That Dáil Éireann condemns the decision to again postpone the commencement of the Tallaght Regional Teaching Hospital; requests that the Kennedy Group complete an Interim Report on Tallaght Hospital at the earliest possible date; and resolves itself to be of the opinion that the necessary capital should be set aside to commence building work in 1992.
The urgency of this motion arises from the fact that the Minister for Health will shortly finalise plans for the expenditure of over £40 million during 1992 on hospital services, investment in new capital projects for hospitals and health care. It is vital that the Minister includes the £5 million necessary to get Tallaght Hospital under way in this allocation, and I hope the Minister will give an indication of his commitment to do this in the House tonight.
The people of Tallaght are no strangers to official foot dragging. They have had to wait for third level education facilities and fight all the way to get them; they have had to wait for shopping facilities and they are still waiting for effective transport services. It is unacceptable that they should still be waiting, 12 years later, for a basic health service.
I do not know, a Cheann Comhairle, if you are familiar with the history of this project, which goes back a very long way. The board, who were first appointed in 1980, had a planning brief drawn up which was completed in December 1983 and accepted by the Minister. They held an architectural competition in March 1984 and the winning design was announced in July 1985. The Department of Health gave their approval to the commencement of the detailed planning in March 1986 and this was completed in December 1987. The Department gave their approval to the commencement of the stage 4 planning process, the builders' drawing stage, in June 1988. In early 1989 the Minister for Health announced that he wanted to see the project accelerated; in an unprecedented move, he wanted to see stage 4 and stage 5 drawn together and completed together. This was done during the autumn of 1990. Tenders were then ready to go in November 1990, but sadly, that is where the matter has rested since then. That state of readiness to go to tender was submitted to the Department of Health in November 1990 but there has been no response to date.
Tallaght hospital was overlooked in the capital programme for 1991, and there is a very real danger that Tallaght will be overlooked yet again in 1992 and that the £5 million necessary to get the hospital under way will not be made available. This is why Fine Gael believe this motion had to be brought to the floor of the House. I am very pleased that the Labour Party and the Democratic Left are supporting this motion and I hope that there will be all-party support for it.
Obviously to the 80,000 people in the Tallaght area this project is crucial. As we know, this community has suffered unusual economic hardship during the past ten years, having the problems of economic recession piled high on them. The unemployment level in some parts of the area is extremely high, up to 70 per cent in some cases. This project is of importance not only to the people of Tallaght but also to a much wider catchment area of some 300,000 people which it will service.
The project has been referred yet again to the Kennedy group, despite the 12 years of preparation. The Kennedy group have laid extreme emphasis on the importance of an integrated service which should have at its heart an acute hospital which would provide a comprehensive range of services. I should like to quote briefly from the earlier work of the Kennedy group which gives a clear illustration of their thinking. In talking about the problems in our health services, as presently constituted, they say:
The present structures are notable for the fragmentation of the health service, the confusion as to roles and responsibilities of the various agencies and the lack of an effective overview of the interaction of services at levels of planning or delivery. The difficulties arise from the scale of the area and population to be served, the operational autonomy of most of the acute general hospitals and many of then non-acute agencies in the city, the fact that the geographical areas which apply in the organisation of community care services do not generally coincide with the configuration of the populations served by acute hospitals, and because of relative isolation of the more than 800 general practitioners in the region from the rest of the health care system, the present structures facilitate a lack of co-ordination and provide no proper basis for resource allocation or for performance review.
That is a short summary of the deficiencies they identified in our health services. Nowhere in the city of Dublin are these deficiencies more stark than in the Tallaght region where acute hospital care is entirely divorced from the region. The Meath Hospital, the Adelaide Hospital and the National Children's Hospital and the Naas hospital on the other side of the region are a long distance from the core populations who have to be served. We expect some of the most deprived people in Dublin city to attend acute hospital facilities long distances from their homes and to do so without a proper transport service.
