I thank you for giving me the opportunity to raise this matter with the Minister. Like many others, when I heard of the decision to close the cardiac surgery centre in the Mater Hospital I was alarmed. Not alone on this side of the House has there been concern at the closure of that and other clinics in the Mater, but the board of management have expressed concern and Dr. Nelligan, interviewed on radio, said he was alarmed at the cutbacks in the hospital. The trade unionist, Mr. Matt Merrigan, has also expressed serious alarm.
The cardiac centre in the Mater is the major national cardiac centre for public patients in Ireland. There is only one other in the country, in the Cork Regional Hospital, but the vast majority of heart sufferers in the country depend on the unit in the Mater. There is a waiting list of 4,000 patients for admission to the general hospital and of these 1,000 are awaiting cardiac surgery. Many of them are awaiting by-pass surgery, and this closure means effectively that there will be a delay for patients seeking admission for heart surgery. This in turn means that all other periods for admission to the hospital will be extended.
Because of the nature of heart surgery quick admission is necessary, and if that is not available obviously lives will be at risk. That has been confirmed by surgeons working in the unit. Therefore, this serious position is not something we are bringing up here out of the blue. One of the most serious aspects of this is that it appears the Government do not have a national policy in regard to heart surgery. In regard to a national heart surgery department I would expect the Government to have a clear cut policy; I would expect them to respond to the requests by the hospital board for special funding in this respect.
It is understandable that when a hospital is confronted with cut-backs it is very difficult for a board of management to decide what their priorities should be. If the hospital board were to allow the cardiac surgery unit to carry on without applying the cut-backs, other departments in the hospital would suffer and people in the general departments could complain that other activities outside the cardiac unit were bearing too much of a burden with serious consequences for the patients attending those departments.
Has the Minister a specific policy in relation to cardiac surgery and has he considered that special funding should be provided for that so that this unit would not be affected by cut-backs.
The other specialist units in the Mater will be affected and so will similar departments in the Meath Hospital and elsewhere. The hospital board would like to see separate funding of the different departments. Not only is the heart surgery department in the Mater facing suffering but all activities in the hospital will suffer because between now and the end of the year 50 beds will be closed. As I said, there are 4,000 patients awaiting admission and some of those may be suffering from illnesses requiring immediate treatment. Many of them will be suffering from painful illnesses which would require more urgent attention than the hospital will be able to offer, but instead of extending the number of beds the Mater is faced with a reduction of 50. This will create great hardship, if not more serious consequences, for many patients.
It has been decided to reduce the out-patient clinics by 40 per cent. I need not say how serious this will be and the difficult decisions it will pose for the board of management. They will have to tell patients that they have not the funding from the Department to carry on with these clinics. It is difficult to understand why the out-patient clinics cannot be continued. I have seen a list of clinics which one consultant received which he will have to abandon during the summer. It will cause chaos. For instance, the fracture clinic will be closed at a time when people are likely to be injured and need help. Everybody knows that bone injuries are extremely painful.
This, of course, will cause a lengthening of the waiting list of people suffering extreme pain. The diabetic clinic is a classical example of why an out-patient department should not be reduced during the summer. The diabetic unit in the Mater is of world standard excellence, comparing favourably with any diabetic treatment unit in the world. The results have been excellent and one of the hallmarks of that clinic is the care and attention given to individual patients. They are brought back only when necessary. What will be done now? We are aware that persons suffering from diabetes can have the complaint get out of control if there are delays and they will then suffer side effects such as gangrene. If only one patient suffers gangrene as a result of these cut-backs and has a foot removed it will cost more to look after that person for the rest of his life than the cost of keeping the unit open. The consultant in that unit who is due to retire on age grounds should be replaced by two consultants. That is not happening.
More serious is the fact that the diabetic unit in the Mater Hospital has looked after diabetic patients attending the three maternity hospitals in Dublin. There are approximately 22,000 deliveries per year in the three hospitals in Dublin. The maternity hospital system in Dublin is unique in the western world and thus a diabetic unit looking after those patients would also be unique. The diabetic unit in the Mater is a unit of excellence and would stand with the best throughout the world in terms of the excellent results obtained in treating diabetic mothers. Now the patients will be divided between three different general hospitals. I should like to know what is the Minister's policy in this regard. Can something not be done to ensure that that unit of excellence, built up over 40 years, is maintained? I am sure everyone who cares for the welfare of patients would agree that every effort must be made to ensure the maintenance of that unit intact.
