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Seanad Éireann debate -
Wednesday, 26 Jun 1996

Vol. 148 No. 4

Health (Amendment) (No. 2) Bill, 1996: Second Stage.

For the information of Members, the debate on item 3 is being taken in conjunction with Second Stage.

Question proposed: "That the Bill be now read a Second Time."

The implementation of the Health (Amendment) (No. 2) Bill, 1996, is intended to amend section 76 of the Health Act, 1970 — which deals with the amendment by order of a hospital charter — and to amend the Hospitals Federation and Amalgamation Act, 1961.

The primary reason for bringing forward this Bill at this time is to facilitate the Minister for Health in meeting the wishes of the three voluntary hospitals, that is the Adelaide, the Meath and the National Children's Hospital, which are combining to form the new hospital at Tallaght. The hospitals have agreed that the legal basis for the governance of the hospital at Tallaght will be an amended charter of the Adelaide Hospital in accordance with the draft of the order which the Minister has now laid before the Seanad and the Dáil. The governing body of the Adelaide Hospital, in accordance with section 76 of the Health Act, 1970, has made an application to the Minister for an amendment to its charter.

The Minister for Health has agreed to amend the Adelaide Charter, as proposed by the Adelaide, in agreement with the Meath and the National Children's Hospital. The Office of the Attorney General has been consulted and an order has been drafted by the parliamentary draftsman's office pursuant to section 76 of the Health Act, 1970, amending the Adelaide Charter to give effect to the wishes of the hospitals. The Minister has also consulted with the Commissioners of Charitable Donations and Bequests.

The Office of the Attorney General has advised that certain amendments of a technical legal nature require to be made to section 76 of the Health Act, 1970, and to the Hospitals Federation and Amalgamation Act, 1961, to allow the processing of the order amending the Adelaide Hospital Charter in a manner which meets the needs of the three hospitals.

The Hospitals Federation and Amalgamation Act, 1961, created a federation of seven hospitals, including the Adelaide, the Meath and National Children's Hospitals, and transferred certain powers and functions of the federated hospitals to the Central Council of the Federated Dublin Voluntary Hospitals. The Bill ensures that the provisions of the 1961 Act will not impinge in any way on the functioning of the new hospital.

The new hospital at Tallaght is the largest hospital project ever commissioned in the history of the State and the people of Tallaght will have a hospital that will match the best in the world in terms of its design, quality and its state of the art technology. I have no doubt that this hospital will make an invaluable contribution to the economic infrastructure of Tallaght as well as to its more specific health and hospital services needs.

The provision of the legal framework for the new hospital at Tallaght has been complex and subject to protracted negotiations between all those concerned. It is, indeed, a credit to the commitment of the transferring hospitals that they have been able to agree, in conjunction with the Minister for Health, on the legal framework now being placed before this House. You will note that the draft of the order contains provisions for the management of the three hospitals by a single authority prior to the move to Tallaght. This is important in an organisational and logistical development of such magnitude.

In 1993, the board structure and other issues relating to the new hospital were agreed by the three hospital boards and approved by the Government. This represented a considerable amount of hard work by the three hospitals, but in the end a resolution was reached. That agreement is the basis on which the legal framework is now being proposed so as to finalise these matters. This detailed legal framework has also been agreed by the boards of the three hospitals who are integrating to provide the services so badly needed at Tallaght. I am happy to say these developments clearly indicate that, where goodwill exists on all sides, seemingly insurmountable problems can be overcome. In this regard, I welcome the joint statement made by the chairmen of the three hospitals which I understand has been issued to each member of this House and which fully endorses the legislative proposals now being put forward.

The people of Tallaght deserve a major hospital of the quality being provided, and it is important that we continue to proceed as quickly as possible to ensure the detailed arrangements for the management and transfer of the hospitals to Tallaght, and the establishment of services in the new premises in the middle of next year, will proceed without any delay or setbacks.

I take this opportunity to thank the boards of the hospitals, and also the medical, nursing and other staff, for the excellent work they have performed over a very long time in treating many thousands of public and private patients. I am confident that this great work, together with the acute psychiatric services transferring from St. Loman's Hospital, will continue at Tallaght. I have no doubt that the facilities at the new hospital will allow for an even greater enhancement of these services.

This is a unique occasion where this House is facilitating the joining together of three historic institutions which for many years with their diverse backgrounds and history have provided health services to the people of Dublin and the country at large. I feel privileged to be part of this process which I have no doubt will be seen by future historians as a most enlightened and progressive development of our hospital services.

The main provisions of the Bill are quite straightforward. Section 2 enhances the powers of the Minister for Health under section 76 of the Health Act, 1970. Section 76 of the Health Act, 1970, empowers the Minister for Health, by order, to amend the charter of a hospital subject to the order in draft form being approved by both Houses of the Oireachtas following consultation with the Commissioners for Charitable Donations and Bequests. Section 2 of the Bill expands the Minister's powers under section 76 of the Health Act, 1970, as the present section does not allow for facilitating the legal arrangements now requested by the three hospitals, that is, it does not provide for the establishment of a new body corporate and the assignment of a title to it. Section 2 (1) (a) provides for this.

Section 2 (1) (b) provides for the application of a charter which is being amended to the new body corporate established under section 2 (1) (a). This allows for the Adelaide Hospital Charter as amended to be applied to the new body corporate.

Section 2 (2) (a) provides for the transfer to the new body corporate of the functions, property, rights, liabilities and members of staff of the transferring agencies. This provision will allow for the integration of the three base hospitals, of the Tallaght Hospital Board established to construct the hospital and of the Central Council of Federated Dublin Hospitals. Section 2 (2) (b) allows for the conferral of such powers on the original body — in this case the Adelaide Hospital — as, in the opinion of the Minister, are necessary to enable it to wind up its affairs or otherwise to deal with any property, rights or liabilities of it. This is to ensure that on the disapplication of the charter to the original Adelaide Hospital that hospital will still have powers to take care of its residual affairs.

