Deputy Molloy to move the motion in his name and in the names of Deputy D. O'Malley and others.
Private Members' Business. - Limerick Hospital Proposed Closure: Motion.
Tá sé i gceist agam go labhródh na Teachtaí Des O'Malley agus Peadar Clohessy san am atá curtha ar fáil don pháirtí a mhol an rún, má aontaíonn an Teach leis sin.
An bhfuil sé sin aontáithe? Aontaithe.
I move:
That Dáil Éireann, disturbed at the implications of the proposed closure of Barringtons Hospital, Limerick; mindful of the fact that it is a major public hospital facility in the mid-west region, with the busiest out-patient department outside Dublin city, treating approximately 45,000 patients annually, and being open 24 hours a day, seven days a week with 80 per cent of its in-patients being public patients; and in view of the fact that it is a highly cost-efficient hospital and that its facilities will have to be replicated elsewhere at heavy cost to the Exchequer, directs the Minister for Health to rescind his proposal to close the hospital from 31st March, 1988, since such an action is not justified on either financial, medical or social grounds.
The Progressive Democrats are opposed to wasteful expenditure of scarce national resources and are committed to carefully scrutinising all Government proposals on a need and cost-efficiency basis. The health services account for a very large proportion of annual Exchequer spending and lack of planning and inefficiency in this sector in the past has resulted in the crisis that we are now confronted with. The Progressive Democrats believe it is the duty of a democratic Government to make adequate provision to ensure that each member of our community has access to needed health care as a fundamental right. We also believe that equity must be a central value in health policy both in regard to access to services and in the quality of care available to all. We believe there is an obligation on Governments to ensure that health care is provided efficiently because wastage of scarce public resources can result in a denial of needed care. Efficiency, therefore, is linked closely with equity.
Because resources are scarce and wastefulness denies needed care to many, it is most important that we reorganise our health care system to make it more cost efficient. It costs £700 per week to keep a patient in an acute hospital bed. We have more hospital beds than are needed for a country of our size and too many people are being referred to hospitals who could be better catered for at a much lower cost if we developed a comprehensive community primary care system to enable more people to be treated at home in the environment where the patient would be more content.
At a recent health conference organised by the Department of Health a senior public health official stated:
The Irish public hospitals have got themselves into the position reached by many old English industries, like the motor car industry, steel and so forth. Their product is old-fashioned and their price is not competitive — customers will leave them. Unfortunately, in health, the customers cannot leave but the taxpayer has to pick up an ever-increasing tab and this he is no longer able to afford.
Those who have had responsibility for hospital policy over the past ten years have presided over an inefficient and wasteful system. The Progressive Democrats see the need for proper long-term planning after full consultation with those involved in providing the services. Unfortunately the Minister for Health since coming into office has proceeded to act in an arbitrary way announcing major decisions without adequate consultations with the practitioners who will have to operate under the new regime. In the case of Limerick it is generally accepted that there are too many voluntary hospital beds, there are three major voluntary acute hospitals and it is generally accepted that the needs of the Limerick area can be adequately provided for by closing down one of these hospitals. The need for the services provided at the Regional Hospital is accepted by all which means that a decision has to be made on whether it would be St. John's or Barringtons hospital which should be closed. Having carefully examined the evidence made available to us and having examined the Minister's statements we could only come to the conclusion that Barringtons hospital should be retained.
We are amazed that a Minister flying in the face of all available evidence should in fact decide to close Barringtons. Our consideration of this matter has been based on choosing between Barringtons and St. John's as voluntary hospitals. We have not been influenced by considerations regarding the future use of St. John's should that be the hospital that is closed. What we are concerned with here is the level of services available in voluntary hospitals in the Limerick area. It is quite extraordinary that the weight of opinion in Limerick among doctors, nurses, paramedicals and health board officials should all favour the retention of Barringtons viz-á-viz St. John's and yet the Minister insists on the opposite view in deciding to retain St. John's and close Barringtons.
It is more extraordinary when the weight of opinion among public representatives in Limerick in every political party, the Progressive Democrats, Fine Gael, Labour, The Workers' Party, Democratic Socialists and even the Minister's own party should favour the retention of Barringtons but the Minister ignores all these views and insists that his personal view must prevail and Barringtons be closed.
The Progressive Democrats regret the necessity to bring this matter to the floor of the House but, in view of the additional costs that will arise and the level of services that will be available in the Limerick area in future, we feel we have a public duty to let Dáil Éireann decide this matter. Our motion is worded in such a way that it directs the Minister to rescind his proposal to close Barringtons from 31 March this year.
Speaking in the Dáil on 3 February on behalf of the Minister for Health, the Minister of State said that in arriving at this decision Deputy O'Hanlon had available to him an architectural report on the suitability of both hospitals as to their future participation in public hospital service in the area and that all the evidence and the outcome of meetings he had with the Mid-Western Health Board and the management of St. John's and Barringtons hospitals on the architectural aspect all pointed to the retention of St. John's.
I would remind the Minister, however, that though it was agreed at a meeting held in Limerick on Friday, 14 August between officials of his Department and the board of Barringtons hospital that a sub-committee on the speciality needs of the region be set up with two members from Barringtons, one medical and one management, in fact, no such committee was ever set up and no meetings took place with the Barringtons hospital officials and the Department between then and the date that the Minister announced that the subvention was being withdrawn from Barringtons in favour of St. John's. This announcement was made on 10 December 1987.
Among the other reasons given by the Minister are the following: St. John's is a more spacious building; St. John's is in better condition because £0.5 million was spent on improving the fabric of the hospital in 1986; St. John's is more readily adaptable to the changing emphasis in the practice of acute medicine; St. John's is suitable for day hospital services and its mechanical and electrical services are superior to those at Barringtons hospital.
Finally, the Minister states that his decision is based purely on the basis of the physical facilities available in both hospitals and the management co-operation of the two bodies concerned. Of course, what the Minister did not tell the Dáil is that Barringtons hospital is in excellent structural condition, being entirely built of cutstone and all floors are of reinforced concrete. A number of major improvements were carried out in recent years with the approval of, and funding by, the Department of Health.
In 1981 and 1982 the mechanical and electrical services were upgraded to meet the Chief Fire Officer's requirements, the boilerhouse was reroofed and the kitchen renovated and refurbished. A new medical oxygen system, etc. was also installed. The total cost of these works with some ancillary improvements amounted to £212,000 approximately.
In 1983-1984 a new lift and lift shaft were installed and a ward was converted and refurbished as an intensive care unit at an approximate cost of £13,000. A suite of two totally enclosed, fully air-conditioned and pressurised operating theatres was completed in 1969. These theatres are equipped with every modern facility and are considered to be the best in the mid-west region with the exception of the recently completed specialised theatres in Croom. Every form of surgery has been undertaken here with a sepsis rate that is considerably lower than in comparative units.
In addition to the above capital works the Department of Health approved and funded the purchase of two houses adjacent to the hospital in 1985 at a cost of £60,000 to provide additional space for the development of the casualty-out-patients department. A planning brief for this development was submitted to the Department in April 1986. Since 1982 capital grants totalling £190,000 have been received for the purchase of replacement items of equipment.
