Seanad Éireann díospóireacht -
Thursday, 21 Feb 1929

Vol. 11 No. 6

HOSPITAL ACCOMMODATION IN KERRY.

The McGILLYCUDDY

I move:—

That, in view of the serious nature of the remarks made on page 31 of the Report of the Commission on the Relief of the Sick and Destitute Poor, 1927, it is the opinion of the Seanad that the Minister for Local Government and Public Health should exercise his powers under Section 20 (3) of the Kerry County Scheme Order, 1923, to ensure that adequate hospital accommodation as outlined in Section 15 (b) of the said Order is provided at an early date.

The object of this motion is to draw attention to the delay on the part of the Kerry Board of Health in dealing with the question of providing a county hospital affording accommodation for the poor of Tralee and the urgent surgical cases in the county. As long ago as 1923, under the Local Government (Temporary Provisions) Act an order was made by which the Board of Health was charged with the duties of providing a county hospital for the treatment of medical, surgical and maternity cases, and cases of infectious and contagious diseases in Tralee. Power was taken for the Minister to issue such directions with respect to the county scheme order as he thought necessary. In spite of that, in 1927 the Institution in Tralee was mentioned in the Report of the Commission on the Relief of the Sick Poor in the following words: "worse accommodation styled a county hospital has not been seen, and the present state of things should not be allowed to continue." From time to time, representations have been made in the County Council and in the local Press, but beyond a few casual discussions as to various alternative sites, the Board of Health has not taken this particular question of hospital accommodation in the county a real step further, and as a result the situation to-day, as it was six years ago, is that there is a surgical hospital with twenty-nine beds, which is housed in an inadequate building with the poorest sanitary and lighting arrangements— in a poor position and inconveniently constructed. There is a waiting list for admission and it is of frequent occurrence that cases under treatment are prematurely removed to make room for other cases of a more urgent nature which are constantly brought in. There is a medical hospital housed in an old workhouse, which is in a desperately bad state of repair, and there is a fever hospital in a wing of the same building in very little better case.

This county has an area of some 3,000 square miles, and a population of approximately 150,000, of whom a very large proportion must be classed, from the nature of their holdings, their accommodation and their land, as poor persons. I think that these facts, and the position of Tralee as regards the bigger towns of the Free State, call for particular attention, and I think that in the chief town of this county there should be a modern hospital; in fact, I think it is an urgent necessity. I am not suggesting a county hospital in the proper sense of the word; there is no medical school; we cannot afford the experts, and we would still have to continue with extern treatment, as we do to-day. But the point I want to bring out is that the present local body is not going on as fast as it should for the provision of a medical hospital in what might be called one of the important towns in the remoter parts of the country. I trust that the House and the Minister will take a sympathetic view of this motion and will realise its urgency.

Mr. COUNIHAN

I second the motion. Senator The McGillycuddy has put the case for the motion very plainly and without exaggeration. I do not know quite so much about the subject as he does, but from what has appeared in the report of the committee that investigated the hospital, it should be clear to every member of the House that the motion should be supported. Kerry is a very important county. It is a very large county. It is five times the size of Carlow or Dublin; in population it is five times as big as Carlow, and I would say three and a half times as big as Longford. The majority of the people are rather poor, and the twenty-nine beds that the report states are in Tralee hospital appear to be insufficient. The Report states "worse accommodation styled a county hospital, has not been seen, and the present state of things should not be allowed to continue." That statement in itself should convince us that something must be done to rectify the state of affairs which exists in Tralee. I am sorry that the report has remained so long without receiving consideration. Kerry sends quite a number of representatives to the Oireachtas; we have two members in the Executive Council, and I think there are three or four Senators representing the county. I ask the Seanad to adopt the motion.

Sir E. COEY BIGGER

I should like to support the motion which has been so ably proposed by Senator The McGillycuddy, but I do not think it goes quite far enough. I would much prefer to see the motion going much further—with regard to the treatment of the sick in the county, more especially cases requiring operations. In the case of major operations, such as internal operations, I think a better arrangement would be to send them to some of the large hospitals in the county boroughs, and I would suggest to the Minister the advisability of appointing a committee, say, of operative surgeons from the four county boroughs to go into the whole question and make some arrangements. I think that that could be done very inexpensively, and it would be of very great advantage to the sick poor and to the whole community if a committee were appointed to investigate the whole question of major operations. I do not care what the arrangements are in some of the hospitals as regards construction and equipment. That is not the essential point. The essential point is the operations. I know the Minister's interest in public health, I know that he has made himself au fait with a very difficult problem, I know he has done a great deal, and I am sure that he will look at this matter in a sympathetic way.