Section 2 (3) (a) allows the Minister on the application of the new body corporate — in this case the new Tallaght Hospital — established by an order under section 76 of the Health Act, 1970, to amend that order of the body corporate. Section 2 (4) facilitates the circumstances of this particular case by allowing for the simultaneous movement of this Bill and of the draft order establishing the new hospital through the Houses of the Oireachtas. Section 3 provides that notwithstanding the provision of the Hospitals Federation and Amalgamation Act, 1961, in particular the provision of section 14 of that Act, the new hospital will be able to exercise all functions which are exercised by the Central Council of Federated Dublin Voluntary Hospitals in respect of the three base hospitals. This provision is required to ensure that the new hospital will be able to exercise those functions.

The main purpose of the draft order is to comply with the wishes of the three hospitals in providing for the governance of a major acute voluntary hospital at Tallaght. The explanatory memorandum, circulated with the draft order, explains the various amendments. Now that agreement has been reached on the details of the revised charter, it is urgent to provide the necessary legislative measures to give effect to the agreement. It is important to allow the hospitals to put a unified management structure in place for the three transferring hospitals and to do this as soon as possible, well in advance of the move to the new premises at Tallaght.

I have no doubt the House will welcome the provisions contained in the draft of the order. I do not propose to refer to each section of the order, but I would like to highlight some of the provisions which might be regarded as exceptional to the normal provisions needed to govern a major acute hospital. These provisions have been incorporated in the draft order to reflect the agreement entered into between the hospitals. These include section 5(c), which provides that the hospital will ensure the availability of all medical and surgical procedures which may lawfully be provided without prejudice to the rights of conscience of staff. The order also provides at section 5(j) that the fundamental principle of the Adelaide Hospital as an essentially religious and Protestant institution will be maintained, while guaranteeing rights of conscience and providing that the hospital will have a multi-denominational and pluralist character.

Also of note is section 24, which establishes a college of nursing at the new hospital but provides that for student nurse entry purposes the Meath, Adelaide and National Children's Hospital will have separate constituent schools of nursing. Each of the schools of nursing will be autonomous for student nurse intake purposes and may take up to 40 entrants in the case of the Adelaide, 60 in the case of the Meath and 21 in the case of the National Children's Hospital.

I am also pleased with the terms of the order which provide for the composition of the board of the hospital and which allow for the appropriate representation from each of the base hospitals and the medical staff of the hospital. The draft order also contains provision for industrial relations matters surrounding the transfer of services and staff to Tallaght to be addressed through a Protocol which has been agreed to by the Department of Health and the management and unions representing staff in the transferring agencies comprehended by the draft order. This is to ensure that best industrial relations and personnel practices are adhered to.

In preparing the draft order the Minister and the Department of Health were conscious that the hospitals transferring to Tallaght were three different institutions, each having its own background and ethos. It is important that each of the three hospitals is enabled to enter into an arrangement where they feel that their interests and their honourable traditions are repeated and acknowledged. I am happy that the draft order now before the House meets this difficult criterion for the integration of the hospitals.

I consider this Bill, while it is essentially of a technical legal nature, to be most important legislation. It is a necessary statutory measure to facilitate, where appropriate, the reorganisation and extension of the public hospital services. The immediate effect of the Bill will allow for the proper establishment of the much needed and fine hospital at Tallaght. I commend the Bill to the House and I ask the Seanad to approve the motion in respect of the draft of the order which has been laid before the House.

I welcome the order and the legislation and I recognise, as the Minister has done, that it brings an end to a difficult period of negotiations. It is important legislation not only for the three institutions involved but also for the life of the nation. There is a lesson to be learned from the negotiations and the compromises that were reached in bringing us to this point today.

The measures aim to bring together three historic institutions — the Meath, the Adelaide and the National Children's Hospital. Each of these institutions has made a unique contribution to the life of the city and the nation. It is, therefore, appropriate on such an occasion to briefly mention the history of these institutions. I was privileged to be a member of the board of the Meath Hospital for some years, so I ask to be forgiven if I am a little parochial and if I recognise the unique contribution made by that hospital. The Meath Hospital is an institution which has contributed in a unique way to the colourful history of this city. I want to celebrate the lives of the men and women who contributed to the hospital, the city and to the development of medical life in this country.

The turbulent and interesting history of the Meath Hospital goes back to the end of the 17th century. At that time the Earl of Meath's liberty, the Coombe area of Dublin, was a prosperous community engaged in the wool trade. That prosperity came to a juddering halt when William III banned the export of Irish woollens in order to assist the English weavers. As a result, the Liberties, which had once been a prosperous area in the city, was plunged into poverty. In March 1753 the surgeons from the Charitable Surgery of Spring Gardens in Dame Street published an advertisement in the newspaper announcing their concern for the poor of the Meath Liberties and their intention to take a house in the upper Coombe for the treatment of these people. Subscriptions were requested. That is an interesting connection with the current state of the finances of health institutions in this country. The nation has always contributed to charities.

The Meath Hospital moved from house to house until 1770 when the foundation stone for a custom built hospital in the Coombe was laid by Lord Brabazon, a man whose family retains connections with Bray. Proving that nothing is new under the sun. the new hospital was supported not by State funds but by funds from a lottery with a prize of £1,000, a considerable amount of money in those days, and a bequest. The new building was completed in March 1773. For 50 years the hospital served the people of the area from its new headquarters in the Coombe. After 50 years, however, the hospital building became inadequate for its needs and it had to look for another new home. The Meath Hospital has a fine tradition of moving around the city.

