I welcome the Minister for Health to the House.
Adjournment Matters. - Transfer of Donegal Patients.
An Leas-Chathaoirleach
I also welcome the Minister to the House. I thank him for coming to respond to my request to him to ask the North-Western Health Board to cease the transfer of patients from St. Conal's Hospital to community based nursing units against the expressed wishes of the patients and their families.
I had reason to contact the Minister's office in the first week of January in regard to a number of residents in St. Conal's Hospital, Letterkenny, being transferred to nursing homes against their wishes and those of their families. A number of these residents had been in St. Conal's Hospital for between eight and 50 years of their lives. My point is that to inform them they were being moved on the day after St. Stephen's Day was completely insensitive and cruel and should not have taken place.
One of the people involved had been in St. Conal's Hospital for a long number of years and was subjected to quite an amount of pressure over the past two years to move out of the hospital. This person decided to go in the week prior to New Year's Eve. I went to see that person, with whom I had a good relationship over many years, and her attitude was that she had given in to the pressure put on her over the past two years. She felt there was no point fighting it any longer. Her family had not been informed of her transfer.
Another patient was transferred 30 miles from Letterkenny, not in the direction of his home but in the opposite direction. He ended up approximately 80 miles away from his home. Threats were used against this resident, that he would lose his pension if he did not go. The resident has since returned to the hospital as he was very unhappy in the area to which he was transferred. My information is that the threats of his pension being taken from him still exist. Another resident was transferred to a nursing unit in Letterkenny. He lives 40 miles from Letterkenny and definitely was not sent back to his own area. This person has also returned to the hospital as he was unhappy in the area to which he was moved.
Another person approached me on St. Stephen's Day and said that the family had been asked to attend the hospital the following day to discuss the transfer of a relative. They were unhappy that the message had been sent to them on 26 December, and they were not prepared for it. One of the relatives also had a very close friendship with the person concerned and would have found it much more difficult to visit the person in the nursing unit rather than the hospital. My advice to them on that occasion was that they should visit the nursing home and then make up their minds.
They did this, but, at the end of the following week, they decided the resident should not leave the hospital as she was quite happy there. It also suited the relative who visited the resident on a regular basis. Some time later, this relative who visited the hospital was approached by a member of the management team, who stated that a bed was available in the nursing home and the hospital would facilitate the resident at whatever time they wished to go. This resident was put under extreme pressure and went through a bad time as a result. This transfer did not take place.
A number of other residents in the hospital were pressurised to go to district hospitals, nursing units and nursing homes. In my letter to the Minister, I pointed out the position in St. Conal's and also the attitude of the nursing union within the hospital, which was holding discussions with the management and the North-Western Health Board on staffing levels. The union stated that wards were overcrowded and that this was due to the closure of a ward and that a number of residents had been transferred to other wards. This created overcrowding and worsened the conditions of both the residents and staff in these units.
Christmas is an emotional time, as is the New Year. I received representations not just from residents and their families but also from groups which are members of the Friends of St. Conal's Psychiatric Hospital. They were concerned about residents being moved and also their welfare. In fact, some of them may have written to the Minister on this matter. I received letters from people in regard to a number of residents in St. Conal's, expressing the wish that they not be moved. They maintain that pressure was put on residents and on families at this time of year and I consider that this was wrong and insensitive.
At all times I stressed that my criticism was based on the transfers which took place from the hospital over the Christmas period. I worked in the hospital for a number of years and during this time transfers to the community, which involved a large number of people, took place with the blessing of the residents, their relatives and the staff associations in the hospital. The associations have never criticised this and have always encouraged the transfer of people from the hospital to the community. They have been very consistent on this approach over the years. Many transfers were made with the complete co-operation of the people concerned and the staff associations. However, I am referring to transfers over the Christmas period.
I have yet to receive a reply to a letter I sent to the Minister's Department regarding this matter. I ask that the hospital ceases to pressurise people if it is against their wishes to move out of this institution, which has been their home for between eight and 50 years. As the Minister will understand, many of these residents have no one to speak on their behalf and the fact that they do not have anyone is not a good enough reason for them to be moved against their wishes to accommodation which may leave them very unhappy.
