It is devilled in a sense to get back to this positive business after such a sad and regrettable interlude, but the life and the health of the nation must be catered for and things must go ahead.
I welcome this Bill. I was one of those who raised the issue in the House when it appeared that the so-called ethos of the Adelaide Hospital might be threatened. I tried to deal with that matter with a certain degree of delicacy, because on the one hand there appeared to be what was called the Roman Catholic ethos. This was correctly seen in some circumstances as limiting in terms of the degree of choice regarding the relationship between patient and doctors and in terms of the availability of certain legal procedures which were frowned upon by the Roman Catholic Church for theological reasons. Yet because of the prevalence of the so-called ethical committees within most of the major hospitals here, citizens were not often in a position to make a choice in conscience to avail of those procedures.
On the other hand, I did not terribly like the idea of the Protestant ethos because it seemed to veer from one sectarian label to another, simply assisting the notion that we were a sectarian society. The method I used to justify it was that because the Protestant ethos incorporated the notion of freedom of choice, it incorporated the freedom of Roman Catholics to choose to be limited in this way; and whereas the Protestant ethos could encompass a respect for the Catholic ethos, it was not necessarily true the other way around. It was restricting and negative for people who did not subscribe to the Roman Catholic ethos to be brought in exclusively under its jurisdiction. I would, however, have much preferred if it could be a liberal ethos.
With regard to the composition of the board, the Minister has acceded to the wishes that were strongly expressed from members of the various Protestant communities North and South. The board has been established and reflects the historic derivation of this splendid new hospital and it is nominated by the members of the Adelaide Hospital Society, the Meath Trust and the National Children's Hospital Company Limited, in addition to which there are six nominees of the Church of Ireland Archbishop of Dublin. As a transitional arrangement, this is satisfactory. However, had it been six nominees of the Roman Catholic Archbishop of Dublin, I would have been unhappy and it would have better if it were found to be possible to make this a transitional arrangement and not to lock the hospital in perpetuity to this arrangement.
Instead of having each individual hospital element endlessly repeating its own particular flavour on the board and the very worthy Church of Ireland Archbishop endlessly emitting six representatives reflecting his beliefs, I would like to see that as our society becomes more pluralist, more complex, more liberal and more tolerant, this necessity would automatically wither away and those of us who support choice, who support what is vaguely known as the Protestant ethos, would no longer find it necessary to put this particular sectarian label on it and would instead trust the hospitals to act in their own liberal way.
I know of a number of consultants and eminent persons in the medical world who are devout Roman Catholics but who in their professional lives respect what is vaguely known as the Protestant ethos. That is my first little caveat. I do not imagine that it will have any huge practical effect; but it is important that as a member of the Church of Ireland community who has always striven to be non-sectarian, I welcome the establishment of the board in its present form and I hope that it is a transitional situation that need not necessarily remain for perpetuity as our society develops and matures.
This is a fine facility architecturally and in terms of medical equipment. However, it is not the best that could possibly have been done. This is not a case of saying we are spoiling the ship for hap'worth of tar. This is a good ship and it would be at least ten bob's worth of tar that would be necessary to make it into the kind of vessel that I am thinking of. After the 1991 Kennedy report there were certain cutbacks built into the plan in terms of facilities. The present size of the hospital is less than what was originally envisaged. There are not enough operating theatres. The outpatient space is less than the existing space in the Adelaide Hospital which is already inadequate, although they are expecting greater usage. The number of beds is less than the projected need and, at a mundane level, there is a serious question with regard to car parking.
I want to put this into a particular context. If you look, for example, at the ratio of beds per head of population in Beaumont Hospital, the ratio is one bed per 300 head of population; in the Tallaght hospital it is one per 600. In today's Irish Times there is a report by Padraig Ó Morain, social affairs correspondent headlined “Tallaght survey finds high level of illness.” The report says:
An extremely high use of health services and high levels of ill-health and disability have been found in a survey in the Jobstown area of Tallaght, Dublin.
It was carried out by the Jobstown Integrated Development Project, funded by the Department of Social Welfare, in conjunction with the Department of Community Health and General Practice at Trinity College, Dublin. The survey of 400 households found that: More than half of all households reported having at least one member with a chronic illness or disability. The most common illness was respiratory; A third of households had at least one member in hospital in the last year; Almost one-fifth of households had a family member on the waiting list for hospital treatment. Of these, half had been on the waiting list for more than six months. Almost all (96 per cent) households had at least one member who visited a family doctor in the past year.
The rest of the article is not directly relevant to this afternoon's argument, but it does show that there is a high level of demand upon health services in this area; and when you add that to the fact that there are proportionately fewer bed spaces available, that does make the case that perhaps the provision of extra facilities would have been a good thing. This point may appear to be begrudging and I would ask the Minister of State to accept that it is not.
What is being done here, the enabling of the hospital which will be commissioned in July or August 1997, will make a major contribution to the health care provisions of this city and State. It will be a fine facility, but I have no doubt that in the coming years there will be demands from that source for extra facilities by virtue of the fact that unquestionably there will be extraordinary pressures upon that fine facility.
It is important to put down a marker now and say that some of us at least, even before the hospital goes into operation, are aware that there will be these requirements further down the line so that no Minister will be able to say "We gave you a wonderful hospital and you said 'thank you, this is marvellous and it is one of the greatest things that ever happened but you are never satisfied." It is not a case that we are never satisfied; it is a case that, as this survey appears to demonstrate, there is already a particularly high demand for health care services in this area. Some of us at least believe that, however excellent will be the facilities, services, plant and equipment at Tallaght, nevertheless, they will unfortunately prove to be inadequate.