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Seanad Éireann debate -
Wednesday, 26 Jun 1996

Vol. 148 No. 4

Health (Amendment) (No. 2) Bill, 1996: Second Stage (Resumed) and Subsequent Stages.

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

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.

I welcome this Bill which provides the necessary statutory basis for the establishment of the governing body of the new Tallaght hospital. All of us would accept that there has been a long process of discussion and debate to date leading to the establishment of a single board for the new Tallaght hospital.

This Bill has the support of all the three hospital boards, and the board designate has been working since January last. It now needs this legislative power to proceed with the integration of services which are essential for the transition to the new Tallaght hospital. The board designate urgently wants this legislation passed so that it can proceed with the work it needs to do.

This project began in 1990 when a working group was established under the chairmanship of Mr. David Kennedy. The heads of agreement were reached three years ago and agreement on the draft charter, which formed the basis for this Bill, was finally reached last August.

I welcome the fact that there is all party support for this Bill. The agreement between all three boards shows there is unity among all the parties involved and that augurs well for the working of the new hospital. When the new hospital was built at Beaumont and hospitals of different traditions came together, there were many difficulties which have persisted to this day, so I hope that, because of the long process of negotiation and discussion which has taken place between the three boards who are moving out to this new site, there well be a much smoother transition to Tallaght.

This is a practical example of tolerance and respect for the role of minorities in this State. It acknowledges the contribution which minorities can make, and they have a responsibility to make that contribution to society as a whole and not just to their particular group. The Tallaght hospital will be a new experience. It will be a challenge to all the parties involved and no doubt they will rise to that challenge.

When this Bill is enacted, one board will take over the operations which are now being carried out by the three separate hospital boards, the central council and the Tallaght planning board. This move will enable good management and a smooth transition to Tallaght.

The building of the Tallaght hospital is on schedule and it is expected to open this time next year. We could all be critical of what is and is not being provided. The State's health budget is about £2.4 billion and we would all probably ask for more resources to be made available. The health area is like a bottomless pit. If all the Exchequer's funds were made available to the health services throughout the country, we probably would still not be satisfied with the services provided. There is obviously a huge demand in this area and as technology and developments in the health services improve there is a greater demand on the Exchequer for health service funding.

The new Tallaght hospital is the largest hospital project ever commissioned in the history of this State. It is a great development for the people of Tallaght who have been waiting for it for almost 15 years. With the passage of this Bill, the opening of that hospital is moving ever closer.

The charter of the new hospital is the amended charter of the Adelaide Hospital. It assures patients of all denominations that the hospital will be managed in the interests of patients. It assures patients of the availability of every lawful surgical and medical procedure, with the privacy of the doctor/patient relationship protected without the intervention of any moral big brother. That is important and I welcome it.

It is also important that the staff can exercise their rights of conscience to opt out of procedures with which they do not agree. The staff's freedom of conscience and freedom to practise their religion is guaranteed; this is also important. It is very important to assure society that the Tallaght hospital has a multidenominational and pluralist character, and that is something I would like to see in every hospital. It is unfortunate that certain procedures are not carried out in some hospitals because of their ethos to date. It is also unfortunate that many of these procedures always seem to affect women. My party believes it is regrettable that any particular ethos would have to be enshrined in the public health service, but, if one looks at the overall state of hospital services the Catholic ethos is so extensive that the Adelaide needed this guarantee because it was so vulnerable. I know they fought for this guarantee which involved much protracted negotiations and they had to follow a long hard road. I pay tribute to the members of the Adelaide board and to the boards of the other hospitals who were generous and accepted the Adelaide's legitimate call for a guarantee in this charter.

From the Minister's point of view, much work has gone into bringing this Bill to this point. I pay tribute to the work done in the Department of Health and to the Minister and the Minister of State. Getting to this stage has not been easy. I accept that many people had fears and reservations. It is great that all the members of the boards are in agreement as are all the parties in this House.

I have already referred to one of two important issues, that is, that the fundamental principle of the Adelaide as an essentially religious and Protestant institution will be maintained guaranteeing the rights of practice and providing that the hospital has a multidenominational and pluralist character. Another important issue is the fact that each of the colleges of nursing will be autonomous for student nurse intake. This was necessary because the Adelaide hospital was the only Protestant training hospital for nurses and the guarantee in section 24 was essential.

We are witnessing something historic. The voluntary traditions of the three separate hospitals will continue in the new hospital at Tallaght and the people of Tallaght will benefit from being served by the traditions which each of the three hospitals will bring to them. It is a difficult time for each hospital which is moving from where they have been for so long, but they will face the challenges ahead.