The facilities at Barringtons include the previously mentioned two modern theatres, a well equipped X-ray rooms, an intensive care unit and a casualty department. In this context it is worthy of mention that Barringtons can provide acute hospital services for virtually every type of patient condition presented at the hospital. Obvious exceptions would include head injury cases which are transferred to Cork Regional Hospital and orthopaedic cases which are dealt with at Croom Regional Hospital.
I have here a quantity surveyor's report and an engineer's report on the building which states that the cost of upgrading Barringtons hospital building to presentday requirements would cost only £90,000. It is difficult to understand how the Minister could recommend to the House that Barringtons, a hospital that has all the facilities, be closed and that St. John's, a hospital that does not have the wide range of facilities that are already in operation in Barringtons, be kept open. It is, to put it mildly, an extraordinary decision. I appeal to Deputy Alan Dukes and the Fine Gael Party to withdraw the amendment they have placed on the Order Paper as it is clearly worded in such a way that it will ensure all Opposition parties could not join together to vote for it.
In the Dáil debate on 3 February last, Deputy Michael Noonan, Finance spokesman for Fine Gael, said he disagreed with the Government's decision to close Barringtons hospital. If his party are supporting him in that view, they should support the Progressive Democrats motion without amendment or else propose an amendment that would have the support of all of the Opposition parties.
At present all parties except Fine Gael have indicated they could support the Progressive Democrats motion and thus save Barringtons hospital. However, if Fine Gael proceed with their amendment it will be seen as a device to give the impression that they are opposing the closure while, at the same time, making sure that it did in fact close. The public will know that Labour, The Workers' Party, and Deputy Kemmy's Party as Socialists cannot be expected to accept the Fine Gael amendment which calls for the development of private hospital facilities. It is clear that the Fine Gael motion is worded deliberately to ensure that the Progressive Democrats motion, with the Fine Gael amendment added, will not get the support of the Socialist Deputies and will, therefore, be defeated. Barringtons hospital will close and Fine Gael will have closed it. I want to make it quite clear that we will vote against the Fine Gael amendment, for the reasons I have stated, if it is moved.
Tomorrow night Dáil Éireann can exercise its will if the majority against the closure of Barringtons stand together in voting for an unamended Progressive Democrats motion. I appeal to Fine Gael to reconsider their position in the interest of retaining Barringtons hospital.
There is an assumption on the part of some media commentators and also some members of the public that if one believes in the control of public expenditure and the reduction of the appalling deficits and debt which we have then one must necessarily support every move and every proposal made in a financial context by this Government, irrespective of how demonstrably foolish the particular proposal may be and irrespective of the existence of more sensible alternatives. That is the thinking underlying the Tallaght doctrine also.
I do not subscribe to this blank cheque approach which takes from the Government the onus to get things right. Within the overall valid context of controlling expenditure, errors have inevitably been made but the difference in this Dáil as opposed to any other is that those errors have been underwritten and supported by those who are too terrified to assess individual proposals properly lest they would have to oppose them. Political welfare is paramount for some, even if they can successfully portray it as helping the national welfare.
This whole misconception of newfound financial control and this fundamental misconception of the nature of Opposition in the parliamentary system have been brought to new levels of absurdity in the matter which is before us tonight. The Government take the view that in Limerick one hospital is as good as another and that it is largely the toss of a coin which should close if one hospital has to be closed. They have made a decision that takes no account whatever of the work done in and the service provided by Barringtons hospital to very large numbers of people, the great majority of whom are medical card holders or people with small incomes. Furthermore, they are closing down a hospital which, apart from the orthopaedic hospital in Croom, has the two most modern operating theatres in the mid-west and which has extensive X-ray facilities for a substantial accident and emergency service. They are closing a hospital which, on the Department of Health's figures, is far more cost efficient per occupied bed than any other hospital in Limerick.
Of all unwise decisions that have been made, this one must surely be the craziest of all. The Minister for Health is closing a hospital that contains the facilities that the taxpayer will have to provide in another hospital 500 or 600 yards away which does not have those facilities. To put it in simple terms, if there were two football clubs which it was decided to merge or to close one, and one had the option of closing one or the other and transferring the members and the players to the other club, surely one would close the club with the limited facilities and retain the one with the large existing facilities because otherwise one would have to replicate those facilities in the other club. Even at the most conservative estimate, the closure of Barringtons hospital and the provision of its own facilities elsewhere will cost the taxpayer at least £2 million extra, a cost that would not arise if the normal commonsense decision were made and the closure made elsewhere.
I am accused of parochial special pleading. If this absurd decision were replicated anywhere else in Ireland I would be equally opposed to it for that reason. It makes no financial sense and it makes a joke of the Government's commitment to saving public funds. It actually costs public funds substantially more to do what it is now proposed. I have no objection, as I have made clear in a succession of five or six statements which I have made on this issue, the earliest of them being on the morning of 11 December in this House when I protested at the foolishness of this decision on the Estimate for the Department of Health, to a rationalisation in Limerick. I do not consider that Limerick should be any more exempt than anywhere else, but I have the most strenuous objection to the foolishness and the waste of public money entailed in the way this rationalisation is being carried out.
As well as making absolutely no financial sense but costing the taxpayer substantially more than if there was a different rationalisation, this decision, as Deputy Noonan has said in the House on 3 February, is socially discriminatory. Why should a hospital that treats tens of thousands of less well-off people be closed in this town when another hospital which treats a much smaller number of much better-off people who have easy alternatives open to them is retained? Why must the delays for public patients, which we know are endemic in our hospital system today, be further increased by this proposal and the advantages in our existing system for private patients be further reinforced?
Is it not amazing that this decision is regarded as so perverse that nobody can be found in the mid-west region of Limerick city and county, County Clare and north Tipperary to defend it? Since it is so patently perverse why is it persisted with? What is the point of depriving the poor at considerable cost to the Exchequer? Is it not clear that it makes no financial, medical or social sense? Has not that been said many times by people of all parties and none and it has never been contradicted?
In this House on 1 December 1987, as recorded at column 127, of the Official Report the Minister for Health had this to say:
As regards the closure of acute hospitals, it is not my intention that there should be any further closures of acute hospitals other than those that have been already announced and are either closed or in the process of being closed.
I might draw the attention of the House to the latter part of that quotation in particular: it was not that they had already been announced or were either closed or were in the process of being closed, as the Minister tried to suggest afterwards; it was that they had already been announced and were either closed or in the process of being closed. Clearly no announcement had been made in respect of Barringtons hospital on 1 December last. However, nine days later the Minister for Health totally contradicted what he had said in the House on 1 December. Either he misled the Dáil or this decision was taken out of the blue, at extremely short notice, for an unspecified reason. We are entitled to ask: why was it made? If we do not get a satisfactory answer then, out of the Minister's own mouth, we are entitled to believe that he did mislead the Dáil.