It chose a very interesting site off Heytesbury Street which was known as "The Dean's Vineyard". The land had originally been leased by Dean Swift shortly after he took over the deanship. It was not used as a vineyard but to stable his horses. The land was transferred to the Meath Hospital by order in 1815. Plans were put in hand immediately to build the new hospital but they ran into the inevitable difficulties with the Department of Finance of the day, when the Treasury announced it would not be capable of providing the funds for the new hospital. A charitable donation was made by Thomas Pleasants, whose generosity is remembered to this day by the street named after him beside the hospital. A grant of £6,000 was also received from the County of Dublin. The building of the hospital commenced in 1815 and was completed in 1822. On Christmas Eve 1822 the patients were moved from the Coombe to the Meath Hospital and were welcomed by the staff to their new home.

Throughout the 19th century, and into this century, the Meath Hospital has been synonymous with medical innovation in this city. Robert James Graves and William Stokes were two of the hospital's earliest physicians who distinguished themselves internationally. Graves was born in 1797 and was a graduate of Trinity College, Dublin. He took up his appointment in the Meath Hospital in 1821. He developed a new system of clinical teaching there which is followed to this day in Ireland, the United Kingdom and the United States. William Stokes, who was a student of Graves and was educated in the Meath Hospital, at the very early age of 21 years wrote the first major English language treatise on the use of the stethoscope. Stokes worked with Graves throughout his medical life and developed medical teaching in the Meath Hospital. He later produced a major thesis on the diseases of the chest, heart and aorta.

Richard Lane Joynt was a surgeon in the Meath Hospital who learned in 1896 of Rontgen's discovery of X-rays and felt this would be a useful thing to have in Ireland. He built the first X-ray apparatus himself. In 1897, only a year after the discovery of the X-ray, he produced the first Irish X-ray pictures, which are on view in the Royal College of Surgeons.

There were also developments in the Meath Hospital in this century. Money from the Irish Hospital Sweepstakes made it possible to develop a urological unit there. This speciality will always be associated with a surgeon called TDJ Lane who, having returned from the United States, developed it in the Meath Hospital to the point where the hospital's unit in Heytesbury Street became one of the foremost urological units in the world.

The Meath Hospital's history is not solely concerned with medicine. It also has extraordinary and intriguing connections with Ireland's literary heritage. James Clarence Mangan died there. He died in destitution and was rescued by his friend Stokes and taken to the Meath Hospital where he was cared for in his final days. When Mangan died his face took on a wonderful new look and an extraordinary light shone from it. Stokes contacted the artist Sir Frederick Burton who made a drawing of Mangan which hangs in the National Gallery, a copy of which hangs in the board room of the Meath Hospital.

Oliver St. John Gogarty was a surgeon in the Meath Hospital from 1911 until 1939. On his rounds in the hospital he was inspired to write the beautiful poem "I have seen all the pictures", which celebrates the death of a simple Dubliner who was content to meet his maker having seen all that the Dublin cinemas of the day had to offer. Patrick Kavanagh and Brendan Behan were also in and out of the Meath Hospital over a period of years. Behan died there, having established a unique rapport with the nursing and medical staff.

Perhaps it is odd when dealing with dry legislation to dwell so much on history. I do so, however, to make the point that we are not just dealing with bricks and mortar when we talk about these three fine hospitals, but with living and breathing human organisations with proud traditions and with people who jealously guard those traditions. The tradition in all three hospitals is rightly guarded by their medical, nursing and administrative staff. Perhaps because of this the discussions on the amalgamation of the MANCH group have not always been easy. There has been a good deal of fire and exchange of strong words.

When one looks at charters, which were touched on by the Minister, one finds the original draft starts "George V, by the grace of God, of the United Kingdom of Great Britain and Ireland and of the British Dominions beyond the seas, King defender of the faith to all to whom these presents shall come, greetings". It is rather strange in this day and age for us in a republican Parliament to be effectively endorsing such a charter.

The reality is that goodwill, as the Minister said, has prevailed throughout these negotiations. I am being partisan in this, but I think extraordinary goodwill was particularly shown by the nursing and administrative staff and the board of the Meath Hospital. I recognise the fact that Councillor Brady, the chairman of the Meath Hospital, is here today. Good sense prevailed throughout those negotiations, out of which came compromise, which I welcome. I particularly welcome the fact that the tradition of all three hospitals has, as far as is humanly possible, been protected in the legislative arrangements.

I am particularly glad that the concerns of those associated with the Adelaide Hospital have been defended. I remember having discussions in 1992 with people who were concerned about the ethos of the Adelaide Hospital and who wondered how the various circles could be squared. I think, as far as is humanly possible, goodwill has provided the answer to those very knotty problems. I am delighted the nursing ethos of the Adelaide Hospital will be recognised. I hope there will be generous recognition of what has been done in the formation of the board of the new hospital, which might spark a recognition among our friends, brothers and sisters in the Northern part of this country that compromise is often better than conflict. I welcome the legislation and we will assist the Minister in every way to press the measure through today.

I thank the Senator for the detailed history of the Meath Hospital.

The immediate object of the Bill is to facilitate the provision of a statutory basis for the establishment of the governing body of the new Tallaght hospital. The three hospitals consigned to Tallaght — the Adelaide, the Meath and the National Children's Hospital — reached agreement some time ago that the most appropriate legal vehicle for providing for the new hospital is by way of an amendment to the original charter of the Adelaide Hospital. In order to do this in a way which meets the express needs of the hospitals, it is necessary to amend section 76 of the Health Act, 1970, and the Hospitals Federation and Amalgamation Act, 1961. The Bill enables the Minister to amend the hospital's charter and provides that the Hospitals Federation and Amalgamation Act, 1961, will not impinge in any way on the governance of the new Tallaght hospital.