The people of Tallaght will benefit greatly from this new hospital. Senator Norris and others said this hospital may be the most up-to-date in the country but it will still not be sufficient to meet the demands. It will be difficult to ever meet the demands on the health service, although the resources of £2.4 billion are substantial. I welcome this Bill and I hope it will pass quickly through the House.

I appreciate Senators' unanimous welcome for the Bill and I will attempt to deal with some of their comments.

I welcome Senator Roche's support for this legislation. I thank him for his commendable but slightly lengthy history of the Meath Hospital. I remind him that the Meath Hospital's history will continue in the new Tallaght Hospital under the name as set out in the order — the Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital.

I endorse Senator Doyle's views and pay tribute to the contribution which the Meath Hospital, the Adelaide Hospital and National Children's Hospital have made in providing hospital care over the years. I am happy this contribution will continue at Tallaght hospital and that each of the hospitals' interests and honourable traditions will be respected and acknowledged. The catchment areas of the three hospitals will be served by St. James' hospital.

I am grateful to Senator Maloney for his support for these important measures and for his encouraging outline of Dublin hospital services. As regards beds in Tallaght. it is the Department's opinion, following a detailed analysis, that none of the scare stories to which the Senator referred have any foundation. The emphasis, as set out in the health strategy, will be to consolidate acute services and, in particular, to provide new strong links with GPs and to continue care programmes in the interests of high quality patient care. Negotiations and discussions are already taking place with GPs in the Tallaght area and the hospital will reach out into the community.

Senator Ross referred to what he described as the battle for the Adelaide Hospital and the rights of minorities. Today is a historic day because it is the culmination of a process which has led to the legislative proposals before the House. It is not just a battle won by the Adelaide Hospital but a battle won by the Meath Hospital and the National Children's Hospital. The traditions of each hospital are respected and acknowledged by the legislative framework before the House. The provision of all lawful medical procedures at the hospital is enshrined in the draft order, as are the rights of conscience of staff and others.

I welcome Senator Farrell's support for the Bill. He said it was a triumph for pluralism. I am glad he acknowledged that the three hospitals have an excellent reputation not only in Dublin but in Ireland. The Senator proposed a committee structure to monitor the hospital's functions so that we can avoid some of the problems experienced in Beaumont Hospital. I assure the Senator that we are facilitating a unified management structure for Tallaght hospital before the hospitals merge. The Department is confident that the board designate, which will have a statutory basis after the order has been signed, will have the competence and commitment to ensure the smooth running of the hospital.

Senator Henry was right to congratulate all those involved in this process. I am glad she acknowledged that the essential ethos in each hospital is a caring attitude to patients. It is good that the Senator referred to the transfer from St. Loman's hospital to Tallaght hospital. I, like her, have a particular interest in St. Loman's in that she worked there and I worked for it because it is in my constituency. Tallaght hospital will have 56 acute psychiatric beds, with particular emphasis on services for elderly mentally ill patients. I have already said this will be a fine hospital, providing all procedures which are legal. However, it will also be one of the few hospitals in the country providing a full range of services, including paediatric, geriatric and psychiatric services. I am glad the Senator reminded the House that this day is important in the medical history of Dublin.

I welcome Senator Norris's positive comments. I do not propose to turn this debate into a general debate on our hospital services. I assure the Senator that I do not consider him to be begrudging; I doubt if his opponents would describe him as a begrudger. I have no doubt that Tallaght hospital will be well utilised. I cannot accept that it will prove to be inadequate. Theatre space, an outpatient department and bed numbers are being considered by the Department. A recent study has shown there are adequate beds in Tallaght hospital. There has been an enormous move recently by acute hospitals towards day procedures. I am aware that the provision for day theatres is being looked at in Tallaght hospital which may not be fully provided for because of changing medical practice. Any project of this size merits continuous review and this is happening in relation to Tallaght hospital. I assure the Senator that it will be carefully monitored.

I welcome the comments about the historic nature of this Bill. Senator Roche told us there was a lesson to be learned from the negotiations and the compromise. I am not unaware of the parallels between this problem and the controversy over the Mater Hospital in Belfast, which went on for many years but which was finally resolved. Senator Henry said this was the historic resolution of a tricky problem. I agree with her that all sides deserve to be highly commended. Senator Ross told us we were celebrating a historic occasion, the ending of a battle for the protection of an ethos and a great victory for pluralism. I will convey the congratulations of the House to the Minister, Deputy Noonan. A number of Ministers for Health have been involved in this over the years and he has successfully brought it to a conclusion.

In personal terms, I am not unaware of how privileged I am, because of the Minister's absence, to be the one to bring this Bill to the House this afternoon. I assure Senators that because of my background and experience I greatly appreciate this. I thank Senators for their welcome for the Bill.

Question put and agreed to.
Bill put through Committee, reported without amendment, received for final consideration and passed.