Less than a month before this decision was announced Barringtons hospital was authorised to take on student nurses for a three-year period beginning this month. I wonder why, if there was any intention of closing it down? In October 1987 new permanent staff were taken on with the sanction of the Department of Health. Did that suggest that the hospital was about to close or that it was the intention of the Department to close it?
The only arguments advanced by the Minister that I can see are that there is more room to expand in St. John's hospital and that it is in better condition. I wonder how does the question of expansion arise since a lot of beds have to be closed in Limerick anyway and since there are two wards now closed in the regional hospital, which I presume will not remain closed for all time?
Barringtons hospital has nearly one and a half acres of land including a car park, garden, a whole lot of ancillary buildings and land made available nearby by Limerick Corporation. What expansion is envisaged by the Minister that will require more than one and a half acres when there is already on the site a hospital of close to 100 beds? The difficulties of building at St. John's hospital are well known. I will not go into them. I do not want to have to speak in any critical manner in regard to St. John's hospital. Unfortunately the circumstances surrounding this debate preclude me from ignoring it altogether. The work which has to be done in St. John's hospital and which will be extremely expensive — because of the layout of the hospital, the difficulties of access to it and those created by the existence of the walls of Limerick as almost an integral part of the hospital — has been largely done in Barringtons hospital. I ask again: why repeat it elsewhere, a few hundred yards away, at a huge cost to taxpayers?
The architect of Barringtons hospital, with whom I checked this matter specifically, tells me that it is in excellent condition, that very considerable sums of money were spent on it in recent years, that any remaining minor works that might ideally be required could be done, on his estimate and that of a quantity surveyor, for a sum not exceeding £90,000 including value-added tax. These are not essential works but, in any event, this is a fraction only of the huge sums that will have to be spent elsewhere.
As Deputy Molloy said, within the past two years an adjoining property was bought with funds provided by the Department of Health late in 1986. Is that the action of a Department that felt that hospital should close within a year or so? This House should ask itself once and for all: does stupid waste in this country mean nothing, or does it concern this House any more?
The overwhelming opinion of people who know anything about this matter is that a decision has been taken in regard to the wrong hospital. I have no objection to spelling that out. Neither have I any objection to St. John's hospital formally becoming a private hospital, particularly as that is largely what it is at present and would entail no material change. I have the greatest objection to unnecessarily antagonising those Members of this House who would vote to reverse this perverse decision. That is why we did not include in our motion any references to St. John's hospital or to private medicine. We kept the motion broadly-based, as common sense would dictate, to allow everyone who is genuinely opposed to this ridiculous decision to vote against it.
I might add that, in connection with private medicine, Limerick is now one of the few places in Ireland without any private hospital. It seems obvious that this should happen. Inevitably it would have happened but there is no need to spell it out here in an amendment to a motion. It does not have to happen in that form.
I was interested to learn recently that the Voluntary Health Insurance Board are extremely keen to start a small private hospital of their own and that they are hoping that, in this present year, legislation will be passed in this House that will enable them to do so. For their purposes a relatively small hospital like St. John's in Limerick, owned and run by them as a private hospital, would be enormously beneficial because it would enable them to set a scale of charges for all the other private hospitals in this country, some of which are causing them severe difficulties at present. The Minister would have no difficulty in getting the Voluntary Health Insurance Board to go along with him in that regard. It would suit everybody. I say that by the way but by way of indication of the possibilities that are open if Barringtons hospital is retained, as common sense demands.
Therefore, in common with everyone interested in the future of Barringtons hospital and its preservation, I have the most strenuous objection to the Fine Gael amendment to this motion, not because I disagree with its terms but because it is provocative and designed deliberately to ensure the defeat of the motion and, thereby, the closure of Barringtons hospital.
Deputies in this House cannot have it both ways. If they wish to see this decision reversed let them vote for the motion before them. If they wish to see the decision upheld, and a large amount of public money wasted, with great harm done to the welfare of poorer people in Counties Limerick and Clare, they will vote for the Fine Gael amendment ensuring the defeat of the motion. It is as simple as that. It is a black and white matter and cannot be gainsaid.
At this late point, even after the commencement of this debate, I renew the appeal I made at length last Saturday — and that the entire board and action committee of Barringtons hospital made at length last Saturday — to the Fine Gael Party and their representatives not to persist in this amendment to the motion. The amendment will have one effect, and one only, that is, to close that hospital and to override what I believed, up to recently at any rate, was the majority feeling in this House. Most people to whom one speaks privately, and all people who know anything about the position are agreed that this decision is wrong. What is happening now is an unfortunate parliamentary tactic to enable a decision by the Minister which is generally agreed to be wrong to be upheld, causing the foolish closure of this hospital and at the same time, trying to give the impression that one is in support of the hospital and wants its retention. I do not think any members of the public were fooled by that.
I would say very earnestly to members of the Fine Gael Party in particular: "You will not get any benefit from the course of action you are now pursuing. The public know perfectly well what you are up to. You will get benefit if you desist from that course of action, allow commonsense to prevail and allow a sum of £2 million or more to be saved for the taxpayers. You will be acting in accordance with financial rectitude if you have the wisdom to realise that this ploy has already been seen through very widely and that it will do you no good." I would ask members of Fine Gael, of whom there are only a few here but I am sure many are listening, to think again. If my references to the fact that we and we alone brought this motion for debate caused offence to any of them, I can assure them that if they have the commonsense not to persist with this amendment, I will not say anything that will give them cause for offence.
This is a matter on which there is extraordinary unanimity among all who know anything about it. What amazed me was that doctors, nurses, paramedical staff and ambulance drivers from the Regional Hospital said to me within the past week: "For God's sake, try to prevail on them to keep Barringtons open. What are we going to do if it closes? Look at us — people queuing for five, six or seven hours even with Barringtons open. What in the name of God are we going to do? Are they mad in Dublin? Have they a tittle of commonsense? Surely anybody looking at what is happening here will know that to close Barringtons is crazy." I believe a majority in this House would tell the Government to stop if they were allowed to do so. The difficulty is now in the Fine Gael Party. I make a particular appeal to the leader of that party to ensure that commonsense prevails, that needless expenditure is not incurred, that needless hardship is not caused and that the obvious necessity to rescind this decision is allowed to go through this House.
There is extraordinary unanimity in all political parties in Limerick about this issue. I look around to see where Deputy O'Dea is. I have not seen him for a long time. I am not surprised because, if I were in his unfortunate position, an absolutely indefensible position, I might not be here either.
I ask the Minister not to think of this in terms of politics and victories or defeats. I ask the Fine Gael Party to do the same, and between them to unwind this concoction of an amendment and allow this motion to be put to the House and carried, which is the desire of this House.
Deputy Clohessy is sharing time with Deputy Molloy and Deputy O'Malley. I must remind you, Deputy, that you have seven minutes left.
The reason we in the Progressive Democrats have tabled this motion on Barringtons hospital is that it makes no economic, social or medical sense to close that hospital.
It is obvious to all that more and more cutbacks are needed in the levels of public spending in this country. For far too many years we have being living beyond our means and spending money which we could never really afford to spend. Now, however, the time has come to pay for our mistakes.