As Senator Roche said, it is only right on an occasion such as this to pay tribute to the service which these three hospitals have given the city of Dublin over a long number of years. I do not have the detailed history which Senator Roche has but I have made some notes in relation to the three hospitals. I found their history most interesting.

Tradition has it that the Adelaide Hospital was founded by Dr. Albert Walsh. In his history of the Royal College of Surgeons in 1886, Sir Charles Cameron, who had been president of the college between 1817-71, wrote of Walsh, whom he probably knew personally: "Walsh, while still a medical student, formed the idea and established a hospital."

That such a notion should occur to a medical student seems strange. Stranger still that when only two years qualified he should, at the age of 26, establish an institution, see it flourish and continue to act as a senior surgeon in it for the next 38 years, then a consulting surgeon until his death three years later at the age of 65.

The premises which Dr. Walsh established as the Adelaide Hospital was located at 39 Bride Street. The hospital continued there until 1846, when it was closed, and in October 1858 the Adelaide Hospital reopened at Nos. 24 and 25 Peter Street. In 1891, by the will of the late Ms Fetherstonhaugh, the hospital received over £5,000, a substantial sum in those days, for the specific purpose of building a convalescent home for the hospital.

I am thankful to Mr. Tim Delaney, secretary manager of the Adelaide Hospital, for presenting me with the history of the Hospital entitled A Peculiar Place by Mr. David Mitchell. It was interesting to note in the history that in July 1894 the Fetherstonhaugh Convalescent Home was dedicated by the Archbishop of Dublin, The Right Honourable and Most Reverend William Cunningham, Lord Plunkett. A fine statue to the late Archbishop stands on Kildare Street.

Section 2 of this Bill enables the Minister to amend by order the charter of the hospital. According to David Mitchell's book, it is not true to say that the first reference to the charter is in the committee minutes of 6 January 1920, because in February 1876 Mr. J.B. Pim had handed in a notice of a motion, which he later withdrew, that a Royal Charter should be sought for the hospital. This apart, Mr. Law, who had been recently appointed solicitor to the hospital, laid counsel's opinion before the committee on 6 January 1920. This was approved on 30 March and Mr. Law produced drafts of the petition for the charter and by-laws. There is a long minute instructing Mr. Law to take such steps as may be requisite for obtaining the same charter. It is interesting to note that the charter was granted on 27 November 1920 and enrolled in the Consolidated Judgement Record and Writ Office of his Majesty's High Court of Justice in Ireland, Chancery Division, on 15 February 1921. On 11 July 1921 the truce came into operation and on 6 December the treaty was signed conferring dominion status on the Irish Free State. It would appear, therefore, that the charter for the Adelaide Hospital was the last Royal Charter granted in Ireland.

The Adelaide Hospital has been a general teaching hospital and has been in the forefront of many medical advances, including the development of antiseptic surgery and pioneering work in preventive medicine with children in Dublin. In addition, it has been the first general teaching hospital to introduce a skin clinic, in 1866, a gynaecological clinic, in 1868, and a psychiatric outpatients unit in 1936. Special wards were also provided for TB sufferers in 1938 and as late as 1965 it was one of the first hospitals in Dublin to establish an intensive care unit. During its long and interesting history the hospital has served the people of Dublin with great dedication and care. I know from looking at its annual report that Senator Henry has a special interest in it.

The Meath Hospital has its origins in an institution which was opened by four surgeons in the library of the house of the Earl of Meath in the Upper Coombe, near Meath Street, on 2 March 1753. The premises proved inadequate and necessitated several moves of the institution — to Meath Street in 1760, Earl Street in 1766 and a new building in the Coombe in 1773.

The building in the Coombe was inconveniently small and an Act of Parliament was passed in 1815 to facilitate the erection of a new hospital. One of the main functions of the hospital was to provide prompt and surgical assistance to the poor, especially those in the manufacturing industry, whose occupations rendered them liable to serious diseases and frequently exposed them to accidents. A new site for the hospital was purchased from the Dean and Chapter of Saint Patrick's Cathedral and the new building for the hospital was completed and opened in 1882 in Heytesbury Street. Since that date the hospital has continued to provide medical and nursing care, especially for the poor and underprivileged and in more recent times has developed specialised services in a number of medical disciplines.

The National Children's Hospital was founded as a hospital for sick children in 1821 by Mr. Henry March, later Sir Henry March, Mr. Charles Johnson and Mr. Philip Crampton, who at that time was also attached to the Adelaide Hospital. It was the first teaching hospital in Ireland and Great Britain with the following objectives: first, to afford medical and surgical aid to sick children; second, to give students the opportunity of acquiring a knowledge of infantile diseases with clinical instruction; and third, to extend information in health care to mothers and nurses as regards the proper medical care of children.

Like the Meath Hospital, the National Children's Hospital moved to a number of premises and was finally established in Harcourt Street in 1887. It also assumed the paediatric services formerly provided by St. James Hospital in 1978, St. Ultans Children's Hospital in 1982 and the Adelaide Hospital in 1987. It treats over 50,000 children each year and is involved in an extensive research programme into children's disease and health.

The Adelaide Hospital, the Meath Hospital and the National Children's Hospital joined with four other hospitals to form the Federation of Voluntary Hospitals under the Hospitals Federation and Amalgamation Act, 1961, in the hope of replacing smaller hospitals with a large, modern, public voluntary teaching hospital. This would require the amalgamation of the Adelaide Hospital, the Meath Hospital and the National Children's Hospital on agreed terms between the parties.

In August 1990, the then Minister for Health established a working party, chaired by Mr. David Kingston, to consider possible future management arrangements for the new Tallaght hospital. The working party was comprised of representatives of the three hospitals transferring to Tallaght — the Adelaide Hospital, the Meath Hospital and the National Children's Hospital. In its report submitted to the then Minister for Health in November 1991, the working party stated inter alia that the three hospitals had agreed that the legal instrument governing the new Tallaght hospital would be an amendment of the existing Adelaide Hospital Charter of 1921.