Because of the cut-backs, the general practitioners in the area of the Mater Hospital will not have access to the diagnostic facilities. This will cause serious problems for patients. When we debate health matters here, Members on all sides talk about transferring resources from the hospital to the community, trying to look after as many patients as possible in the community and trying to keep them away from hospital because it is an expensive location in which to treat patients. Yet, now a major hospital on the north side of the city is obliged to refuse the local general practitioners access to facilities in the hospital such as X-ray and pathology facilities, to allow them to investigate and treat patients in the community, something all of us have advocated here.
The hospital has been forced to take this action because of lack of funding and there is nothing they can do about it. The Mater Hospital is the major hospital on the north side. On many occasions we have discussed Beaumont Hospital and the reason it is not open. The Government should be concerned about that matter and should be ashamed that the hospital is not open but we are not discussing Beaumont here today. Again, I ask the Minister if he or the Government have any positive policy in relation to the transfer of resources from the hospital to the community to ensure that as many patients as possible are treated in the community and keep away from the expensive location of hospital.
The reason the hospital is forced to curtail the number of outpatient clinics and why it is obliged to refuse to look after patients referred to it by family doctors is that the hospital authorities do not have funding from the Government to replace staff. We know that the embargo implemented in 1981, with two out of three vacancies remaining unfilled, has been extended to the health services in the past two years and locums in the health services are not being replaced at the moment. If somebody goes on sick leave or on annual or special leave, neither the health boards nor the voluntary hospitals are able to replace the absent staff members. That is why the hospital is now obliged to take this remedial action.
The board of management were obliged to take these measures because of insufficient funding from the Government. From replies I received in answer to parliamentary questions I find that the Mater Hospital received an allocation of £25.169 million in 1985 while their outturn for the year was £25.313 million. For 1986 their allocation was £25.655 million, an increase of £300,000 on the outturn for 1985. After four months of this year they found they had overrun their budget on a month-by-month basis and they had to take remedial action because of the insufficient funding from the Government. The reason they overran their allocation was an increased workload this winter. There was an excessive amount of infection and this fact has been recognised generally. It was a particularly harsh winter and this was reflected in the cost of drugs in hospitals, just to mention one area. In addition, recently they introduced a new oncology service for the treatment of cancer and obviously as this service is expensive it will increase the amount of money necessary to maintain services at the 1985 level. These are the reasons the hospital found itself facing this problem.
I should like to refer to a statement which appeared in The Irish Times of today's date, allegedly from the Department of Health. It stated:
...All agencies must take action to contain expenditure and that the measures selected should not cause problems in relation to the maintenance of essential services, including hospital emergency services.
Will the Minister explain how the hospital can stay within their allocation without having a major deficit at the end of the year if they do not spread the cutbacks across the board? What other choice had they? The statement continued:
The Department said that the Minister, Mr. Desmond, regretted the public concern caused by the release of information "as to the measures claimed by the hospital to be necessary to live within their 1986 budget prior to discussion with the Department."
I ask the Minister, did they not have discussions in May with the Department? I ask him to say if that part of the statement is correct.
In conclusion I will read a letter of 9 June 1986 which I got from a constituent.
Dear Sir,
I would be most grateful for your help in the following matter.
I am on the waiting list for a by pass operation at the Mater Hospital since September 1985 and was hoping to be called in the near future for the operation. While listening to the radio on Friday, 6 June, I heard Dr. Nelligan of the Cardiac Unit state that owing to lack of money due to the Government's further cut-backs in the health service the unit will have to close for the month of August. He also stated about 100 patients would be affected.
Well, I think that is scandalous behaviour of the Government to be so uncaring that such a place would have to close down. Apart from the long waiting list of patients, what about the emergency cases? I hope you will, with the help of your colleagues in the Dáil, demand that the necessary money be made available immediately to keep this unit open.
Thanking you...
Yours sincerely.
That letter spells out exactly what many people feel, even people who are not on the waiting list for admission to hospital. I ask the Minister as a matter of urgency to ensure that the services at the Mater Hospital are restored to their original level.