If there is going to be any improvement in the public finances, all areas of society will have to play their part. It is not going to be easy but, at this stage, there really is no choice in the matter. Like everyone else the whole health sector is going to have to get used to less public money. The problem with this particular attempt at rationalisation in Limerick, however, is that it just makes no sense whatsoever. It will actually end up costing more money to the State to close Barringtons and provide the same care elsewhere than it would to keep the hospital open. In comparison with other hospitals in the area, Barringtons is very economical to run and, more important, treats a very high proportion of public patients.
That is another problem with the decision to close Barringtons. If the hospital is closed it will be the poor people of the area who will be most affected. These are the people who use the hospital most and they will be caused a great amount of hardship if this terrible mistake goes ahead.
This is very different from the promises which Fianna Fáil made to the people of this country during the last election. Over the past few months we have nearly become used to the fact that that party have changed their mind on nearly every issue that has come up, be it the Anglo-Irish Agreement, or the need for cutbacks, or whatever.
I believe that Fianna Fáil realise full well that they have made a wrong decision in the case of Barringtons and that is the clear message they are getting from whatever supporters they have left in the Limerick region.
They are a party who have now got quite used to making U-turns, and I appeal to them again tonight to make at least one more such turn. They had to admit the error of their ways in their badly thought out primary education cuts, and it is now quite plain that that policy is effectively reversed.
The Dáil has also forced them to change their disastrous decision to abolish the National Social Service Board. They had the sense then, too, to bow to the will of a majority in the Dáil. I am appealing to the Government to show some similar sense here tonight and to reverse their decision on Barringtons.
Of course, if they fail to do that, it still lies in the hands of the Opposition in this House to force a change of policy on the Government. That surely is what the Dáil should be all about — giving the Opposition the opportunity to force a change of mind on the Government where wrong decisions are concerned.
That is why I am also appealing to the Fine Gael Party to stop their codology. Everyone can now see through their tactics. They are pretending to be in favour of Barringtons but they know full well that their amendment will so divide the Opposition parties that the Government will win. If they continue with their amendment, they must share just as much blame as the Government for this unfortunate wrong decision.
I must say I was initially rather surprised when the original motion in relation to the closure of Barringtons hospital was put down by the Progressive Democrats, given their stated policies in relation to the control of public expenditure. On reflection, however, their attitude on this issue must come as no surprise to anybody because since their inception, they have failed abjectly to show that they have the courage of their convictions.
Public expenditure was to be mercilessly slashed and the incentives of the free market were to be allowed full rein. The Government have attempted to put some order back into the public finances and, at the same time, protect the weak and the underprivileged from the so-called "free" market of the Progressive Democrats. In the lifetime of this Dáil the Progressive Democrats have continually reneged on their stated position and have supported populist policies as we witness here tonight.
In this country we have a relatively high number of acute consultant staffed beds by comparison with numbers in other countries and particularly by comparison with that in the United Kingdom which has a health service and structure which is broadly comparable with that in Ireland. I would also like to point out that over 50 per cent of all expenditure on health services in Ireland relates to general hospital services.
In order to ensure that the available resources are used as efficiently as possible, I initiated a review of the acute hospital care system. This review confirmed what was already recognised — that there was a surplus of acute hospital beds in the City of Limerick. So, if money is to be spent where it is to have the most effect, at least one of the hospitals in Limerick has to close.
This issue has been a good acid test for the Progressive Democratic Party. Where now are the statements of principle and the clarion calls for cutbacks? Where now is the much vaunted ideology of free enterprise? Where now are the mould breakers of Irish politics?
Close the other hospital and save more money.
That is not in the Deputy's motion. We will come to that in a minute. When these Deputies have to face a point of principal on their front doors as they do today, their courage evaporates, their principles disintegrate and their images crumble. I think, perhaps that, on this occasion, they have forsaken national politics for parochial party politics. Here we have a party without direction. The reasons they thought they had for existence are no more.
Might I quote a passage from one of their policy papers produced for their first national conference in May of last year? It reads:
During periods of fast growth certain services no longer relevant to modern needs are allowed to remain in place, while new services tend to overlap existing ones. There is in this area a clear need to rationalise these services, to discontinue obsolete ones and to eradicate overlap. These are best achieved through good management practices.
Exactly.
Might I quote a further passage from what Deputy Molloy said in this House when speaking on the Health Vote last July? He said:
Why do we spend a higher proportion of our GDP on health care spending than many of our European neighbours? Are we really getting a better service for this money? Why do we need significantly more hospital beds per 1,000 people than the UK or Denmark.
Mr. O'Malley
Exactly. So what?
There are indeed many other statements of the Progressive Democrats which I could instance but I do not propose to delay the time of the House. How do the statements which I have just read out compare with the Progressive Democrats' stance on the Barrington's hospital issue? Here we have the Government practising the good management which the Progressive Democrats called for; we are phasing out overlapping services and reducing the overall level of acute hospital bed provision. This plan of action is necessary in terms of better acute hospital services, is one with which the Progressive Democrats agree and yet what do they do? They oppose it.
In Limerick, we have three hospitals providing the same type of services with three separate administrations and within a short distance of each other. We are talking about rationalisation and this is what the Progressive Democrats are opposing in their motion. It appears tonight that the Progressive Democrats are running away from their own motion and are following Fine Gael in asking for the closure of St. John's.
The Minister's arguments are childish.
Before I go on to outline the position in relation to Barrington's hospital I would like to set out very briefly a few salient points in relation to the acute hospital services. The past 12 months have certainly seen a considerable level of activity in this area. Most of the attention has focussed on the negative aspects of hospital and bed closures but I think I can claim that these were more than out weighed by the positive aspects of what we achieved. As part of the rationalisation it was inevitable that some hospitals had to close. This was also necessary if we were to control the level of spending on the health services and yet achieve the difficult balancing act of protecting to the maximum extent possible the funds available for other essential and priority services such as health promotion and community-based facilities.
There have been many advances and innovations in the practice of hospital medicine in recent years. This is evidenced by shorter lengths of stay in hospital, an increasing emphasis on technology and a change in the focus of our general hospitals away from the traditional in-patient care to treatment on a day or out-patient basis.
The practice of hospital medicine is going through a very dynamic phase. It is essential that our hospital structures and organisation are adapted to meet the modern day demands and challenges with which we are faced. The changes themselves mean that some hospital closures were inevitable if the rest of the system was to be adapted and strengthened to fulfil its new role.
My concern at all times has been to minimise the level of closures and at the same time to ensure that a viable network of hospitals is retained. I am satisfied that the measures which I have adopted have not only minimised any hardship which might otherwise have resulted from the hospital and bed closures but they have also allowed us to make considerable progress in strengthening and modernising our acute care hospital system. This will enable us to provide the highest level of hospital and bed closures but have
This House will be aware, for example, that at long last the new Beaumont hospital was opened in November last and that major hospital building and development projects are under way at Ardkeen, Waterford, Sligo, Wexford, Cavan, Mullingar and Castlebar.