On 3 November 1992, the Government decided, subject to the transferring hospitals reaching agreement on the composition of a board for Tallaght hospital, to commence the construction of a hospital at Tallaght. On 25 May 1993 agreement was reached between the boards of the three hospitals and approval by Government was obtained on the composition of the board and other issues.

The legal route chosen by the hospitals to give effect to the establishment of the new facilities at Tallaght is by way of a charter. The new charter, which has been negotiated by representatives of the three hospitals, is intended to reflect the interests of the three hospitals and form the basis for the management of the new hospital.

The Cental Council of the Federated Dublin Voluntary Hospitals operates under the provisions of the Hospital Federation and Amalgamation Act, 1961. Under the proposed legislation the powers and functions performed by the central council in relation to the Adelaide, Meath, National Children's Hospitals and the new Tallaght hospital will pass to the Tallaght hospital board.

The Tallaght hospital is designed to serve the needs of a catchment area of 250,000 people in west Dublin and to provide a range of speciality services from the transferring hospitals. At present, people in the catchment area must travel long distances to receive acute hospital care in the city centre hospitals. These facilities will now be available to the community in west Tallaght.

I am concerned about the closure of the last three remaining hospitals in the inner city, an area I have represented for a number of years. However, I am satisfied that discussions are ongoing with service providers in St. James', the Mater, St. Vincent's and James Connolly Memorial Hospitals and the Children's Hospital in Crumlin regarding the extent to which their existing services may be redirected to take account of the major development in Tallaght. The hospitals can expect fewer patients to attend from west Dublin than heretofore. Equally, patients from the city centre who traditionally availed of the MANCH hospitals will receive treatment elsewhere. A vacuum will not be created in Dublin city hospital services as a result of the building of the new hospital in Tallaght. The city centre hospitals look forward to being in a position to serve their area in a more focused manner under the new arrangement in addition to their national specialist responsibilities.

I welcome the measures in the Bill. It is historic that the legislation has the agreement of the three hospitals concerned. This aspect was mentioned earlier and I will not dwell on it but I am glad agreement has been reached. I congratulate the three hospitals for coming to that arrangement. As the Minister pointed out, Members received a letter expressing the hospitals' wish that the legislation be speedily passed by both Houses of the Oireachtas. I hope that will be the case in the Seanad and I commend the Bill.

I welcome the Minister and the Bill. I take a proprietorial attitude towards it because next year I hope to move from the Adelaide Hospital to Tallaght hospital. I had a deep interest in the negotiations in bringing forward compromise proposals for the Bill and I congratulate all those involved on the satisfactory conclusion which has been reached.

Much has been said about the differences in terms of the background, and ethos of the hospitals. However, I was a student in the Meath and National Children's Hospitals and I worked in the Adelaide Hospital and I hesitate to stress the differences. There is a commitment among the staff of the hospitals to the treatment of patients not just from Dublin but from the country. This is the important aspect of the move to Tallaght rather than any differences which may have existed. The people of Dublin and Ireland will be served to the highest level because that is the essential ethos of all the hospitals and this will be maintained in the hospital in Tallaght.

I am glad the Minister mentioned that St. Loman's Hospital is also moving to Tallaght. I was a student in that institution and it is an important move for it also. The integration of acute psychiatric care in the new hospital in Tallaght is welcome.

The people of Tallaght and the board deserve enormous congratulations for pushing for progress on the new hospital. The many meetings I attended in Jobstown, Firhouse, Brookfield and Tallaght Square over the last five years were incredible in terms of the amount of energy and enthusiasm the Tallaght Hospital Action Group put into the drive for that facility. We made many visits to the Department of Health and I met three or four Ministers for Health. The group's efforts were sustained. There is a lovely pyramidal sculpture in Tallaght village by Dick Joynt, featuring large people at the bottom supporting increasingly smaller people as it goes up. This exemplifies the spirit of Tallaght. They support each other and they pushed for the various institutions established in the area — the regional technical college, the basketball arena, the shopping centre and the hospital.

It is also important to remember the three hospitals will not just serve the area. It will be a tertiary referral hospital for different specialities from all over the country. This is an important point. As Senator Roche and Senator Doyle said, there are hundreds of years' service behind the three hospitals moving to Tallaght. I will not deal in depth with the hospitals' histories but interested people should buy the books of Professors Lyons, Coakley and Gatenby or Dr. Mitchell. I am sure a small commission will come my way if the sales are good enough. The books give a detailed history of the development of the institutions and a foreseeing person could start making notes for the first book on the Tallaght hospital.

The hospital will have a bright future. The long association with the Trinity medical school will continue and the campus on the Tallaght site will have the same type of facilities as those at St. James Hospital. Trinity has already started raising funds for the new university facilities required in Tallaght and I look forward to receiving further contributions from the State.

The emphasis being placed on integrating general practitioners in the area in the working of the Tallaght hospital plan is important. They are the life blood of any medical organisation in an area and they have put enormous work into fulfilling the dreams of the people of Tallaght. People in paramedical institutions established in the area over the years have also put in a huge amount of work. Tallaght was a very problematic area when it was built. There was little in terms of facilities and transport was poor. I recall seeing pregnant women in the Rotunda Hospital who had travelled from Tallaght; this required taking two or three buses to cross the city. The hospital in Tallaght is late in the day for the people of the area, but if everything goes according to plan the wait will have been worthwhile.

