Dr. Pat Lee gave me notice of his intention to raise on the Adjournment the subject matter of the cancellation of routine admissions to the Mater Hospital.
Adjournment Debate. - Mater Hospital Routine Admissions.
I wish to thank you sincerely, a Cheann Comhairle, for allowing me to bring to the attention of the Dáil what, in my opinion and in that of many learned people in the medical profession, is one of the most serious issues that has arisen in the short life of this Dáil, namely, the practical elimination of all elective and routine admissions to the Mater Hospital on the north side of Dublin as a result of improper provisions and improper planning to provide for the downstream effects of a huge influx of patients to the Mater Hospital as a result of the fire brigade action of the Minister for Health in opening all the casualty departments on the north side of Dublin.
Let me briefly outline to the House exactly what has happened. Approximately two weeks ago the Mater Hospital had an in-patient population of 510 The Department of Health provides subventions for only 457. The board of the Mater Hospital met and decided, in their wisdom, that they would endeavour to reduce the in-patient population. The following Friday when all the five day wards had been emptied the administrators in the Mater Hospital moved the extra patients into the five day wards. On the following Monday all five day wards were shut and as a consequence of that the consultants' organisation decided to highlight on the radio what had happened. The Minister came on the radio that day and informed the country at large that his Department had provided a budget of £750,000 when the reality is that the figure was £250,000 which the Department of Health paid over the hospital administration for the extra services. I am prepared, a Cheann Comhairle, in the privacy of your own chambers, to give you the source of my information because I feel it is very important that statements of a misleading nature emanating from the Department of Health should be investigated. It seems that serious liberties are being taken with the dictionary description of the truth in this House and it is only proper that there should be an investigation into this.
We have another problem at the Mater Hospital. Some orthopaedic consultants came to me recently and told me that because of the huge influx of patients at the Mater Hospital a particular consultant's operations for one day consisted of one toenail removal and one bunion operation, despite the fact that he has 200 patients on his elective waiting list of routine admissions for hip operations. This is surely a vast wastage of resources and expertise of medical people who have the highest qualifications.
Another orthopaedic surgeon was appointed to the Mater Hospital last March to replace Mr. McCauley. He has yet to have an out-patient orthopaedic clinic. He has a fracture clinic but he has yet to secure an out-patient orthopaedic clinic solely because the administrators in the Mater Hospital refuse to appoint any clerical staff to run his clinic. Surely this must be an outrageous waste of resources and one that the Minister should look at immediately.
I have no particular pleasure in attempting, day after day, to highlight these gross in justices of the health service. I take no pleasure in castigating a fellow general practitioner. I take no particular pleasure in calling into question the veracity of the Minister's statements. The Minister and I were both educated in the same medical school and trained in the same hospital which is now the subject of this debate. We both practise in the same speciality. If the health of this community and the health of the people of the northside of Dublin, and the health of the people in the immediate environs of the Mater Hospital is under attack then I will take any and all means at my disposal to highlight the grave injustice the Minister and Fianna Fáil have inflicted on the Irish population. I will take any and all means to highlight the reality that now exists, that is, that we have had the development of a two-tier hospital service, a two-tier health service, one for the rich and wealthy where they can avail of all services and one for a certain section of the community which has become marginalised and reduced to the status of second-class citizens, a system where the folding stuff, which now seems to be the word for money, opens all doors. The Minister and his Government have brought to fruition, for the first time in the history of this State, a two-tier health service and I would say shame on them.
I would also like to state, in conclusion, that very eminent, highly trained surgeons and physicians have a letter in The Irish Times this morning in which they highlight in no uncertain terms exactly what is going on. They had a straw poll last week in the Mater Hospital, because of the misinformation and disinformation that is coming from the Minister's Department, to find out what percentage of patients were admitted from the waiting list, and that figure was 5 per cent. In other words, 95 per cent of the people who were in the Mater Hospital last week were admitted through accident and emergency casualty departments. I do not know what to say to the Minister. I listen to him on the radio and I listen to him on television and I know what he is going to say. He is going to speak in vague generalities.
No.
The Minister will indeed. He has before. He will tell the nation we have a great health service and ever more money to put into it. The Minister said on radio two weeks ago that the majority of patients in the hospital were from the routine admission list. They were, because the Minister's Department only put the embargo on two or three days before that. That is the reality.
The Department failed to make provision for the downstream effects of opening all the casualty departments on the northside. Did the Minister employ extra nurses? Did he employ extra physiotherapy staff? Did he open extra beds? He did — for two to three weeks. Incidentally, when the five-day patients had gone home on Friday week last, the Minister put the extra patients into these beds so that there were then no facilities available for five-day patients.
Surgeons and physicians have stated that perhaps in the new year they will have to consider the cancellation of all outpatient services in some of these hospitals. This is a horrific development on the north side of the city and the Minister, more so than anyone else, is answerable to this House as to why one set of statistics say that the Department only gave us £250,000 and the Minister says it was £750,000. There is a difference of £500,000. In all honesty, the Minister should answer that and explain to the House exactly what is happening. The personnel involved are very highly qualified people. They are trying to look after the health of the poorer sections, the marginalised sections of the community, and I would ask the Minister to look at it in that light.