The hospital in Wexford is closing.
These are some of the more positive aspects of what is being achieved but sadly these points are usually lost in the emotion which can be aroused in relation to a hospital closure. I fully acknowledge that it can be difficult for the local community and interests to accept the closure of a hospital but I have a wider responsibility for hospital and health services in the country as a whole. I fully intend to discharge that responsibility in a constructive and responsible manner. If this means that difficult decisions have to be taken then I will not shirk that task.
As a result of what I, as Minister for Health, and the Government have achieved in less than 12 months I am fully confident that our hospital system can cope with any demands which will be placed on it and that nobody who is genuinely in need of attention will go without it.
Before any hospital closes it is necessary for the Minister of the day to satisfy himself that the hospitals remaining in the system are adequate to cater for the needs of the catchment population. I would now like to deal in some detail with the reasons which led me to decide to close Barringtons as a public hospital and with the alternative arrangements which I am making for the provision of hospital services in the Limerick city area.
Shortly after I assumed office it became apparent to me that, in view of the oversupply of acute hospital beds, we could not continue to sustain the existing number of acute hospitals. Many of these acute hospitals had become redundant because of other hospital developments in the areas. In any event, it appeared that we had a surplus of such beds when we compared our level of provision with that obtaining elsewhere. One of the initiatives I took was to establish a review group to examine the entire acute hospital system in order to identify the changes needed to bring the service into line with present day requirements, taking account of absolute need and the likely availability of resources.
This group had discussions with every public hospital agency, both health board and voluntary, and in many instances more than one meeting took place where the optimum organisation of services was not immediately obvious.
In March 1987, when I came into office, I was presented with a list of possible hospital closures. One of the items on the list was Barringtons - St. John's. No previous decision had been made by either my Department or any previous Minister for Health as to whether St. John's or Barringtons, which are only 400 yards apart, should be retained.
In the Mid-Western Health Board area two series of meetings took place — in June and again in August. On each occasion the group met the Mid-Western Health Board and the two voluntary hospitals — Barringtons and St. John's. At these meetings it was pointed out that the mid-western area seemed to have a surplus of acute hospital beds and even though this is a relatively compact area hospital services were scattered over a large number of locations — all located within 25 miles of Limerick city. The area had a total of 1,119 consultant staffed beds in nine different locations. Since I understand there is some confusion on this point I will list them. They were: Limerick Regional Hospital 385 beds, Limerick Maternity Hospital 129 beds — of which 31 are for the care of sick neonates; Barringtons, 88 beds; St. John's 100 beds; St. Camillus — this is a geriatric hospital but it did contain 30 paediatric beds; Croom, 120 beds; Nenagh, 110 beds; Ennis, 127 beds; Cahercalla, 30 maternity beds.
The health board had gone some way towards rationalising the services in its hospitals by closing the 30-bed maternity unit at Cahercalla and the 30-bed paediatric unit in St. Camillus. However, it was clear that there was scope for and indeed a need for further rationalisation. Because of this, at the June meetings the review group discussed with all the interests involved the possibility and desirability of concentrating the services of the two voluntary hospitals — Barringtons and St. John's — on one site with about 100 beds. At the August meetings the policy of concentrating the services of both hospitals on one site was considered. I have already pointed out that these two hospitals are only 400 yards apart.
Now I am aware that claims are being made that the possibility of one of the voluntary hospitals closing was not made clear at these meetings. However, I must point out that in August both voluntary hospitals put forward detailed submissions as to why each of them should be the hospital to be retained. Significantly, neither submission suggested that both hospitals were fully aware of the possibility that one or other should be closed and that the logic of the situation was accepted by them.
When the review group reported back to me I considered very carefully the outcomes of the meetings in Limerick. In addition I obtained an architectural report of the suitability of both hospitals as to their participation in the public health service in Limerick. I would challenge Deputy Molloy to produce the evidence from the Mid-Western Health Board which suggested that Barringtons should be retained rather than St. John's.
I should say at this stage that there is a school of thought that both Barringtons and St. John's should be closed. I must say that this idea has much to commend it, and indeed, I did give it serious consideration. However, I finally decided that one of the two voluntary hospitals should be retained to co-ordinate with the Regional Hospital in providing acute hospital services in Limerick.
Having decided that one of the hospitals should be retained as a publicly funded hospital I am satisfied on the basis of all the evidence presented to me that St. John's is the more appropriate location. I have already indicated on a number of occasions why I decided that St. John's was the hospital to be retained but for the record I will repeat them:
—St. John's is a more spacious site.
—St. John's is a larger building. It has a capacity of 120 beds as opposed to 90 at Barringtons. I am aware that additional bed capacity could be provided at Barringtons by taking over staff accommodation but adequate bed capacity is already available at St. John's.
—St. John's provides better potential for adapting to the changing needs of hospital medicine. For example, it has a unit which is very well suited for the provision of day hospital services. It contains an endoscopy room, two five-bedded rooms and an area for a theatre.
—The St. John's hospital building and services are on balance superior to those in Barringtons. This is due largely to the fact that £500,000 was spent on improvements in 1985 and 1986.
—The St. John's mechanical and electrical services are better.
Deputy O'Malley drew the analogy with football clubs. I do not think we can look at this in the context of football clubs. It appears to me that it is in the same context that the Progressive Democrats are looking at what is a very serious issue for the people in Limerick.
I do accept that some services in Barringtons hospital are superior to those in St. John's, for example, the theatres and the x-ray unit. However, these advantages are more than outweighed by those I have listed above for St. John's and indeed the operating theatres at St. John's are more than adequate to meet the needs of the people.
How many?
On balance all the advice available to me in my Department indicated that St. John's should be the hospital to be retained and on the wider front I am satisfied that the facilities at St. John's will link in with the Regional Hospital to provide an integrated first class hospital service for the people of Limerick.
Deputy O'Malley referred to the fact that Barringtons was a hospital for the poor. There appears to be an implication that St. John's and the Regional do not cater for the poor of Limerick. I have made it clear on numerous occasions that, as Minister for Health, I will not tolerate a situation in any hospital in this country funded from public funds that does not provide the very highest level of care for the poor in this country. I am satisfied from the information I have received——
For four years.
——that both the Regional Hospital and St. John's hospital do provide the highest level of care for the poor in Limerick and the surrounding districts.
Listen to the facts.
In their motion the Progressive Democrats say that Barringtons is a highly cost-efficient hospital and I accept that it is but I will now deal with the issue. If we compare the costs per patient treated in St. John's and Barringtons for 1986, the last year for which we have completed returns, we do find that Barringtons appears to be more cost-efficient than St. John's. The average cost per discharged patient in Barringtons is £447 as opposed to £672 in St. John's. However, these figures do not take any account of the nature of the work undertaken in both hospitals.