I am glad the Bill has all party support — all parties were involved in it — and that is has been processed so speedily through the Oireachtas. I met numerous Ministers for Health from different parties who were involved in the planning of the hospital and the consideration of how changes to the charter could accommodate the views of the different groups. It is good the negotiations have come to a satisfactory conclusion and the legislation is going through the House as swiftly as possible. This is important because, while the board designate is in place, legislation is required for the appointment of a chief executive officer and a management team and so that the formation of operational policies can begin. These matters take time to organise and the building is well under way, as those who have visited the site are aware. It is hoped the hospital will be up and running by this time next year.

The Bill is historic in several ways. It is a concrete example of the Republic taking care of the anxieties of minorities. It is important to point out the Bill does not just take care of the anxieties of a small religious minority but rather of a large number of people — it could be the majority nowadays — who want the Republic to go forward as a pluralist, multidenominational State. I have seen far more support for such ideas within Ireland than any suggestion that the rights of minorities are not being looked after.

The nursing school was of particular importance in this legislation and it was one of the most difficult areas to deal with. Nursing schools of all three institutions have been incredibly important in training nurses in Ireland and it is good that a tricky problem has been dealt with satisfactorily.

Should anyone query what minorities wanted made available in the hospital, I am glad that the Minister said in his opening statement that section 5 will ensure that the hospital makes available all medical and surgical procedures which may lawfully be provided without prejudice to the rights of conscience of staff. This is important because we have had problems over the years with procedures legally available in Ireland being unavailable in many hospitals within the State. All procedures which are legal should be available within State hospitals. This hospital differs from others only where such procedures are available in that the board is bound to provide these procedures, subject to the rights of conscience of staff.

Rights of conscience are absolutely essential within all working conditions such as this. I do not think it has been suggested anywhere within the State that this should not be so. I was dismayed with the attitude of members of the Irish Medical Organisation who suggested — the motion was carried — that if one does not agree with a procedure, one does not have a duty to refer a patient to a colleague to discuss a procedure legally available in this State. I was glad that the Medical Council firmly stated that one had a duty to refer people, because while we in the medical profession and associated disciplines have rights of conscience, it is important to remember that our first ethical duty is to our patients and that their rights must also be respected.

This legislation is for ourselves within this Republic, but note will be taken of it in Northern Ireland. A minority's rights are not dependent on its size and, as far as I am concerned, should not be. I was dismayed that a newspaper commentator suggested to the IRA that there was no need to continue fighting because the Catholic population in Northern Ireland would shortly outnumber the Protestant. At best this is sectarian triumphalism and at worst it is looking at Northern Irish women as two groups of brood mares, one out breeding the other. This is disgraceful and any Northern Irish women I have met do not plan their families' sizes on demographic logistics. It is a most insulting suggestion that anything like that should happen. While people in Northern Ireland are inclined to say that they take no notice of what we do, I have a sneaking suspicion that they will take a good deal of notice of this and be pleased that it has happened.

The establishment of this hospital is the establishment of the last of the six hospitals which were planned for the Dublin area. They were first mooted nearly 30 years ago in the Fitzgerald report and they will be in place by next summer. Having worked in small Dublin hospitals with such tremendous commitment to medicine within this State, it is sad to be moving out of these institutions into the bright new future of a big institution. I welcome the formation of these hospitals. I went from Sir Patrick Dun's to welcoming, open arms in the Adelaide Hospital. I remember that I was warned not to unpack because we would be moving to Tallaght almost immediately. I did unpack and it was just as well. I have had the privilege of working there for some time and have enjoyed it enormously. This is an important day, not just for the hospitals involved, but for medicine in Ireland. The great emphasis in Tallaght will not be the differences in background or ethos of the hospitals, but the tremendous commitment of everyone within them to working in a spirit of service for the people of Dublin and of the country.

Would I be permitted to share my time with Senator Ross?

Is that agreed? Agreed.

I am sure that all Senators welcome this Bill as I do. It is a short enabling measure to permit the Minister for Health to provide the necessary statutory basis for the establishment of the governing body of the new Tallaght hospital.

In an understated way, it has taken a large and significant step forward in hospital provisions for the people of our capital city. The new Tallaght hospital, when the Bill is enacted, will involve the amalgamation of three great institutions — the Adelaide Hospital, the Meath Hospital and the National Children's Hospital — which have given enormous service to the people of this city and country over many years. These great hospitals will continue to provide service to the community in a new context and with enhanced facilities. That is a vital and historical development which we all welcome.

The new Tallaght hospital will represent more than an extrapolation of a most distinguished past into the future. This new hospital on the south side of Dublin, catering for a vast catchment area, has a unique opportunity to adopt a totally new and imaginative approach in the delivery of acute hospital services to the population in that catchment area.

There is another aspect of the new Tallaght hospital which is historically important. The opening of this hospital will fill in the last piece in the major reorganisation of acute hospital services in the greater Dublin area which has been taking place over the past 20 years. When one goes back a relatively short number of years, the centre of Dublin was served by relatively small, older hospitals such as the Charitable Infirmary, which was Jervis Street, St. Laurence's Hospital, the Richmond, Sir Patrick Dun's Hospital, Baggot Street Hospital and Dr. Steeven's Hospital. All of these are now closed and will soon be followed by the Adelaide, the Meath and the National Children's Hospital. In place of these, we have a new flagship acute public hospital on the north side of Dublin, Beaumont Hospital. We shall soon have another state-of-the-art hospital in Tallaght. St. James' Hospital has been hugely developed and is a crucial modern facility in the centre of our capital. These are supplemented by general hospitals such as the Mater, St. Vincent's, St. Michael's in Dún Laoghaire, St. Columcille's in Loughlinstown, James Connolly Memorial Hospital in Blanchardstown, by specialist institutions such as the Coombe, the Rotunda and Holles Street, by the children's hospitals in Crumlin and Temple Street, by other institutions such as the Eye and Ear Hospital on Adelaide Road, where I had my tonsils taken out many years ago — I remember the day I was being discharged; the Dublin-Monaghan bombs went off, so I was kept for another day — and by Hume Street and other public and private institutions.