At the core of the Kennedy group's recommendations for restructuring health care in Dublin is the idea that there should be five regions with integrated and comprehensive services which would be capable of being supported by a given population and would be provided locally to that population. Those are the key elements of the report. As the Minister knows, they go on to say that one of the key areas was to be the Tallaght region, centred on the Tallaght Hospital. It was to serve a population of 250,000 people, under the section "the south west region". The Tallaght Hospital and the development of a comprehensive range of services is at the core of the Kennedy group proposals. It has already been established by that committee what they want to see in the way of development of health services for the population to which I referred.
Against that background people have been rightly dismayed at the recent suggestion by the Minister for Health that the Adelaide Hospital should be kept open. That would involve the splitting of specialties and would leave some key specialties not available as part of a comprehensive service to the people of Tallaght and the surrounding region, known as the south west, which takes in part of Wicklow and Kildare as well as the south west regions of Dublin. It is disturbing to hear the Minister making these announcements. It is hard to accept he is acting in good faith in commissioning and urging the completion of this report when he makes suggestions like this which are not only ill-thought out but cannot be seen as anything but put together to prejudge a conclusion which is likely to emerge from the Kennedy report based on their existing work, mainly the recommendation, as a matter of urgency, that we go ahead with a comprehensive service in Tallaght, drawing together all the elements of care now split between the fragmented services of the existing hospitals.
People in Tallaght and the surrounding regions must rightly feel aggrieved that they are being turned into a political football after the long history, which I described, dating back to 1980 when this project was being brought painstakingly through the different stages of development, that a new committee has been appointed at the last hurdle to investigate afresh the functions, scope and scale of the hospital.
Despite being concerned as to whether the review is in good faith and not just a stalling tactic, I accept that since 1980 there have been significant changes in the approach to hospital care and in the needs for bed complements relating to different specialities. I accept — as do the board of Tallaght Hospital — that the changes in health care have also changed the balance between in-hospital stay and day care which should be provided for in the Tallaght Hospital project. However, they have been acutely conscious of that throughout the design stage, they have not been living in an ivory tower divorced from these trends; they have been acutely conscious of those trends and have designed a hospital explicitly to have that flexibility to convert stay care into day care in a way which can respond to the emerging needs and process of effective health care which is developing.
The continued delay is pushing that future — where there is flexibility between stay and day care — further and further from our grasp; that is the reality. The delay means that the old Nightingale wards in the Meath and other hospitals will continue. It is hard to credit that the Meath Hospital is 270 years old and that the Adelaide Hospital is 150 years old. Conditions in those buildings cannot result in the sort of modern care which I know the Minister wants to see delivered. Tallaght Hospital is there to fill that gap. We all know that it would be a total waste to see money being sunk into an attempt to patch up these hospitals and to keep them going to a date long beyond when they can provide the sort of services that either the staff working there or the patients have learned to accept. It is like the old story of the roads network, we have seen to our cost that this patchwork of putting a small amount of money here and there is a total waste of money and leaves a service which is structurally unsound in the long run. We must arrest that possibility in this instance by not having continued delay in regard to this project.
People were also dismayed at the Minister's recent suggestion that some sort of municipal loan would be the basis on which this project would stand or fall. I do not know who the Minister thinks he is fooling by suggesting that a municipal loan is some way of resolving the problem of finance for this project. We do not have to go to the United States of America to learn how to borrow money, this country is better than any at borrowing money. We are borrowing money this year to give the Minister £42 million to provide capital for his hospital programmes and his health investment. To talk of some mysterious US loan as being the answer is just pie in the sky and the Minister must know that. It cannot deliver an effective solution to this problem because the Minister for Finance, who sits beside the Minister for Health at the Cabinet table day after day, has made it crystal clear that he will not sanction more borrowing for health purposes; he will not go beyond the £42 million which he has made available. The net issue here is not a new loan to divert attention to a different area of work, the issue is whether the Minister and his colleague will make available from the £42 million the sum of £5 million to build the Tallaght Hospital.
I look forward to the Minister's response because people want him to prove he is not engaged in a stalling tactic in the various suggestions he has made and that he is committed to starting work on the project which emerges from the review by the Kennedy group. As I understand it, the Kennedy group will, very shortly, be in a position to give an answer in regard to the sort of service they envisage as suitable for serving the people of the south west of Dublin. The manoeuvring and political brinkmanship in regard to the Tallaght Hospital must come to an end. It is not as if the money is not there, that is manifestly untrue; not only is there £42 million available this year to be spent, since the sod was first turned on the Tallaght site in 1986, the Government have spent a colossal £350 million on hospitals and yet Tallaght Hospital did not get the go-ahead. That sum would have built Tallaght Hospital three times over and more no matter what estimates are given of the cost of the project. If the Government had the will, that project would now be underway. However, it seems that the Government do not have the will.