The patients treated in Barringtons have a much shorter length of stay than those treated in St. John's. This is what one would expect since Barringtons with its casualty unit is bound to have a large number of patients who need only a day or two in hospital. This reduces dramatically their overall average length of stay. If, however, we compare the average weekly cost per occupied bed in the two hospitals a different picture emerges. Now we find that the average weekly cost in Barringtons was £631 while the cost in St. John's was only £602. On this criterion St. John's is more cost-effective than Barringtons. From these figures it is not possible to sustain the argument that Barringtons is much more cost-efficient than St. John's. I might also add that the pathology service for Barringtons is provided from St. John's hospital.
I am aware that certain suggestions and innuendos are being put about that I had some ulterior motive in choosing St. John's rather than Barringtons. I want to say here and now that this is not the case. Prior to announcing my decision I received representations from no quarter or person whatsoever, apart from the two submissions made by the hospitals which I have already referred to.
It has also been alleged that all previous considerations of hospital closures in Limerick focused on St. John's rather than Barringtons and that I have rejected the advice of my Department in this matter. These suggestions have come from Deputy Desmond, among others. Again I must put it on record that this is not the case. I have here with me a list of possible hospital closures which was on Deputy Desmond's desk when he was Minister for Health and one of the items on the list is Barringtons-St. John's. This is clear evidence that no previous decision as to whether St. John's or Barringtons should be retained was made by——
On a point of order, would the Minister accept in good faith that I am in a position to produce to him a Government Memorandum which directly contradicts what he has just said?
That is not a point of order. Would the Deputy resume his seat?
I asked the Minister to accept in good faith what I have just said. I can produce and give him a copy of it and I will do so tomorrow night when I speak.
——my Department or by any previous Minister for Health.
(Interruptions.)
The half million pounds spent in 1985-86 is an indication that in 1986, the year before the change of Government, the Coalition, including the then Minister for Health, Deputy Desmond, intended St. John's to provide public hospital facilities for many years to come. If they did not do that they should not have spent £500,000 or he should have been before the Committee of Public Accounts.
Since I announced my decision on Barringtons on 10 December there have been some allegations of inconsistency on my part in view of an earlier statement I made in this House on 1 December that I did not envisage any further hospital closures in 1988 other than those which had already been announced or were in train.
It has to be accepted from what I have outlined already that the closure of a voluntary hospital in Limerick was well in train by the beginning of December. Consequently there is no inconsistency between my statement here on 1 December and my subsequent announcement on Barringtons on 10 December.
The Minister is saying that——
In my view it is preferable that discussions in relation to hospitals' roles or closures should first take place with the hospital authorities involved so that the business can be conducted in a calm, professional manner and away from the pressure which can be generated by premature public pronouncements.
I might point out, lest there be any confusion on the issue, that I also informed this House in a reply to a parliamentary question last week that a small number of other acute hospitals, funded directly by my Department, are likely to close this year and in all these cases discussions on the future roles of these hospitals have been in progress for some time.
(Limerick East): Have they been announced?
While on the question of alleged inconsistencies I would also like to deal with this issue of student nurses. It has been stated, correctly I may add, that officers of my Department visited the hospitals in Limerick last November and discussed a level of intake of student nurses with these hospitals, including Barringtons.
This is being interpreted as an indication that my Department did not know in November of the proposal to close Barringtons and that my decision in December came as a "bolt from the blue". This is not so. It was necessary in November to try to achieve agreement on the overall intake of student nurses for the entire country for 1988 and this was done on the basis of the anticipated requirement for each hospital. The number of students required for the Limerick area would be the same no matter how many or how few hospitals were to remain and it was considered at the time that the best approach was to agree a figure with each hospital as they then existed. The whole question of nurse training in Limerick is a matter which still has to be resolved and this will be done in the near future in association with An Bord Altranais, my Department and the hospital authorities involved.
The closure of Barringtons as a public hospital does mean that certain facilities at St. John's and the Regional Hospital in Limerick will have to be strengthened. This applies in a particular way to the accident and emergency departments at these two hospitals. I have already announced that I am making available a capital grant of £400,000 for this purpose — £150,000 at St. John's Hospital and £250,000 at the Regional Hospital.
These amounts are sufficient not only to provide a first class casualty unit at each hospital but also excellent day hospital facilities in both hospitals which is in keeping with the best practices in modern day hospital management. It is well known that the casualty unit at Barringtons hospital needed to be replaced. There were long standing plans in my Department for a new facility at Barringtons which would have cost about £1.3 million to provide.
How will the Minister provide it elsewhere with £150,000?
I am satisfied that the two new casualty units in the Regional and St. John's will provide Limerick city and the surrounding areas with a first class casualty service.
It is a fair question and it is not being answered.
I am further satisfied that this revised arrangement will not result in any hardship for patients.
The Minister will not answer the question.
The new casualty unit at St. John's is only 400 yards distant from the existing unit at Barringtons and, contrary to popular belief, the number of casualty attenders at Barringtons at night time is not very great — approximately 14 or 15 per night.
I have often seen 15 there together.
These patients will now be referred to the Regional Hospital at night time.
Apart from any question of the closure of Barringtons there was an obvious need to rationalise casualty services in Limerick. Does it make sense to staff and run on a 24-hour, seven-day basis two casualty units which are only a few miles apart in a city the size of Limerick? Indeed it is worth repeating that Tallaght in Dublin, which has a population roughly the same size as Limerick, does not have any casualty service and that in Dublin as a whole there are only two casualty units open after 5 p.m. — one on the north side and one on the south side——
The Minister stands over that.
——and the Progressive Democrats are demanding two such units in Limerick.
The Minister should be providing services and not taking them away.
Considerable comment has been made in relation to the numbers who find it necessary to attend at the casualty unit in Barringtons. The numbers are extraordinarily high at over 34,000 in 1987 and, indeed, there were over 40,000 attendances in 1986. In fact, about 72,000 people attended at casualty at Barringtons, St. John's and the Regional Hospital in 1987 and this figure was over 82,000 in 1986. This is an amazing figure and is all the more so when one considers that only slightly over 30,000 attended the casualty unit in Galway Regional Hospital last year which serves a catchment population roughly the same as that served by the Limerick hospitals.
Covering an area 70 miles away. This is happening in Limerick. A new casualty hospital is being built in Galway.
These figures deserve some explanation and I will be having immediate discussions with the Mid-Western Health Board as to how the Limerick figures can be reduced. It would seem that many of those who go direct to the casualty units in Limerick do so for rather trivial reasons and should have been more properly treated by their general practitioner.
While on the question of casualty and emergency services I would like to mention the major emergency plan for the Limerick area. I know that the suggestion has been made that Barringtons hospital has the primary role within the context of this plan. This of course is not so. The primary role in an emergency rests with the Regional Hospital and Barringtons and St. John's have been allocated support roles only. The major emergency plan for the Limerick area is now being revised in the light of my decision on Barringtons. I am satisfied that this revised plan will enable the health services in the area to cope adequately with any emergency which may arise.
I am somewhat concerned at the level of specialist hospital services provided at Limerick Regional Hospital. In my view these should be strengthened considerably. I intend to do this to the maximum extent possible within the limits of the resources which can be provided by the Mid-Western Health Board. With general hospital services spread over three sites and some other services at other locations it would be difficult to achieve any worthwhile degree of specialisation. I intend taking advantage of the rationalisation now in train to begin to rectify this situation. In addition, it so happens that a number of consultant vacancies exist in Limerick and further vacancies are due in the near future.
