We now come to deal with matters on the Adjournment. We have two items before us, one requested by Deputy Taylor-Quinn in respect of the dispute at Ennis Hospital and the other at the request of Deputy Ryan in respect of the provision of a new school at Fingal. Ordinarily, there is a procedure which is followed and the Ceann Comhairle's office has indicated the order in which they are to be taken. On the other hand I notice that we have a senior Minister present in this House. However, given the request which has been made——
Adjournment Debate. - Ennis Hospital Dispute.
I understand that the lady and gentleman from County Clare have to travel so I am very glad to yield my place to them.
You are a lady. I thank you, a Leas-Cheann Comhairle; you obviously have been in communication with the Minister. I thank you for this. I wonder would it be possible to allow my colleague, Deputy Carey, with whom I would like to share my time to speak first?
We first have to go through the formality of getting the agreement of the House that the Deputy may share her time and that Deputy Carey speak first. Is that agreed? Agreed.
I thank the Minister for Education, Deputy O'Rourke, Deputy Ryan and, in particular, Deputy Taylor-Quinn for giving me this opportunity to contribute to this debate this evening on the withdrawal of labour by nurses at Ennis Hospital, where there has been severe overcrowding, particularly in the casualty department, for the past number of years and where an insufficient number of acute beds is available to meet demand.
This problem arose following a policy decision of the Minister for Health, Deputy O'Hanlon, to cut down on the number of acute beds to be made available in the area, from 127 to 70. However, following negotiations this number was increased to 78. The statistics compiled by the hospital administrator indicate that even in the period of lowest demand, the August holiday period, the average number of beds required is 85. This is the position that obtained in both 1988 and 1989. When we contrast this statistic with the original allocation of 70 beds we can see that even in the period of lowest demand 15 extra beds are needed. The Minister and the health board took a decision to close a ward in the hospital and this has led to great distress being caused. We have now reached the stage where if a major disaster occurred in the mid-western region there would be no beds available, as all 78 beds are being used.
Clearly an insufficient number of beds is being provided at Ennis Hospital. The Minister will have to make a policy decision to reconsider the allocation for County Clare agreed with the officers of the health board. The population of County Clare is over 90,000. Given what Deputy Foxe was able to secure for County Roscommon the other day the Minister should reconsider the decision made in respect of Ennis. I understand that a meeting was held here yesterday between representatives of the Minister's party and himself at which he indicated that a geriatrician would be appointed. However, I do not believe that this will solve the problem as what the staff are calling for is the reopening of the ward. In fairness, there has to be equity and we need to recognise the position the staff find themselves in. They are working in intolerable conditions and have been for a long time. I ask the Minister to review his policy decision.
I thank you, a Leas-Cheann Comhairle, for allowing me to raise this matter on the Adjournment and the Minister for Education and Deputy Ryan for allowing this matter to be taken first. I join with Deputy Carey in making the case on behalf of Ennis Hospital. The proposed go-slow which will commence as and from next Monday could have serious consequences for those who are due to be admitted to the hospital. At present the number of beds available is insufficient to meet the demands being made on the hospital. We will soon reach the position where the casualty department will be unable to cope.
During the course of the go-slow no extra beds will be made available. Therefore there is an onus on the Minister to inform the House where those people who come to casualty are going to be admitted if no additional beds are made available. As Deputy Carey said, the demand far exceeds the number of beds available. This is the position right throughout the year. The increased demand is not due, as was claimed recently by the Minister, to the 'flu epidemic. In the height of the summer season in the month of August demand far exceeds the number of beds available. In view of this there is an onus on the Minister to reopen the ward that was closed and which contains 22 acute beds. The Minister must be aware of the need to do so as three years ago when Opposition spokesperson on health he called for the provision of 200 beds in Ennis Hospital. However he now seems to think that 78 beds is an adequate number. Some of his colleagues even claim that because medical technology has advanced so much a reduction in the number of beds from 127 to 78 is justified. Of course this is ludicrous and untrue. I am afraid medical technology has not advanced to such an extent that the number of beds could be reduced by that number. Therefore that is an unacceptable argument.