Many people have gone out on transfer over the years and quite a few have returned. There are no winners or losers in this situation, but it has always been the policy of both the management and unions in the North-Western Health Board to do what is best for the people concerned. This is the way the matter has been dealt with over the years. What happened in the hospital over the Christmas period was wrong and I refer the Minister to his letter to Deputy Paddy Harte on Tuesday, 31 January, in which the Christmas transfers were not addressed. In the Minister's reply to Deputy Harte, there was no difficulty with regard to the situation as outlined by the North-Western Health Board, which was the basis for the letter. However, the statement did not once address the situation that occurred at Christmas in St. Conal's. While I agree wholeheartedly with the statement as outlined by the health board, which has been most forward thinking in regard to the services it provides, a mistake was made at this time and should have been addressed.
At present, there are moves from the general hospital with the transfer of services to vacant units in St. Conal's Hospital. This is to be welcomed. In other statements to the paper this week, the former chairman of the board of management of the regional technical college in Letterkenny, who has been a member of the North-Western Health Board for 24 years, says the problem at St. Conal's Hospital at Christmas was not addressed. This was another vicious attack on the attitude I have taken on behalf of the people who were not able to speak for themselves. These are the politics in Donegal; one looks on some of these statements as nothing more than vindictive and trivial.
I ask the Minister to take on board the points raised and to request the North-Western Health Board to investigate the situation in relation to the transfers from St. Conal's at Christmas and not to depend on statements from the health board which completely ignored what happened there. I thank the Minister for his attention.
Limerick East): I thank Senator Maloney for raising, this issue today. I have listened carefully to what he has said. The information I have is in contrast with the information he has provided to the House so I do not think we will resolve the issue. However, I will get a copy of the Official Report of the Seanad and ensure that the claims made by the Senator are fully investigated.
The North-Western Health Board is responsible for the delivery of health services in County Donegal. The board has been working consistently to develop its psychiatric service in line with the recommendations of the report Planning for the Future which was published in 1984, and its services for the elderly in line with The Years Ahead report published in 1988. Planning for the Future recommended a shift from the psychiatric hospital being the focal point of the psychiatric service. It proposed a service which was comprehensive, community oriented, sectorised, integrated and appropriate to the needs of the patient.
As the Senator will be aware, the Green Paper on Mental Health which was published in 1992 documented the progress to date of the development of a new psychiatric service in the context of the implementation of the recommendations of Planning for the Future while identifying areas which still needed to be addressed.
The Green Paper on Mental Health looked at the needs of specific groups. In 1992 there were over 3,000 persons aged 65 years and over in psychiatric hospitals, the majority of whom had been there for a long time. Few of these elderly patients have an active psychiatric component to their illness but they remain heavily institutionalised. With appropriate rehabilitation it is considered that many of them could live in more appropriate accommodation in the community which would lead to an improvement in the quality of life for the patients.
The 20 or so elderly patients to whom the Senator is referring were long stay patients in St. Conal's. They were no longer psychiatric patients and, whenever needed, received their medical care not from the psychiatric medical team but from a general practitioner. Most of these former residents of St. Conal's are not from the Letterkenny area but from the south-west, middle and north-west of Donegal. It is a cornerstone of health policy toward the dependent elderly as set out in The Years Ahead report that they should be supported at home and where this is not possible, to provide their care in a residential home as close as possible to the person's home and family. The North-Western Health Board has consistently worked towards achieving this objective. The transfer of patients from St. Conal's to residential care in their communities is consistent with this objective.
In all cases they have been transferred to either other health board units or to registered private nursing homes whose facilities comply fully with the provisions of the nursing homes regulations vis-á-vis the Health (Nursing Homes) Act, 1990. The board is satisfied that the services being provided to these patients are excellent and are being delivered in a homely setting.
Before any transfers took place there were discussions with the families of the residents and where, concerns were expressed these were fully taken into account. All arrangements had been in place by the end of October 1994 and no patient was moved either against his or her wishes or those of their families. A small number of transfers were made on a trial basis and where this proved unsatisfactory the patients were returned to receive continuing care in St. Conal's.
The transfer of these elderly patients from St. Conal's coincides with a major £1 million development at the hospital which will result in additional health facilities and refurbished accommodation for the remaining patients there. These refurbishments when complete will result in two fully modernised ward areas with the full facilities necessary to ensure the comfort and privacy of patients. These changes are part of the continuing programme to develop the mental health services and to ensure that residential care is provided in an environment which respects the dignity of the individual patient.
I would like to express my confidence that the staff of the North-Western Health Board have taken the necessary steps to ensure that the transfer of patients from St. Conal's was carried out in a way that respected the wishes of those concerned and was in the best interests of the patients. I thank the Senator for bringing this matter to my attention. If there are matters outstanding which are a cause of concern I will have my Department take them up with the health board to see if there is at least agreement on the facts.