In this connection I might add that of the seven consultant posts at Barringtons hospital at present, five are vacant or about to become vacant. There are also vacancies at Limerick Regional and other hospitals in the area. It is my intention that these vacancies will be filled. They will be filled by consultants from disciplines which will provide the mid-western area with the specialist services which the patients need.
I will be asking my Department and Comhairle na nOspidéal to commence immediate discussions with the Mid-Western Health Board and other local interests with a view to putting this reorganised and enhanced hospital system in place.
Some Deputies may be aware of recent difficulties in filling the critical post of chief executive officer in the Mid-Western Health Board. This was a matter of particular concern to me. I took immediate action to remedy this problem. A new chief executive officer is now in place in the mid-west and I have every confidence that he will be able to give the health board, its staff and other health personnel in the area the confidence and the sense of purpose which are required to enable the provision of the maximum level of health services in the area within the limits of the resources at his disposal. I can also assure him of my wholehearted support and that of my Department.
He must be a Houdini.
I would now like to comment on the Fine Gael stance on this issue. Unlike the Progressive Democrats, I am glad to see that Fine Gael accept in their motion that the closure of some public hospital facilities in Limerick and the Mid-Western Health Board area is inevitable. If Barringtons does not close then the spectre of closure looms for St. John's. This is the reality of the situation.
It is not realistic to have three hospitals with less than 600 beds in a city the size of Limerick. I would hope that the Progressive Democrats would have the capacity to grasp this essential fact which is apparently only too evident to Fine Gael. However, my difficulty with the Fine Gael amendment is that it still would provide for hospitals at three locations, even though one of them would be a private hospital. Presumably this would involve some consultants working out of all these locations. I do not consider this to be either desirable or necessary.
The main problem with the Fine Gael motion is that the VHI are simply not in a position to afford the creation of further private hospitals. They have stated this publicly and from the detailed discussions I have had with them I accept this fact. Otherwise VHI premia would become prohibitively expensive for the vast bulk of the people who insure with them at present. In any event, I am satisfied that the Regional Hospital and St. John's between them will be in a position to provide sufficient private and semi-private beds to meet the demand for such facilities in the Limerick area.
However, there is one important point I would like to emphasise and that is that I would consider it wrong on my part or on the part of any political grouping to direct or suggest to any hospital authority that they should go private. As Minister for Health I have no powers in this area nor would I wish to have them. This has to remain a decision for the interests involved. It is an area in which I do not intend to get involved.
That is consistent.
Before I conclude I would like to place on the record of this House my appreciation, the appreciation of the Government and, I am sure, of the people of Limerick, of the marvellous service which Barringtons hospital has provided over the 160 years of its existence. However, time marches on. We have to face the realities of the present and, perhaps, more importantly plan for the future. This is something that I, as Minister for Health, am committed to do in relation to our health services.
In relation to this issue I am satisfied that I have taken the correct course. I am satisfied that it makes good sense from the medical, social and economic points of view.
Out of decency the Minister should have left that out.
I move amendment No. 2:
To add to the motion:
"that if, however, in the opinion of the Minister for Health, the rationalisation of the health service in Limerick requires the closure of a voluntary hospital, Dáil Éireann considers that St. John's hospital, rather than Barringtons hospital should be closed, and in the event of such closure, Dáil Éireann being aware that private medical interests have offered to purchase St. John's hospital with a view to keeping it in operation as a private hospital calls on the Minister not to inhibit this, or any other initiative along these lines."
I should like to divide my time with some of my colleagues. My party agree that the health services require a major review. In a service spending £1.2 billion each year a radical review must take place to eliminate inefficiencies, abuses, duplication and over-administration. Unfortunately, the Minister came to office after four years in Opposition without a policy to his name. He has implemented a series of decisions which did not tackle the fundamental problems besetting our health services and, instead, butchered the services that go direct to the public.
The Barringtons hospital issue is a simple one. Stripped of the hype and the emotions it has generated it remains a simple issue. Fundamentally it is a question of whether the Government are wrong in calling for its closure or whether the people of Limerick are right in demanding its retention. I, or my party, have no problem in coming to a definite conclusion in relation to this central issue. From the beginning it has been quite apparent that the Government have got it wrong. A simple issue requiring an equally simple solution was totally immersed in Government messing that enraged a city and surprised even the diehard advocates of health cuts. It remains a simple problem that has been mishandled by the Minister, in the first place, and by the Government. They have made Barringtons a central issue in a health policy which has neither cogency nor coherency. They have endeavoured to push it through as if there was no simple, rational, constructive or prudent alternative.
It is blatantly obnoxious for the Government to behave in this highhanded fashion despite all the points put forward to the contrary. Of course, arrogance is not new to the Fianna Fáil Party. Our position on this issue is clear. We believe that Barringtons must be retained in its present format and if in the overall health budget one hospital in Limerick must be closed that hospital must be St. John's. We believe that if private sources are interested in St. John's no obstacle should be placed in their way. Private medicine is a fact of life here, as it is in all developed countries. Our party do not have anything to apologise for in that respect. State controlled medicine has run into problems worldwide and even the most prosperous of nations cannot afford to provide funding at a level that will adequately fulfil health obligations to their people.
We have struck this problem but the Government in their muddled haste to get things in order have floundered and got things wrong. Barringtons is one of those wrongs. We have been criticised in recent days for allegedly advocating two-tier medicine and for encouraging private interests to step into the breach. The policy of the Labour Party, and the other Left wing parties, is not necessarily the policy of the Right and, certainly, not in relation to my party's overall proposal in regard to Barringtons. It is spurious and need not be addressed further in the debate.
For some reason we can only guess at the Government's mule-headed approach to this controversy. To me it is incomprehensible. They have marooned their health policy, such as it is, in quicksand. I should like to make it clear that Fine Gael in Government recognised the need for a new approach to our growing financial problems. We campaigned on that issue in the election. Charity, and time, prevent an exposé of Fianna Fáil's disgraceful performance in Opposition on this crucial issue and now their incompetence in Government when their Damascus-like conversion to our strategy took effect is unbelievable. Their preelection promises misled many cities and, in fact, misled the nation.
We have not abandoned our committed support for the policy of financial restraint that we pursued in Government and continue to advocate in Opposition. We are proposing a sensible and meaningful solution that does not breach the guidelines we have set for ourselves and for the country. Yes, we say, one hospital must close. Barringtons and St. John's almost side by side are too great a burden together. The one we believe should close is St. John's and we have spelt out the future for that hospital.
I share the intrigue felt by a growing number of disillusioned supporters of the Progressive Democrats at their party's ambivalence as underlined in this case and at their performance tonight. They are voluble enough in their enunciation of their policy of financial rectitude when they are sweeping the political canvas with the national brush. However, on specifics such as this case when a local nerve is exposed they are deliberately imperfect. I do not see this as the proper forum — we do not have the time — to highlight PD double talk when it suits that party but being all things to all men is indeed a hazardous course and the painful pitfalls of that course are now beginning to surface.
