Deputy Kenny has been given permission to raise on the Adjournment the question of the provision of a new general hospital in Castlebar. The Deputy has 20 minutes.
Adjournment Debate. - Castlebar General Hospital.
I thank the Ceann Comhairle for giving me the opportunity to raise this very important matter. It gives me a chance to state a case for this hospital and also gives the Minister for Health an opportunity to state his case and the Government's position on the problem relating to the provision of the new general hospital in Castlebar.
This is the single most important and pressing problem in County Mayo. It has been accepted for a long time by all sides, including those on the political divide, that the provision of a general hospital is something which should have been done many years ago. It is now a pressing and most acute problem. I asked a question on 6 May in which I sought to know if the Minister for Health was in a position to release to tender stage the proposals already drawn up for the provision of the new hospital in Castlebar. That is all I want the Minister to do.
In his reply, I would appreciate if the Minister would set the record straight as to the chain of events which led to the situation in which the tender proposals have not yet been released. On 18 November 1981 I received a letter from the former Minister of State at the Department of Health in which he indicated:
The position is that it has been agreed that Castlebar General Hospital will be developed as a general hospital to cater for the people of County Mayo. The hospital is being planned to have total bed complement of approximately 341 beds which will be an increase of about 139 on the existing number. The full range of general hospital specialties will be provided together with all the required back-up services, such as radiology, pathology, etc. The development will also include residential accommodation for on-call staff and the provision of a nurses home.
With regard to the planning of the project, tender documentation is now almost completed but is being delayed pending the outcome of an appeal by the health board against a decision by the council to re-route a main road through the proposed site.
That has now been dispensed with and everything is ready to have this released to tender. Allegations have been made that the priority rating of Castlebar general hospital was changed by the last Minister for Health. I should like the present Minister to outline the situation as he found it on taking office. This is something that must be straightened out and put on the record.
The Taoiseach, prior to the general election, visited the hospital in Castlebar with many members of his party and on 10 February a report in the Connaught Telegraph stated:
Mr. Haughey while in Castlebar gave an assurance that if Fianna Fáil were returned to power the General Hospital plan for the town would be proceeded with
The scheme has been shelved by the Government but Mr. Haughey gave a "solemn assurance" if in Government that they would press ahead with the scheme.
Said Mr. Haughey: "It was always our intention that it should proceed and money will be provided to fill the serious gap in the Western Health Board region."
He is now the Taoiseach and holds the reins of office. After yesterday's result one does not know how long he may hold the same reins. Will the Minister outline clearly whether he intends to release to tender stage the proposals for the general hospital? Everyone is aware that it is a very complicated procedure and method of building. It involves reconstruction, change of use, a new building and also means that the existing facilities for the staff and patients must be maintained. Trailer advertisements by the health board must be put in train and when the qualified and competent contractors tender for the hospital works the remaining stages of the tender process will be proceded with. This means no building can start in 1982 and it will probably be well into 1983 before any actual building takes place. This means that no money will be spent on the hospital this year and, therefore, the Government must include it in their 1983 budget proposals. I should like the Minister to outline that position for me.
Castlebar is the county town of county Mayo and the population has grown significantly in recent years. This bears out the annual report of 31 December 1981 with regard to conditions and facilities in the hospital. When I last asked the Minister about this matter a statement by one of the senior consultants appeared in The Irish Press stating that a case of chickenpox had infected all the surgical cases in the hospital. This is a very serious matter and one that caused great concern to everyone, particularly to the staff. With the lack of facilities and overcrowding they are working under stress and pressure conditions at all times. The quality of service, however, is second to none. For its size the hospital is one of the busiest in the British Isles. I recently had a letter from the matron urging me to continue my efforts to ensure that the problem of having this released to tender stage would be sorted out as soon as possible because, as she said, the problems of the hospital are increasing every day.
The percentage occupancy of what is a very acute hospital increased during 1981 and in the report for the year ended 31 December 1981 it is stated that overcrowding is now a source of concern. I visit the hospital on many occasions. The overcrowding is a topic of conversation in practically every house in the county. One has only to see the beds in the corridors and nurses who are overworked having to deal with too many patients in small wards. That is particularly so in the case of the children's ward which is acutely overcrowded and forces the staff to work beyond their limits. As a result, they are under an extreme degree of stress and pressure. I hope in his reply the Minister will set out clearly that he intends to release plans for the hospital to tender immediately.
I have spoken to the Chief Executive Officer of the Western Health Board who recently led a deputation to the Minister, having come away without receiving much satisfaction. The fact that in 1971 there were 8,366 admissions to Castlebar Hospital is significant when one considers that, ten years later, in 1981, the number of admissions had risen to 13,221, a vast percentage increase. The number of actual bed days in 1971 was 70,675 and in 1981 that figure had increased to 89,333. This vast increase in both admissions and bed days has been brought about without any increase in the facilities or space available, which means that the trained personnel are working under conditions they should not have to put up with in 1982. The responsibility for this rests on the Minister's shoulders. I expect that in his reply he will indicate he is about to announce good news for the people of County Mayo and of Castlebar in particular.