I welcome the Minister's commitment to the movement of acute psychiatric services from St. Loman's. I had the pleasure many years ago of working as ward sister in St. Conal's Hospital in the psychiatric end when the change was taking place from the psychiatric to the general end. I remember the mayhem talked about at the time that would follow when this change took place. I was also the union secretary for the nurses so I was in a catch-22 situation. The present acute service now available within the general area is one that is most welcome. It has been a great innovation.

I do not think Dubliners can complain that they are not well-served in the provision of hospital facilities. I was disappointed to hear that complaints are being made publicly by people from some of the hospitals going to Tallaght that not enough beds are being provided. I do not think you can ever provide enough beds for hospital doctors. A bed provided is a bed filled. No matter how many beds the Minister provides, there will be complaints that it is not enough. The new Tallaght hospital facility will be in a position to provide magnificent services to the people in the catchment area. The confidence in a facility should not be undermined by irresponsible commentary. I am sure the Seanad will appreciate the Minister's assurances on this issue. Doctors going to Tallaght should rejoice that they will be able to practice medicine in modern conditions by virtue of a massive Government investment in the hospital, which has been paid for by the people with a contribution from EU Structural Funds. People in my constituency of Donegal North East would be delighted if a fraction of that investment was diverted to provide public services and infrastructure in their area.

Rather than spending time worrying about the concerns of a small minority of hospital doctors, I look to this hospital as being patient centred. Many of the people in this hospital's catchment area are relatively disadvantaged. I am glad they will soon have access to modern acute hospital facilities of the highest standard the State can provide.

In the last century the population of Tallaght was comparable to that of the city of Limerick. Furthermore, as it is one of the fastest growing areas in the country, the provision of Tallaght hospital is timely. In addition, account must be taken of the fact that when the Luas is up and running in a few years time the number of people to which Tallaght hospital will be accessible will be substantially increased. By any standards this new hospital will be a major institution serving the community into the next century.

Tallaght will be a major teaching hospital. It has concluded an academic agreement with Trinity College medical school. This will enhance the hospital's attraction for the best medical and nursing staff and will ensure that the quality of medical care available to patients is second to none.

Trinity College medical school has academic agreements both with St. James' Hospital and Tallaght hospital. In considering the amalgamation of the three hospitals going to Tallaght and the agreement reached between the hospital and Trinity College, it is evident that we owe a debt of gratitude to all the institutions concerned for reaching an agreement which has allowed this development to go ahead to the point where the Bill is before the Seanad today.

Over the past few years one heard of disagreements between the base hospitals on some aspects of the amalgamation. Happily, these difficulties have been resolved to everyone's satisfaction. I congratulate the base hospitals and the Minister for the constructive role played in bringing this development about.

I referred earlier to the different approach to the provision of acute hospital services which the new Tallaght hospital can provide if it is of a mind to do so. I was thinking about a community centred approach, where the hospital reaches out to the community it aims to serve and makes itself more amenable and less forbidding to people in its catchment area. There is a pressing need for an integration of services between the health boards and the larger health care institutions in so far as community care is concerned.

A number of years ago care in the community, as opposed to care in institutions, was flavour of the month, but it now seems to have fallen out of fashion. I am firmly of the view that it was a worthwhile concept provided it is fully recognised that it is not an inexpensive option. Older people who live alone are being discharged from acute hospitals, in some cases without health board community care specialists being notified. Such people are frequently unable to look after themselves without a minimum level of support and they will inevitably revert to hospitalisation if they do not receive community care. I cannot understand why health boards and the larger institutions have such difficulty liaising on this aspect of medical provision.

The other dimension to innovation in the medical care of patients pertains to the integration of services between primary care providers, general and family practitioners and hospital medical nursing staff. There is a strong case to be made for general practitioners to be given greater access to hospital facilities, such as laboratories and X-ray units, without having to go through long-established and relatively inefficient channels.

There is a substantial degree of restrictive practice at work in the medical area which will have to be tackled sooner or later. The Bill provides an occasion for congratulations to all concerned in this great Tallaght hospital project. It is also an occasion for celebration of the birth of a new institution whose role in the years ahead could not be clearer or more vital. I am pleased to have been involved in debating this landmark legislation and I warmly welcome the passage of this Bill through the Houses of Oireachtas.

I thank Senator Maloney for sharing his time with me. Many Senators have taken this opportunity to discuss hospitals and the general area of health. However, that is not what we are celebrating today. We normally do not have a Bill or charter to mark the opening of a new hospital or an extension of hospital beds. We are celebrating an historic occasion — the end of a long battle which was fought principally by the Adelaide Hospital for the protection of its ethos.

To some extent people have been dancing on pins in the debate but that is what the Bill was about. It was about a battle for protecting the rights of minorities and their ethos in the Republic of Ireland. It was about a special relationship between doctors and patients which the Adelaide and many others thought was threatened.

Let us not be triumphalist, but what has happened today is a great victory for pluralism in this part of the country. It is a day which many of us feared we would never see. Those of us who were involved only in a peripheral way in this House sometimes came close to despair about what would happen on this issue. Senator Henry and Senator Norris are aware that time after time this issue was raised in the House, at the instigation and with the support of many people in the Adelaide; Ministers promised the world, but delivered nothing.