There is a responsibility on us as politicians to ensure that the health services are delivered in as equitable a manner as possible and that everybody gets a fair crack of the whip. I would remind the Minister that the population of County Clare is 93,000 people, yet only 78 beds are provided at Ennis Hospital. In County Roscommon the population of which is 53,000, 70 beds are provided, with another 20 promised. If we were to do our sums County Clare should have 140 beds and if we take into account the promises given in respect of County Roscommon the number of beds available should be close to 160. The people of County Clare are being very badly treated.
The staff of the hospital decided to take this action as a last resort. They have been working in extremely difficult circumstances and in appalling conditions and only took this decision after much consideration. They have not taken it lightly. They realise that the position is very serious and that the future of the hospital is highly questionable. They are also concerned at the attitude adopted by the Minister and the health board. I am sure the Minister will stand up to tell us that it has been decided to appoint a geriatrician in County Clare and to make ten additional beds available at Ennis Hospital to carry out geriatric assessments. While we welcome this appointment we would like to remind him that there are young people as well as old people in County Clare and while a geriatrician will be more than welcome at St. Joseph's Hospital there is no point in appointing one at Ennis Hospital. What we want is an increased number of acute beds.
What is the Minister's answer to the people of County Clare who find themselves on waiting lists and who have no hope of having their operations carried out in the immediate future? The people of Clare are looking to the Minister for an answer. These are matters that must be considered. The Minister must recognise the seriousness of the situation in the county. We have not repeatedly raised the matter here in the House lightly, but because of our concern and the concern of the people of the county about the provision of a health service.
At the outset I would like to allocate some of my time to my ministerial colleague, Deputy Daly.
Is that agreed? Agreed.
I am very reluctantly intervening at this stage because on the last occasion when a similar question was raised here I was accused by my local constituency, because I did not intervene, of having no particular interest in the hospital in Ennis. Lest the same thing happen on this occasion I want to briefly intervene to say that the Government are totally committed to the development and maintenance of Ennis General Hospital as an acute medical surgical hospital.
As a further indication of that commitment, the Minister for Health, only yesterday, indicated that he had decided to appoint a geriatrician with the full back up services he will require, which is a very important additional vote of confidence in the hospital. This appointment will necessitate the appointment of some medical back up staff, some nursing staff, additional beds in the assessment unit and the reopening of part of the hospital that is at present closed. It will also mean the permanent establishment of a 22 bed unit linked to that in the geriatric hospital, St. Josephs.
Overall what we have at present from the Government and the Minister is a deep and firm commitment to the maintenance of Ennis Hospital as an acute hospital and the provision of the best possible medical service for the people of the county who need those services. I would also like to put on record that the services which are being provided at Ennis are of the highest possible standard and I would like to compliment the medical and surgical personnel of the hospital, the nursing staff and all the staff at Ennis Hospital for the first class service which they are providing for the people of County Clare. It will now be further enhanced by the new appointment and further provisions which will be made there for physiotherapy services and casualty services.
Rather than being negative about this, as Deputy Taylor-Quinn appears to be, we are being positive and working consistently to provide in Ennis the best possible level of service that can be provided for the people of County Clare.
Bureaucratic baloney.
The Minister for Health has already informed Deputy Taylor-Quinn, as recently as 30 January last, that the management and organisation of hospital services in Ennis General Hospital is a matter for the Mid-Western Health Board in the first instance. The Minister stated at the time that the number of beds and resources to be provided at Ennis Hospital was a matter for decision by the Mid-Western Health Board following assessment of all the relevant facts. Taking into account the extent to which the Limerick Regional Hospital provides services for County Clare the board decided on the appropriate number of beds which is considered sufficient to provide an excellent level of service in the county.
Why was it different for Roscommon?