This report states also that the issue of the hospital had become part of the political football league. Health, health care, the provision of hospitals and certainly general hospitals such as this one should be matters above politics. That is why I expect the Minister to indicate clearly what are his intentions.
The report by the Chairman of the Executive Committee says that in 1981 the project was sanctioned and funds promised but that these were withdrawn subsequently by the incoming Government. I should like the Minister to comment on that. The Chairman of the Executive Committee went on to say that other projects in the area were promised also and that it would appear that the shelving of the new hospital was on account of political rather than financial considerations. In that context I want the Minister to spell out clearly whether the priority rating of Castlebar Hospital was changed, if so, who changed it and if there was any reason for such change. I want the Minister to explain further if he intends to reverse that decision — in the event of its having been changed originally — and, if so, when he expects the release of tender to take place.
I might repeat that the number of patients treated in 1971 was 8,366 and, in 1981, that figure had risen to 13,221, a vast increase in itself. The number of casualty and clinic patients treated in 1979 was 31,576, whereas, two years later, in 1981, that figure had reached 36,049.
I am endeavouring to get across to the Minister the extreme urgency of this matter which should be dealt with above politics in the shortest possible time. It is simply not fair or morally right or just that the people of a county town, or a county, as a unit, should be denied the single most important and pressing facility they need at present. I cannot overstress for the Minister and his officials the very high efficiency of the staff of the hospital and the courteous manner in which they work in conditions not in keeping with their training or their ability to do their job properly. There is one paediatrician only in Castlebar Hospital at present and he is on call 24 hours a day. The fact that the children's ward is vastly overcrowded in itself leads to further pressure being created in that area. I should like the Minister to comment on that aspect also when replying.
In the town of Castlebar we have a full Cabinet Minister. If the good news is to be announced then the Minister for Health should be able to advise his colleague to make such an announcement right away. In replying I expect the Minister to indicate the history of the matter in so far as he has knowledge of it since taking up office. I assume he sees the urgency, indeed absolute necessity, of having the tender stage released immediately and that he will make this announcement in the shortest possible time. I cannot overstress the absolute necessity and urgency of the matter, particularly in view of the fact that consultants have said that cross-infection and its accompanying dangers have occurred already in the hospital wards. Again this is something requiring immediate attention. The only way hope can be held out, that morale can be raised and increased confidence felt by the already severely pressed staff in Castlebar Hospital is through the release of tender stage of the proposals for the building of the new hospital.
I might mention further that some beds in the Sacred Heart Home in Castlebar are at present being used for convalescent purposes. There is there an admission committee, run on very strict lines, allowing into that home an overflow of patients from the general hospital. That should not be happening and, were proper facilities laid on in the general hospital, that need would not arise.
Responsibility for the release of tender stage of the new hospital rests fairly and squarely on the Minister for Health. I know he visited Castlebar Hospital himself. He has already admitted that the overcrowding there is most acute, that it is one of the most overcrowded hospitals he has even had occasion to visit. In view of his capacity as a senior Minister in the Cabinet, with vast resources at his disposal, he is a man who understands priorities, also in view of the fact that the Taoiseach himself travelled to Castlebar some years ago and unveiled a plaque at his birthplace less than 100 yards from the hospital, in view of all of those aspects, the political, social or whatever, I expect that the Minister in replying will cast all doubts aside, will clarify the position, saying what it is as he finds it and will make a statement indicating that he intends to release to tender stage the proposals for the new hospital immediately.
In thanking the Chair for having allowed me raise this very important matter I could not overstress for the Minister the urgency and absolute necessity to have this matter dealt with rightaway, because irrespective of the politics of the matter, the provision of such a hospital should be above all political considerations. Hopefully the Minister in replying will indicate to the people of my town and county that he, as Minister for Health, intends to deal immediately with what is the most important and pressing problem in County Mayo at present.
At the outset I should say that I agree with Deputy Kenny that this is a most important and pressing problem. I can assure him that that is the way I am treating this question. The Deputy raised a number of issues in his contribution and I shall endeavour to deal with them as far as I can in the order in which he raised them.
Firstly, the Deputy said he wanted to highlight the fact that this was a most acute problem and he asked me to outline the chain of events to date. I agree with the Deputy that it is an acute problem. I visited the hospital during my previous term as Minister for Health and gave that hospital priority, having brought it into our national hospital programme. The Deputy said he was aware of this fact in the course of his contribution.
The question of the claim of events would appear to be of some concern to Deputy Kenny at this stage and he has asked that I clarify them. I shall endeavour to do so. The Deputy said that the Minister of State had said at the end of last year that it had been decided to develop Castlebar Hospital on agreed general lines. Of course that was true, that the tender documentation was almost completed. He went on to say that prior to the budget everything was in order and that, since, an allegation had been made to the effect that the hospital's priority rating had been changed by the previous Government. I am sorry to have to say to the Deputy that that is true, that the priority rating was changed.