Dr. O'SULLIVAN

I cannot agree with what has been said in this matter. I cannot subscribe to what Senator The McGillycuddy said. I know Kerry very well, and I know the hospital accommodation. Prior to amalgamation we had six unions. In each union there was a workhouse and a district hospital, and the work in the county, as far as the sick poor were concerned, was carried out very well. Some years ago a board that was not representative of the ratepayers or of the people of Kerry thought that they should amalgamate those unions. Amalgamation of the unions was all right, but they also wished to amalgamate hospitals, and they reduced the six hospitals to four in number, abolishing two. They might as well have tried to abolish illness as to have tried to do that, and they could not abolish sickness, because it will come whether we have hospitals or not. A great outcry arose, with the result that they had to restore these, so that we have now hospitals in Killarney, Cahirciveen, Listowel, Tralee, Dingle and Kenmare, with a central hospital in Tralee. As Senator The McGillycuddy has said, the County Hospital in Tralee is divided into two parts. You have the old County Infirmary, which was taken over on the amalgamation. That is devoted altogether to surgery, and there is accommodation there for about thirty persons. There is an operating theatre which is centrally situated and, as things go, fairly well equipped. There is a medical hospital, under the charge of Dr. Coffey, in the old workhouse building—the old district hospital—and if that is not in as good a state of repair as it ought to be in, that is the fault of the old Board of Guardians, because the other district hospitals are in a very good condition of repair and carry on their work remarkably well.

When this amalgamation scheme for the county was brought up it was agreed that there should be a county home in Killarney. The old people, people who are bed-ridden and who require the best of care, were transferred from their respective workhouses to the county home in Killarney, and they are now looked after there, and looked after fairly well.

This scheme was drawn up in a period of difficulty, when the country was in a bad condition and when there was chaos, and the scheme was rushed through without due regard to the requirements of the poor of the entire county. Senator Sir Edward Bigger referred to people requiring operations of a serious nature, and suggested that they ought to be sent away to hospitals in Cork or Dublin. That is being done, and a considerable sum of money is being spent by the Kerry Board of Health in sending these poor people to hospitals where they will be suitably and properly treated. In no case that I ever heard of have they refused to send to these hospitals persons who required such treatment; in fact they have rather acted the other way, and have sent people who did not quite come within the meaning of the Poor Law Act, with the result that the cost of extern treatment has risen in the last four years from something like £400 a year to £2,000, and the attention of the doctors has had to be drawn to it recently. Honestly, I do believe that we are treating the poor people in County Kerry remarkably well as far as illness is concerned. We have gone further than any other county in Ireland, because we bring to Tralee to treat people who are suffering from nose trouble or eye trouble specialists who see to it that the poor people get glasses, or whatever they require, at the expense of the rates.

The most important subject in connection with the sick of County Kerry is tuberculosis, and that has not been touched upon at all. Some years ago we spent a comparatively small sum on the treatment of tuberculosis, but now our expenditure amounts to £14,000 a year, and this is a great waste of money. There is no use sending a poor person to a sanatorium for three, six or nine months and then sending him back to live in a miserably dirty slum. We should start out to get rid of the places where consumption is bred, but instead of doing that we first breed consumption and then try to cure it, and that is tackling it at the wrong end. I would suggest to the Minister that instead of wasting money on a scheme of that nature somebody like a medical officer of health for schools should be appointed, and that the children should be examined fairly regularly so that the disease could be caught in its incipient stages. Then we would have some chance of doing good. What we are doing at present is throwing away a lot of money and doing no good. As far as tuberculosis is concerned, what we require to do is to give the people improved houses and good food. As it is we are wasting money.

The Tralee people want a most expensive institution; anything up to £20,000 has been suggested. It would be an outrage to ask the people of Kerry to subscribe £20,000 towards the erection of a hospital which, call it what you will, will not serve the needs of the county. Everyone knows that serious surgical and medical cases have to be treated by team work, and they have to go where there are medical schools, and I do not believe that highly technical work like that could be done anywhere except in Cork, where they have a teaching school, or in Dublin. I will not say anything about Galway. I could not praise it, and consequently I will not say anything about it. As I said before, the poor people who require treatment are never refused it. But I think it would be unfair to saddle the ratepayers with a big sum of money for building a most expensive institution. I think we ought to improve the existing institution and carry on for a while until we reach better times.

MINISTER for LOCAL GOVERNMENT and PUBLIC HEALTH (General Mulcahy)

The effect of this motion would be that the Seanad would ask me to issue a mandamus to cause the Kerry County Council to do a certain thing. I do not know whether the Seanad has any information upon which it would pass such a resolution. At any rate, that would be the effect. While Senator The McGillycuddy suggests that the attention that has been given to this particular matter has been casual, in so far as there is any information at my disposal in regard to what has been done by the Department in the matter, that information is at the disposal of the Senator. In 1927 a certain amount of time was spent by the Kerry Board of Health in considering one particular site. There was a general election in that year. Things like that react on administrative work, both of County Councils and of other bodies, but I am speaking now of the Board of Health.