That is the one the Deputy is trying to follow with his amendment.
Is the Deputy for or against the closure of Barringtons?
I listened to the rubbish and doubt talk of the Deputies for long enough. We will continue on our policy course and we have not been found wanting in regard to it. If we could see sense in the decision to close Barringtons we would, as we have done in the past, support the Government but getting it right has not been the Government's strong point when dealing with the health services. Admittedly, their task is difficult but by their actions they have more than often created insurmountable barriers for themselves. Barringtons is a case in point.
The decision to close Barringtons is unjustified on social, medical and economic grounds. It is a busy hospital that is stretched to the limit. Its standards of medical treatment are widely known and recognised. Therefore, there is no case for closure on medical or social grounds. The closure of Barringtons makes no economic sense. The facts show that there will be no savings in terms of staff and that there will be extra expenditure of £500,000 on the capital side. Not only is it a bad decision on medical and social grounds but it is a dreadful decision on financial grounds.
In the course of a debate in the House on 3 February Deputy Michael Noonan spelled out the real case for keeping Barringtons open. I should like to ask the Minister to defer his decision to close Barringtons and have a look at the matter again. It takes a good person to admit that a mistake has been made. The case put forward by Deputy Noonan earlier this month was a strong one. The Minister's decision has all the signs of a panic one. In the course of a reply to a supplementary question put by me on 1 December the Minister assured the House that there would be no further closures of acute beds in our hospitals. However, eight or nine days later he did a U-turn or he seriously misled the Dáil. It has all the signs of a panic decision by a man under pressure, a Minister who has lost his way and has no health policy. He is pursuing a policy of cost-cutting in a hamfisted way. People are suffering. Some time ago I made the allegation here that people were dying. I gave the evidence to the Minister but he has not yet replied.
The Deputy was challenged.
I met the challenge by giving details of a specific case. That was three months ago but the Minister has not come back on that case. I put up and I shut up. My case in relation to Barringtons has been made and I wish to give my colleague, Deputy Carey, the opportunity to contribute.
Deputy Carey is sharing Deputy Allen's time.
I rise to support the amendment tabled by my party regarding the closure of Barringtons hospital. There has been much discussion on this subject on radio, television and in the newspapers. The whole issue is very emotive because Barringtons has given a great service to Limerick, Clare and parts of Tipperary. Everybody was very surprised that this Government would take such a decision, especially in view of the promises they made when trying to get into power. They created the illusion that when they came into power there would be no hospital closures or bed closures. This message was conveyed particularly by the then spokesman, now the Minister for Health. It is my lot to represent County Clare and we had a particular problem in Ennis County Hospital. Deputy O'Hanlon asked repeatedly in this House for the extension of Ennis County Hospital, saying that facilities there needed to be improved. Now we find that Ennis is to be rationalised and will be called a satellite of the Regional Hospital in the plan put forward by the Minister.
Everyone in the region was shocked by the proposal to close Barringtons hospital. It was realised that one of the two hospitals would go, either St. John's or Barringtons. I do not know what element of competition existed between the two hospitals in getting to the Minister's desk but it seems that some particular group in St. John's had better bargaining power when the chips were down. The general public believe that the wrong decision has been made and that Fianna Fáil are closing the wrong hospital. They should have closed St. John's but instead they are about to close Barringtons. That is the issue.
The Minister outlined his reasons and spoke about cost effectiveness. I am not convinced that figures quoted to justify closure are ever totally accurate. I am not impressed by the analysis done by the Department of Health and the Mid-Western Health Board in relation to cost efficiency.
People have used Barringtons for emergency and casualty services and it has been very effective. The Minister has said that in the case of an emergency or serious accident Barringtons does not figure high on the emergency list. Geographically Barringtons is on the north side of the river. There is easier access to it for the people of Clare or in the case of an accident at Shannon or in one of the factories north of the river. This is the hospital which has been used traditionally in such cases. There is not easy access to St. John's, even though the Minister has spoken about 400 yards. There is a great traffic bottleneck in this area and the additional 400 yards would cause grave problems for Clare people. I cannot say I admire Limerick for everything because one problem they have not solved is that relating to traffic, especially in this area.
The Fine Gael motion calls for the closure of St. John's hospital. This is the populist decision. It is what the ordinary people want and they are the people who use public acute beds. St. John's as I understand it, caters mainly for private and semi-private patients. These would be VHI patients with B and C cover. More public acute beds would become available in the Regional Hospital. That is why I expect the Labour Party to support this motion rather than reject it.
(Interruptions.)
Deputy Howlin had better stay in Wexford. All Deputies from the mid-west region should plead with the Minister for the retention of Barringtons hospital. They should show solidarity with the people of the region.
I rise to support the Fine Gael motion. The Minister states that before any hospital closes it is necessary for the Minister to satisfy himself that the hospitals remaining in the system are adequate to cater for the needs of the catchment population. He went on to give the reasons for selecting for closure Barringtons rather than St. John's. Nothing he said convinced me that he had made the right decision. I would ask him seriously to reconsider before tomorrow evening the statement he made this evening.
His decision was based on a number of points, the first being that St. John's has a more spacious site. The Minister is talking about 2.5 acres versus two acres and an additional two houses in Barringtons. That argument is really quits. The number of beds is 120 versus 90. There is plenty of room in the Regional Hospital to make up the additional 30 beds if St. John's is closed.
When talking about the potential for adapting to the changing needs of hospital medicine, the Minister went on to say that there is a unit in St. John's which is suitable for day hospital services. That may well be, but there is plenty of space and potential within Barringtons to provide the same service. In regard to structure, the Minister said that St. John's was in a far more satisfactory structural condition than Barringtons. Basically the Minister was talking about a new floor structure which has been installed in St. John's but not in Barringtons. That is very flimsy ground on which to base a decision.
The Minister also said that some services in Barringtons are superior. As far as the people of Clare and Limerick are concerned, all services in Barringtons are superior, in particular the casualty and out-patients unit. It is the largest such unit outside the Dublin region. If other hospitals in the region were offering superior services would the people not be going to those hospitals? They are not. They are going to Barringtons because they have confidence in it. They have shown their confidence in Barringtons by their attendance. It has the largest attendance outside Dublin.
The Minister's statement on student nurses and their future in the region is totally unsatisfactory. The Minister stated that the whole question of nursing training in Limerick is a matter still to be resolved. That is not acceptable. It is appalling that a Minister should come in here tonight and say that. In relation to the overall casualty-accident-emergency department, the Minister suggests that he will spend £150,000 on Saint John's and £250,000 on the Regional. The Minister knows that to spend that sort of money in both those hospitals will not provide an adequate service such as that being provided in Barringtons. Where will all the numbers of people from Clare and Limerick at present being treated in Barringtons go to be treated? The other hospitals are incapable of treating them. I am now calling on the Minister to seriously reconsider his decision and to accept the Fine Gael amendment which is constructive, realistic and possible.
Debate adjourned.