ethos and tradition could be lost or in some way diminished if it were to amalgamate with the two other hospitals, the Meath and the National Children's Hospital, and move to a new campus in Tallaght. Indeed, I am also mindful of the history and traditions of the Meath and the National Children's Hospitals. Both have made a significant contribution to the development of medicine in Ireland. They, too, have a very special place in the hearts of the people of the south inner city. They, too, have unique traditions which must be protected. The challenge facing us, therefore, is to ensure that all that is rich and valuable in the traditions of the three hospitals is successfully transferred to the new hospital in Tallaght.

I would like to assure the Adelaide Hospital and the Protestant community in Ireland that in me they will have a fair and strong advocate on their behalf because of my close association with the hospital and also because of the very important part it plays in Ireland. It represents the Protestant community in Ireland I will meet the board again in two weeks because I want to be kept fully informed of the problem. I can assure the Senators there will be no further problem about the Adelaide Hospital as far as I am concerned.

Mr. Ross

I thank the Minister. I utterly respect him because I know how genuine he is on these issues and his record in this area is impeccable. The commitment which he has given is reassuring especially as it comes from him. I know his commitment is watertight in its intent but could he go further and commit himself to saying that the Adelaide, in whatever form it finally finds itself, will have control on the board or some form of identifiable control over the ethos prevailing in the hospital?

Dr. O'Connell

This is why I am asking if the board can enter into discussions again because before a full commitment is made to the Tallaght Hospital I would like the Adelaide and Meath Hospitals to get together and reach an agreement because the Adelaide want control and I recognise that. The Kingston report made recommendations and if Kingston and Kennedy get together with the two boards they may reach agreement to enable us to go ahead with the Tallaght Hospital. I will ask them to do so as soon as possible.

The Seanad adjourned at 4.40 p.m. until 2.30 p.m. on Wednesday, 27 May, 1992.