That might have been expected to react on them, but at any rate the site was considered and dropped. During 1928 three sites were under consideration, and I think that the Senator himself is now adding a fourth to the discussion, in correspondence with me at any rate. But as recently as the middle of last November a medical inspector from the Department was down surveying some of these sites, in particular one of them. Subsequently the engineer of the Board of Health surveyed another, and subsequent to that the architect of the Board of Health was asked to make plans for the third site. The consideration of the cost of all these plans has to be gone into before a decision can be taken. If a county hospital is going to be established in Tralee, it is important that time should be taken to consider what is the most suitable site and the cost, because on all these matters will depend the efficiency and the economy of the medical services that will be provided in the county hospital for many years to come. I simply want to say that the matter has not been dealt with by the Department in anything like as casual a way as has been stated. The Department has given every possible assistance to the Board of Health in connection with the matter, and, personally, if in the circumstances that have existed and that exist now, the Minister for Local Government and Public Health was to mandamus the Kerry Board of Health, I doubt if he would get costs from the Court in the matter, because it would be quite easy to establish that it was an absurd action. That is as far as the present motion is concerned. But I would like the Seanad to find out from the Senator who moved the motion, or to examine themselves, what would be the effect of passing the motion, as far as I am concerned, as far as the Board of Health is concerned, or as far as the Seanad is concerned. If this is one hospital of a large number of hospitals that the Minister has to deal with and if hospitals are only one of a very large number of matters that he has to deal with, how many motions like this, dealing with individual cases of his administration, has the Minister to deal with on occasion, or is the Seanad going to be asked to express an opinion on? The Minister for Local Government is only one Minister and if there are several others, each of whom has his own matters to deal with in administration, what position will the Ministers be in and what position will the Seanad as a whole be in if such action were taken generally? I think that these are matters for careful consideration before the Seanad should pass a motion of this kind.

Mr. COUNIHAN

Does the Minister agree with the Report of the Commission which stated, "we have not seen worse arrangements styled a county hospital, and we think that the arrangements should be altered?" It was that statement in the report which led me to second the motion. I do not know as much about the circumstances in Kerry as Senator The McGillycuddy or Senator O'Sullivan, but I think such statements in the Report of the Commission require some explanation, and if that is so I think that the Minister should take some action.

General MULCAHY

I do not know what the Senator means by "some action." I am not called upon to agree or to disagree with what the members of the Commission stated. If the members of the Commission stated a thing like that I take it that they stated what was really their opinion, that they spoke from their experience, and that they spoke truly. But, as I say, I am not called upon to say whether I agree with them or not. What I am called upon to do is to try to reconcile the difficulties and get over them, and as far as doing something is concerned, I would like to know if the Senator suggests that I have done nothing, or that the Department has done nothing. I would like the Senator to suggest if there is anything additional that the Department might do. We might issue a mandamus against the County Board of Health, but something more practical is required in the matter.

Mr. JOHNSON

I would like to say for my part that this is not the kind of question that I for one would vote for. A mere statement from the Senator of the facts as he sees them, a contrary statement by Senator O'Sullivan in regard to a purely local question of purely local interest, is surely not the kind of question that the Seanad should be asked to declare itself upon. I rather imagined that I heard yesterday some Senators who were eloquent in declaring that the function of the Seanad was to revise—sit quiet until Ministers bring up Bills and then revise them. But if there is any class of matter on which the Seanad should not be called upon to declare itself it is purely a local subject of this kind in respect of one county which has no general application. If this is put forward as an instance to show that the whole poor law system, or the whole system of hospital accommodation throughout the country, needs to be considered, and that this is merely an example, then the motion might very well be within the functions of the Seanad. But to deal with a simple local issue in County Kerry, and to ask the Seanad, which is not representative of the district at all, to decide upon it is, I think, going beyond the true functions of the Seanad, and is doing very much worse than anybody has suggested hitherto in regard to the use that should be made of the Seanad's authority or prestige.

The McGILLYCUDDY

With regard to what Senator O'Sullivan said, I do not think I disagree with him in practically anything, but as far as I can see, he did not say anything with regard to the particular point I brought forward, except to suggest the actual sum required. I say the sum required is very doubtful, but I do not think it would be anything like the sum he suggested. I do not want to go into details of that here. These details are available if this question is to be further examined at a future date. There is one point on which I do not agree with Senator O'Sullivan, and that is where he referred to the accommodation in Tralee as being "fairly well equipped as things go." Though I agree that, chiefly due to his efforts, things are excellently managed elsewhere in the county, I can hardly agree with him with regard to Tralee in view of the report and of the fact that this hospital stands to-day as it stood six years ago, that things are good enough.

As regards the Minister's point, the Kerry county scheme was published as an order in 1923. Part 2 deals with the relief to be provided by the County Hospital at Tralee. Section 20 says the Board of Health shall observe and carry into effect all orders and directions issued by the Minister in respect to any prescribed matter. I submit, in spite of that, that for six years the local body has not carried out the functions with which it was charged, and that it becomes incumbent on the Minister as the controlling head to make such orders as will provide an efficient scheme as laid down seven years ago, and that has not since been altered, and to issue such orders as would provide an efficient service within a reasonable time. There is general feeling, and there is no doubt that so far Tralee has not got what the rest of this big county has, and Tralee has paid its share of it. I do not want to press the motion any further. I only raised it in the Seanad because, as far as I could see, there was no other way of bringing it under public notice. I believe that there are other hospitals in the country not as good as they should be, but I am only concerned with this one as being a typical instance of delay. In view of what has been said by Senators I do not propose to proceed with the motion, and I ask the leave of the House to withdraw it.

Motion, by leave, withdrawn.