Deputy Lee talked about misleading statements. The very terms of his own motion are misleading. It refers to the cancellation of all elective admissions to the Mater Hospital. They are not all cancelled. Those are the terms of the Deputy's own motion. I am glad the Deputy raised the issue in the House so that we can put the record straight.
(Interruptions.)
I am disturbed at the manner in which this subject has been treated by the Deputy and others, including Mr. Finbar Fitzpatrick. All elective admissions to the Mater Hospital have not been cancelled. Therefore, Deputy Lee's statement is quite incorrect. Statements by the Irish Hospitals' Consultants Association on this subject are also incorrect, and I have said so publicly. Wild statements about the hospital services show no regard for the facts. They cause unnecessary worry for patients and their families as well as damaging the wellbeing of the service. I assure the House that patients who are in need of urgent treatment will be admitted and treated, and I reject allegations that people may die as a result of the current situation.
I would like to give the House an indication of the type of resource going into the hospitals on the north side of the city. For the Mater Hospital the amount is £27.5 million, Beaumont Hospital £35 million, Blanchardstown £11 million; 3,700 staff are working in these hospitals and I assure the House that each and every one of them is fully committed to the provision of an excellent hospital service for the area. One would think to hear the allegations here tonight that I, as Minister, had provided hardly any resource at all for the hospital services in north Dublin. These are major flagship hospitals which provide an excellent service and I am concerned that the wild allegations should not damage the public's confidence in these institutions. The Mater Hospital, for example, is an excellent institution, where the quality of care is second to none by world standards. For the secretary of the Irish hospital consultants' association to refer to the services on the north side of the city as a shambles is a disgrace and is a reflection on the staff working in them, having regard to the money provided and the number of staff working there.
(Interruptions.)
Please, Deputy Lee, you had your opportunity.
Some people seem to regard knocking the health service as a legitimate and profitable exercise. The factual position is that the Mater is not cancelling all elective admissions. There will be no reduction in cardiac surgery in the Mater for the remainder of the year. There are 56 in-patients in the Mater today who were admitted as urgent cases via the out-patient department, and this was not affected by the situation in accident and emergency. Consultants will continue to make decisions on admissions of urgent cases. Administrators do not make decisions about who is admitted. They convey the board's decisions on an overall amount of service that can be provided.
There will be some reduction in elective admissions during December. Three of the consultants at the Mater Hospital have taken issue with me on the source of referrals of patients at the hospital. They have dealt with only 244 patients in the hospital when there were almost 500 patients in the hospital on the day in question. They have taken their figures from the 244. They have been very selective and have produced figures in respect of only one part of the hospital service. They have not included cardiac surgery, ophthalmology or oncology and they do not reflect the true position. Today there are 488 patients in the hospital; 285 of them came through accident and emergency and the remainder came from waiting lists through the out-patient transfer from other hospitals, from consultants' rooms and in different ways. Therefore, of the 500 patients in the Mater Hospital today 285 were from accident and emergency, around 100 planned and 95 were urgent admissions in other ways. Recently I made an additional allocation of £475,000 to improve the services at the Mater Hospital.
I accept there is an increase in the number of admissions to the north Dublin hospitals as a result of the introduction of the 24 hour A and E service and this has been felt most acutely at the Mater Hospital. In fact, there has been an increase at the six major Dublin hospitals. This increase shows that Government answered the need in introducing the new arrangement, and large numbers of people are getting a much better hospital service than heretofore. I hope the Deputy is not suggesting we should refuse to treat the extra patients who require admissions so that less urgent cases are dealt with. I am sure he does not want us to do that. The board of the Mater Hospital acted in a very responsible fashion and the decision has had the effect of them living within their cash limits while ensuring that priority is given to those most in need for a limited period.
A detailed survey of the usage of this service has been carried out and decisions on any further improvement thought necessary will be made when the results of the survey are available. In the meantime the operation of the service is being regularly reviewed by the standing committee on accident and emergency services under the chairmanship of the Eastern Health Board. This standing committee include a consultant from each of the hospitals concerned. I have not been taken unaware by the increase in attendances and my Department and the EHB have had numerous consultations on the matter. My Department have been involved in the establishment of the survey.
I had a letter on 30 November 1989 from Finbar Fitzpatrick, General Secretary of the hospital consultants' association inviting me to meet with representatives of the hospitals in Dublin to discuss the issue of accident and emergency cases. I responded that I would be glad to meet them and I intend to meet them next Friday, but that is not what appears when the association go to press to talk about it.
Full services will be restarted in the Mater from the beginning of January and I am confident that the institution concerned will continue to provide an excellent hospital service during the coming year. On the question of the new orthopaedic surgeon we provided for new secretarial assistance in the Mater ——
When?
We have provided new secretarial assistance recently for the records department and I have no doubt that the Mater will be able to organise their business in such a way, having regard to the resources they are receiving and the staff employed there, as to ensure that the orthopaedic surgeon can provide the necessary out-patient facilities.