The Minister today is, thankfully, delivering at long last what over the years people pursued with hope rather than with total conviction that it would happen. I congratulate the board of the Adelaide Hospital, the Minister and all involved for overcoming what appeared at certain stages to be insuperable obstacles. We have now got a protection for the rights of minorities in medical matters in this country. Everybody who is in favour of that should be congratulated, but I see no reason for apologising for this. People have been fairly reticent to mention that it is about the protection of the Protestant ethos. Let us read clause 5 (j) of the explanatory memorandum, which unequivocally:

ensures that the hospital will maintain the fundamental principle upon which the Adelaide Hospital, Dublin, was established, that it should be an essentially religious and Protestant institution and that it would maintain the hospital as a focus for Protestant participation in the health services and thereby preserving its particular denominational ethos. The clause also provides for the freedom of conscience and free profession and practise of religion by all within the establishment. It states that the hospital will therefore have a multi-denominational and pluralist character, it further recognises that religious welfare is part of the total welfare of the patient and that the support of such religious welfare by chaplains of each major denomination is essential to the attainment of that object.

This means that people of all denominations, whether they are Presbyterians, Church of Ireland or Roman Catholics, have that protection. The fear was, however, that the Protestant minority would not have that protection in the Adelaide's new status within the three hospitals in Tallaght. That fear has now been removed and when this Bill is passed that fear will be gone forever. That is why this Bill is significant. The rest of it is peripheral and insignificant compared to what the Minister has achieved. Of all people, the Minister knows that in Northern Ireland this issue was seen as a litmus test and was quoted as such time and time again. As we equivocated over it, people of a non-liberal, narrow outlook in Northern Ireland would say, "There they are, at it again. They will not give the Protestant minority the sort of rights and liberal treatment they feel they need".

The Minister has passed that test and I congratulate him. The late Senator Gordon Wilson confirmed in this House that this issue was so important it was vital we passed a Bill of this sort. There was resistance. That is why it is historic and why it is a case for congratulation. There is no point pretending there was not fundamentalist resistance to this Act and the thinking behind it. That is why the battle was so long and the Adelaide had such difficulty in getting it through various Ministers. It was a Herculean test, an extraordinary achievement, over enormous obstructions.

It could be said, and resented, that too much protection has been given to the Adelaide in the Board's structure. I do not think it has. It is absolutely essential to convince ourselves and others outside this island that we are liberal and pluralistic. The Board consists of six representatives from the Meath, six from the Adelaide, three from the National Children's Hospital and eight nominated by the Minister — six of whom are nominees of the Archbishop of Dublin and two from the Eastern Health Board — will protect that minority and the medical practices which they believe it is their right to have the option to take.

Nobody wishes to interfere with the medical practices or medical conscience of Roman Catholics, Jews, Presbyterians or any other religion but we have to create a system in the medical services where everybody feels that their right to a particular and confidential relationship with their doctor and to their own ethics where their bodies are concerned, is there and established. What the Adelaide has done in pursuing this matter with such vigour, courage and determination is an enormous triumph for it, the Government and the Republic of Ireland. I congratulate the Minister on the Bill.

I welcome this Bill. It is a triumph for common sense and pluralism. I am delighted the three hospitals have come together. In north Sligo, Catholic and Protestants have lived together for years. At funerals there Catholics went into the Protestant church and vice versa. About ten years ago my Protestant neighbour's father died in Belfast. A group of us went to Belfast, one of whom was the local curate. They were amazed when they saw Catholics, particularly a Catholic priest, going into a Protestant church. We felt nothing about it because it was common practice. The parson and the priest got on very well. I could never understand why there should be any trouble because we always respected the Protestant ethos and they respected ours. No country or society is healthy if they do not respect each other's views. We all adore one God — there are not two of them up there.

These hospitals not only gave a great service to the people of Dublin, but to all the people in Ireland. Long before the health boards, regional hospitals and special services, these hospitals were known in rural Ireland. When children were seriously ill, they were sent to Dublin — to the Adelaide, the Children's Hospital or the Meath. These hospitals were known outside Ireland for the great training and teaching of their staff, who gave great patient care, comfort, etc., wherever they went to work. These hospitals have a long and proud history of caring for people. They did not ask whether people were Protestant or Catholic, they just asked what the medical problem and then tried to solve it.

It is sad to see hospitals closing but, in the world we live in, science and services move on. We have to move on to bigger and better services. It is great that these three hospitals have come together. I believe when they are all working together in Tallaght, the result will be greater than the total of the three parts; it will be a more cohesive and better unit.

I appeal to the Minister to set up a three person committee to monitor the daily working of the hospital. We are bringing three groups together under one roof. We know what happened in Beaumont where eminent surgeons and professors were dragged into nitty gritty problems and, like the fly getting into the spider's web, the longer that continued the more they got entangled. That is why there should be a good monitoring service to deal with these different problems from the start.

I also appeal to visitors and families of people in the new hospital to be patient for the first year or so. Every new undertaking has its teething problems. In my 20 years on the health boards I rarely had complaints from patients. However, we always had complaints from members of the family who thought things were not moving fast enough or were not being done well enough. I often asked them if they were patients themselves and if the patient has complained. They would say no but that they had seen it for themselves. I told them they had seen nothing as they had been there for only five or ten minutes while the patients were there all day. I appeal to people to be patient with the new hospital. Tallaght needs a hospital. Tallaght is bigger than the city of Limerick and has long been in need of a hospital service. I believe it will provide better service than the three old hospitals. There should be a good direct bus service from the city centre to the new hospital to help visitors get to the hospital.

I was delighted to hear Senator Maloney say he was delighted with the psychiatric services in the North-Western Health Board. It is a pity he is not here because, when we were trying to bring in those good services, Senator Maloney was one of the great opposing forces in the local media and wherever he got a platform. He gave us a lot of hassle. We are pleased he is now satisfied we were going the right road and that the services were good.

I have no doubt this will be a good hospital and that the three hospitals will work together in unity and harmony. I hope there will be a small monitoring committee to ensure we do not have any of the problems that arose in Beaumont. I will cut my speech short as I understand there are important statements to be made. I welcome the Bill and give it our full support.

Debate adjourned.