If the Deputy wants external public evidence of this fact he will find it in the public capital programme. The public capital programme is a new departure introduced by the previous Government for their own reasons which, as I mentioned to the Deputy before, places the Minister for Health under constraints which did not exist previously. The Deputy will find the major projects which are sanctioned for this year were sanctioned by the Coalition Government. He will find that Castlebar, along with a number of other major ones which were previously in the programme, has been dropped. I suggest that the Deputy might recognise the fact that small schemes would not need to be included in this programme so that there can be smaller schemes within which there can be virement which was usual in that area up to that time. Castlebar is one of the major schemes. Major schemes had to be included in the programme at the beginning of the year. The Deputy can see that they do not exist in that programme now. I will not delay the House by reading them out, but on page 12 of the public capital programme for 1982 the Deputy will find the major projects which were approved.
A number of other major projects and some not so vast, like Kilcoran and St. Joseph's, the new home for mentally handicapped, a very urgent one, was at tender stage earlier but was dropped. The orthopaedic unit at Merlin Park was also dropped.
The Deputy referred to the report of the Western Health Board. He will find that the most dramatic increase in demand was in the orthopaedic area. That is in complete agreement with what I was trying to do in relation to Merlin Park in regard to the provision of an orthapaedic unit. The Ardkeen Hospital and its development, which some of the Deputy's colleagues have raised in the House, was dropped. The school for the deaf in Cabra, which I was particularly disappointed about because it was one of the major projects I had achieved approval for in the International Year for Disabled Persons, was dropped. I will not go on with the list. There were a couple of others in addition to those which have been dropped. The number which have been dropped this year are in the public record in a way that never happened before.
Castlebar was certainly on the programme. However well intentioned the views of the Minister of State may have been at the end of last year, when it came to the capital allocation for this year the project in Castlebar was dropped. There are a number of projects I want to have restored and I have to find some means of phasing them back in, because I believe that the present programme after a few years will result in a stop-go situation. It was planned by my predecessor, the way I suggested it was when I was in Opposition, where high demands occur, then you go down and start to think about going up again. This in my view is a stop-go situation. I am endeavouring to get a programme under way which will match in with the next five years' requirements because, as the Deputy rightly suggested, the heavy expenditure in this area will not occur this year although there will be reasonably substantial expenditure this year. The heavy expenditure occurs in 1983, 1984, 1985 and 1986.
When one talks about a figure of £49 million this year one can see on the top of page 12 it is stated that the outturn was £44.50 million for 1981. The allocation was £47 million, so £2.5 million was taken out of the programme. That is on the record. A figure of £47 million was on the record earlier and it has now become an actual outturn in capital expenditure last year of £44.50 million. The estimate for the current year is £49.20. The financial difference is there as well as the other aspects of it.
I am very anxious to get this project under way. I accept what the Deputy says in relation to its importance. As far as I am concerned, this will be one of my priority projects in the re-establishment of a programme like we had previously. The Deputy said that while the Taoiseach was down there and travelling around during the election campaign he was asked about this particular hospital in Castlebar. He gave an assurance that Castlebar would be included in the general hospital plan we had. He said that as far as he was concerned the Castlebar project would go ahead. The Deputy can rest assured that that will be the position. The money will be provided in some way.
I note that the Deputy said that after yesterday he has some doubt about proceeding with programmes. It would be a pity if that were so, especially in the Deputy's case, because the alternative would be to go back to no development as the stated programme for this year. There could be a lot of difficulties not only in Castlebar but in other areas. The Deputy referred to the pressure from the hospital and overcrowding. He also said that the health board came to see me. I received a deputation from the health board on 11 May and I discussed the matter in detail with them. They were satisfied that I regarded Castlebar as a priority and that it was my intention at the earliest possible moment to have it restored to the programme. They accepted that they had to give me some time to do this. If the Deputy looks at the health boards' annual report he will see that in relation to the developments which took place last year a new physiotherapy building opened on 30 March 1981, an additional operating theatre was equipped and opened on 24 August 1981, a new steriliser was purchased and installed to serve both theatres, a non-denominational chaplain's room was made available, certain day rooms were made available, bulk storage tanks were provided, a new nurses and para-medical on-call residence and a few other things like this were provided. There is no doubt that the hospital is growing and it is one we have been giving attention to.
The next step is the trailer advertisements. I assure the Deputy that it is my intention to have those placed as soon as possible. The Deputy asked if I intended to give it back its priority. That is certainly my intention. He asked when I will give the good news and if I will give it as soon as possible. I will give it as soon as possible. I am trying to have the negotiations concluded. They are more involved than the Deputy may realise, because it involves the expenditure by the Department over the next five years. It must be matched with expenditure and other projects which have also been dropped. The Deputy will have to allow me some time in that respect because I am also anxious to have some of the others restored if I can possibly do so. I assure the Deputy that Castlebar will be a priority with me and at the earliest possible moment I will go ahead with it after the discussions under way have been brought to a successful conclusion.
The Dáil adjourned at 5.30 p.m. until 2.30 p.m. on Tuesday, 1 June 1982.