These are: 40 beds for general medical; 32 beds for general surgical, which include eight self-funding beds; six beds for intensive care and six day beds giving a total complement of 84 beds.
(Interruptions.)
Deputy Carey, apart from other considerations, the arrangement early on was to accommodate yourself since you had to go for a train. Do not advertise the fact that the concession was made under false circumstances.
On a point of order, I do not think, whatever order you want to have in the House, that you are entitled to pass the remark you did.
Absolutely.
About me personally?
I did not make any request of you.
It was made on your behalf.
I did not make any request.
I regret then that I believed representations made on your behalf.
At present there are seven consultants employed in the hospital. These include two physicians, two surgeons, two anaesthetists and one radiologist. There are five outpatient clinics catered for at the hospital. These include orthopaedics, ENT, antenatal, mammography, gynaecology and a medical surgical clinic. A total of 11,551 out-patients attended the clinics in 1988. There was a total 2,998 inpatients treated in the period January to September 1989. The number of admissions fluctuated between 55 and 91 last year, so 84 beds seems to be a very balanced allocation by the Mid-Western Health Board. In relation to the matters raised by the Deputies, I understand that officers of the Mid-Western Health Board have had a number of meetings recently with nursing representatives at Ennis General Hospital concerning the effect on staff of admissions——
That is why they decided to have a go slow.
——which temporarily take the number of patients in the hospital above the normal complement. This arose most recently during the influenza outbreak over Christmas. I am satisfied that the hospital responded extremely well to the situation and coped satisfactorily with the higher than normal number of admissions. Following these discussions the nursing unions recently notified the board that extra beds would not be put up except in the case of coronary and surgical emergencies as and from 26 February 1990. As the number of admissions is now returning to normal the health board do not anticipate that this action will lead to any major problems in the provision of acute hospital services in County Clare. I would appeal to the unions involved not to proceed with their proposed action because at the end of the day the patients may well be the innocent victims of their decisions and subsequent actions.
Blackmail.
Of course, the situation will be kept under review by the health board and any action required to safeguard the health of the patients will be taken. The problems raised by the Deputies and admissions at Ennis General Hospital received widespread coverage in the media recently. According to the Mid-Western Health Board the hospital responded extremely well to the problem and coped well with the high number of admissions which arose in a short space of time. The problems encountered were not unique and were caused by a higher than usual incidence of respiratory illness mostly related to the influenza outbreak.
Baloney.
The necessary measures were taken by the Mid-Western Health Board to deal with the problem, which was of a temporary nature. These included the opening of a ward at the nearby St. Joseph's Geriatric Hospital to relieve pressure on beds in the general hospital. The ward, which is still open, started with seven beds but the number varies depending on demand. It should be noted that the pattern of admissions at Ennis General Hospital has in recent months been out of line with the general pattern throughout the country. When the CEO of the Mid-Western Health Board suggested that the situation be assessed by the consultant geriatrician at Limerick Regional Hospital there was a significant change which brought the hospital into line with what has been experienced elsewhere.
It is the health board's view, supported by my Department, that the appointment of a consultant geriatrician for Clare and the development of support services for the elderly is the most appropriate and cost effective solution to the problems. I am very pleased to be able to confirm that my Government colleague, the Minister for Health, Deputy Rory O'Hanlon, yesterday approved of the appointment of a consultant geriatrician for County Clare to be located at Ennis General Hospital and ten accompanying assessment beds. This is proof of the positive commitment and attitude of my Ministerial colleague.
They are not impressed.
It ensures that a full complement of medical, consultancy and ancillary services are available to the people of County Clare within their own region.
We will tolerate one question from Deputy De Valera.
I had not planned to speak in this debate because my views on the subject are well known, but I would be interested in knowing what the Minister would think if the CEO of the Mid-Western Health Board was, on behalf of the health board, to prioritise the opening of that ward in Ennis. Would it be then treated with greater urgency?
Is there a quick answer to that?
Any proposals the CEO of the Mid-Western Health Board puts to my Department will get immediate consideration.
Priority?