Dáil Éireann díospóireacht -
Tuesday, 24 Mar 1992

Vol. 417 No. 5

Adjournment Debate. - AIDS and HIV Treatment Facilities.

Mr. Ferris

I thank the Chair for allowing me to raise this matter on the Adjournment and I thank the Minister for coming in to respond.

I wish to raise the recent statement by St. James's Hospital that it has reached its capacity to deal with the AIDS and HIV problem, and that it has increased its bed allocation for HIV and AIDS patients threefold in recent weeks.

The stark background against which this statement must be seen lies in the following figures for December 1991:

HIV positive patients	1,156
AIDS (full blown)	241
Deaths	95

St. James's Hospital is the principal centre for the treatment of the AIDS virus in Ireland. To all intents and purposes, it is in effect the only properly equipped and resourced facility in the country. The revelation that St. James's is now at the limit of its capacity to cope with its present number of AIDS-HIV patients, implies that any further increase in the number of people infected with the HIV virus will be unable to receive treatment at St. James's. This situation must elevate consideration of the Government's AIDS strategy, such as it is, to the position of a major scandal.

It is now imperative that the Government introduce in the Dáil without delay a Supplementary Estimate to provide a special budget for the prevention and treatment of AIDS. For example, there is a dire need for a specialist AIDS consultant to be attached to each of our major hospitals. In 1986 approval was granted by the Department of Health for the appointment of a second specialised consultant to be located on the north side of the city. Moneys were allocated for the appointment of this consultant, but a second consultant was never appointed.

Public health and education programmes in this area are minimal, following the abolition of the Health Education Bureau in 1987. The so-called Health Promotion Unit of the Department of Health is an acknowledged abject failure. Information about the spread of HIV, care, prevention, diagnosis and compassion are just a few of the issues facing us in the fight against AIDS, which the Minister has publicly stated is of major concern. These matters have not been sufficiently addressed and I welcome the Minister's concern.

The Department of Health's education and prevention message, in their effort to prevent the further spread of HIV and AIDS in Ireland, places emphasis only on celibacy rather than confronting in a real way the issue.

Ireland's critical shortage of information lies in our uncertainty about the extent of the spread of the HIV infection. It is imperative that the Government discover the prevalence of the infection in the population at large. Deputy O'Rourke, the former Minister for Health, in her speech to mark World AIDS Day, announced that a single scheme of anonymous, unlinked testing for HIV infection had been started in a Dublin hospital. Similar schemes have been under way in Britain and the US for some time and are producing useful information.

There is no possibility of the patient or anyone else discovering whether a particular individual is infected. Because every patient in the hospital is tested, the results should show, over a period, the extent of the infection in the population using the hospital. I welcome the initiation of this anonymous random testing, but in order for us to receive an overall picture of the spread of AIDS-HIV virus in our community, the scheme must be extended to a number of hospitals.

At present the Department of Health's figures for the HIV and AIDS virus are calculated on a national basis. It would be more effective if the Department of Health figures were broken down on a regional basis in order to allow individual health boards to analyse and react to the AIDS-HIV virus in each locality.

The Government's response to the AIDS virus is shameful in its inadequacy. The Government continue to delay legislating for the wider accessibility of non-medical contraceptives, which must be seen as part of the AIDS prevention programme.

The Taoiseach stated that this will be an open and caring Government. I have yet to see proof of this, although I recognise the Minister's concern and hope he will respond positively.

Minister for Health (Dr. O'Connell)

I am very pleased Deputy Ferris raised this issue and I congratulate him. In doing so he is ensuring that the public are made much more aware of this serious public health problem and the need for us to take effective measures against it and to provide the very best care for the victims of AIDS. I have read the statements in relation to the care and management of persons with AIDS and HIV at St. James's Hospital and I am concerned about them.

I wish at the outset to pay tribute to the excellent work being done at St. James's by Dr. Fiona Mulcahy and her colleagues. I am, however, a little concerned that the impression might be conveyed from the statements that the hospital may not be in a position to continue to provide the appropriate services for patients with HIV and AIDS, because this is not true. In spite of the increasing number of persons with HIV and AIDS requiring services at the hospital, there is no question of any person with the disease not receiving the appropriate care. I have always recognised that AIDS and HIV would make a significant impact on St. James's Hospital and that the hospital would have to be funded to take account of this fact.

At present about 800 persons who are at varying stages of HIV and AIDS are attending that hospital and it is anticipated that, consistent with the natural history of the disease, an increasing number of these people will require in-patient care. The majority of these patients come from the catchment area of St. James's and the hospital will continue to provide services for them during the period of their illness. However, it is the policy of my Department that major acute hospitals should provide services for persons with HIV and AIDS who come from their own catchment areas. At present a number of the persons attending St. James's comes from outside the hospital's catchment area and as soon as appropriate services are developed elsewhere it can be anticipated that the hospital's HIV and AIDS workload will be reduced.

As a major step towards the development of this policy I am pleased to announce that agreement has been reached by my Department with Comhairle na nOspidéal and the Mater and Beaumont hospitals that a consultant in infectious diseases will be appointed to serve the north side of Dublin — I made that announcement earlier today. This post will be shared equally between the Mater and Beaumont and will facilitate the development of a hospital-based AIDS-HIV service for the north side of the city. I am hopeful and determined that the post will be filled very soon. I was very surprised and rather depressed to hear that this post was not filled some years ago. It must be filled now as a matter of urgency.

This development is part of a wider integrated AIDS-HIV service, the components of which are currently under examination by the National AIDS Strategy Committee of which I am chairman. I expect to announce full details of all the components in the very near future. In broad terms, these will involve the provision of services as appropriate and when required at primary, secondary and tertiary care levels to individuals with AIDS and HIV virus, and will facilitate the care and management of such persons, including care outside the setting of acute hospitals. The service will, of course, be provided nationwide. I recognise, however, that St. James's Hospital has particular difficulties at present. I am glad to be able to report to the House tonight that on my initiative and following discussions since February last between my Department and the hospital, agreement has been reached on measures and on the necessary funding to improve the present service for AIDS-HIV patients at the hospital. I will take into account everything Deputy Ferris has said and ensure that effective measures are taken to deal with this national scourge which is reaching almost epidemic proportions.