I should also like to refer to the issue of costs. The Minister and his colleague, the Minister of State, time and again repeat the estimate of £118 million as if that was the proposed scale of expenditure planned by the hospital board at present. That is not the case, the sum of £118 million was based on a 600 bed hospital which the Tallaght board are not pressing at this stage. That sum involved three phases of their plan and, at the request of the Department of Health, they abandoned those three phases to provide this extra scaled-down service. The real project does not run to £118 million but could be financed for under £100 million. It is significant that the Government seem to be putting up the figure to make it seem more difficult to solve this problem.
We would have to draw attention to the fact that a Minister in the present Government voted against his own party in order to secure the survival of Limerick's third hospital, a city with a much smaller population than Tallaght. The Tallaght-Clondalkin area which as the Kennedy report stated is the second largest region and has two Ministers representing it in the House tonight, is still denied a hospital.
In this area incomes are low and people do not have the option of paying for care elsewhere. I am convinced that these people are going without health care and the disadvantage of low income and unemployment they already suffer is compounded. I have spoken to many people directly concerned, our party councillor, Councillor Michael Keating and Senator McMahon, and they have testified to the enormous problems these people face. Picture if you can, a single parent with three or four children trying to cope with the children as well as having to attend an accident and emergency unit, who has to flag down a bus, perhaps in the rain, to make her way into the inner city for hospital care. It is unthinkable that that is the level of service we are providing in such a large area, and it compounds our scandalous neglect of the area. It is a shame that we should continue to neglect health care in this area.
If the Minister goes ahead with his proposal to split the project the Tallaght Hospital project will be seriously damaged. There is not only a clear desire to see the Adelaide approach to care in the Tallaght Hospital and providing the Adelaide with a modern setting, but it is vital that the many excellent consultants in the Adelaide should not be relegated to the second division serving an area which is already adequately served by the existing major hospitals. It would be sad to see the Adelaide Hospital relegated in that way — as the Minister suggests — which is against the tone and approach of the Kennedy report.
There were other suggestions that gave rise to concern. When the Minister talks about looking to other sources of funding for this hospital, I fear that this is some sort of code for private funding. We all know from our experience of privately funded hospitals elsewhere that they are hungry for private patients and their main driving force is to maximise the level of private business in order to generate revenue. It would be very serious if there was any suggestion that the proposed Tallaght Hospital would not be a public hospital committed to the care of public patients as their primary function who, according to the Minister's statement, make up 85 per cent of the patient throughput. It must be clear that the Minister is committed to public care from the outset and any suggestion that we would row back from that commitment and opt for a privately funded hospital that would have different priorities would be damaging.
We must also examine the types of services to be provided in the proposed Tallaght Hospital. It is important that the Minister's suggestion of splitting the project and leaving certain elements, such as the Adelaide Hospital and some of the children's hospital, out of the Tallaght project must be addressed in this debate. I hope the Minister recognises the wisdom of the Kennedy approach where it is clearly proposed that the paediatric speciality would be a core part of the service. What is really needed in an area where there are a great many children is a strong acute hospital with paediatric services and I hope the Minister will confirm that there will be no attempt on his part to row back from the concept of a comprehensive health service in Tallaght. By splitting the project and taking some of the specialities away from the proposed hospital, the Minister would be undermining the concept at the heart of the proposal to develop an effective care service for the people of Dublin.
Tallaght lies within the greater Dublin area and has a population of 250,000 plus. The Kennedy report recommended that an acute hospital be situated in the centre of the area which would build up relationships with the general practitioners and the community care services in the area. That is at the heart of what we want to see developed in the Tallaght area and I hope the Minister will not row back from this.
With your permission, a Cheann Comhairle I wish to draw my comments to a close so that I can share my time with Deputy Fennell.