The Chair has received notice from Senator Fennell that on the Motion for the Adjournment she wishes to raise the matter of: The recent savage cuts by the Department of Health to Hume Street Hospital which will mean the termination of their vital day care treatment for thousands of psoriasis sufferers — and closing from the end of June of the women's screening clinic.
Adjournment Matter. - Hume Street Hospital Cuts.
An Leas-Chathaoirleach
I would like to thank you and say how pleased I am to have been allowed to raise this matter on the Adjournment this evening. I am pleased to see the Minister of State is here to listen to the points put forward. I wish to raise the matter of the severe cutbacks in the allocation for the years 1987-88 to Hume Street Hospital. The allocation has been reduced by one-third from last year and now stands at £796,000. Before I address myself to the main part of what I have to say, I would like to put on record a letter received from the Secretary-Manager, Miss Leahy.
Resulting from reorganisation in August 1985 with the advice and approval of the Department of Health, the first five day week hospital in Ireland was established in Hume Street Hospital (incorporating a Day Care unit). Bed numbers were reduced from 90 to 40 together with agreed reductions in staff complement.
The reorganisation of the hospital is in line with the policy document of the Department of Health "Health — The Wider Dimensions". The distribution of workload away from in-patient care to other delivery modes within the hospital, such as out-patient and day care through the operation of special units, like day-wards, five-day wards and programmed investigation units is a major objective of hospital policy. These concepts are increasingly being embodied in the approach to hospital planning".
The reorganisation of Hume Street Hospital cost £265,000. The hospital contributed £175,000 from voluntary funding and the Department of Health provided a capital grant of £90,000.
In 1984 the hospital deficit came to £1.2 million; if similar expenditure had continued in 1986 the deficit would have been in the region of £1.5 million.
However, Hume Street Hospital is operating in an environment which requires efficient and effective use of the limited resources available as can be seen from the following:
|
1985 deficit |
— |
£1,185,000 |
|
(+£8,000 on previous year) |
||
|
1986 deficit |
— |
£1,050,000 |
|
(–£135,000 on previous year) |
||
|
1987 budget |
£0,930,000 |
|
|
(–£120,000 on previous year). |
We have now been asked to cut back to £796 million. To operate within our estimated budget of £930,000 necessitated terminating the employment of 10 full time staff members.
To comply with the Department of Health allocation would mean terminating the employment of a further 12 staff members.
Clearly, if this hospital's unique and vital economical service is to be viable such a measure is not practical.
Our new hospital is being used as a model for dermatology units in the UK and abroad. Medical/Nursing and Administrative Staff from abroad regularly visit the hospital in order to learn how best to establish similar units.
Hume Street Hospital accepted in 1985, the challenge of a radical change in its operation. They made the savings already. Other services also need to reorganise in line with the economical constraints. How can they be persuaded to follow in the footsteps of Hume Street if the consequences for taking up that challenge is certain death?
That is a letter received from the secretary-manager of the hospital.
I would like to give some background to the hospital itself and to the service provided by Hume Street. As was mentioned, in 1985 this hospital changed quite radically from what was generally known as Hume Street Skin and Cancer Hospital. The emphasis since that time of rationalisation has been on dermatology and it still includes the treatment of skin cancers. However, the very important function performed by this hospital now and which concerns me tonight is unique in this country; it is their day care centre for psoriasis victims. Another imaginative initiative which they took was the operation of the five-day week hospital. When it became apparent that rationalisation was needed many innovative ideas were put forward and discussed and developed in the hospital, one of those being the very popular women's screening clinic which is now under threat also. Prior to that time the personnel at Hume Street Hospital went to a great deal of trouble to see how day care units for treating the condition of psoriasis were organised in other countries. The unit which exists now in Hume Street is modelled on treatment centres in Sweden and the United States. It was designed and set up with assisted funding, as has already been said, from the Department of Health.
I would like to pay tribute to the members of the board of Hume Street, to the staff in Hume Street, particularly its matron, Miss Maeve O'Dwyer, and to its secretary-manager both of whom are committed to the concept of a day treatment centre. It has to be said and anyone who has been a patient in Hume Street knows that this hospital has an ambience and a cheerful and willing staff that is in my opinion rather unusual even in the caring world of medicine. It is thanks both to the Department of Health and the work of Hume Street Hospital that the hospital was able successfully to transform and change its services and develop a highly successful treatment centre.
I have asked for this debate because I want to put it very forcibly to the Minister that what is happening in Hume Street is, in my opinion and in many other people's opinions, what is needed throughout the country: that people who do not need to be hospitalised, who do not need to occupy acute beds, who are sufficiently healthy to come to well-equipped day treatment centres should be encouraged to do that. This makes good sense and is good political housekeeping.
Hume Street's approach to its work is to discourage people from feeling that they are ill and to let them see that in many instances they can continue with their normal lives and their jobs while being treated for a particular complaint. I regret to say that this type of petty pruning which the Minister has exercised in this case is very shortsighted. Hume Street Hospital is not of an enormous scale in its budget. It does not involve anything like the kinds of amounts that are discussed in both Houses when cuts are being debated. Perhaps it is because of this fact, that it is only such a small amount by comparison, that it has been overlooked and suffers a 30 per cent reduction which is felt very severely by them. It does not get the prominence and the attention that the larger reductions in other hospitals have had. This is something the Minister should look at very carefully.
I suggest that initiatives such as those which have been taken in Hume Street need to be cherished, encouraged and copied. I am not proposing the retention of acute hospitals or acute beds because I am fully aware that we are spending too much money on the number of acute beds we have at the moment. Hume Street Hospital is showing that there is a better way. That was the slogan that was very much used before the general election by the Fianna Fáil Party. There is a new philosophy of shared care there, where patients who occupy hospital beds for five days of the week: those patients go home to their families at the weekend and return on Monday. The hospital has shown that the State need not in all instances take over total care for people who are ill. It is a case of sharing responsibility and support. I believe our idea has to be to encourage people to do this.
I appeal to the Minister personally to look into the work of this hospital and he will see that it is a very encouraging development that people have related to and are using with great results. Those people are sufferers from psoriasis which is a very debilitating and incurable skin condition. This unit serves patients from all over the country. They can come in as early as 8 o'clock in the morning, can have an hour or two of treatment and can then quite comfortably go to their jobs. Employers who have workers who suffer from psoriasis are now aware of the treatment available. Due to the fact that it has cut down on absenteeism they are very ready and willing to give time off, if this is necessary, in the mornings so that workers do not have to become in-patients in hospital for treatment.
The in-patient treatment was the only service that existed prior to August 1985 when the condition of psoriasis became so severe that treatment was necessary. A patient would have to spend two or three weeks in hospital being sick, or pretending to be sick, when in fact he or she was not really sick enough to be in bed, in order to get specialised care. I put it to the Minister that if he compares the cost factor of putting in hospital a person who does not really need in-care treatment, and all this involves, compared with facilitating that same person with two hours treatment daily, extending only the specialised treatment and care he or she needs, he will have to see the sense and reason in the argument for funding Hume Street Hospital to enable it to continue its valuable work.
On its present grant Hume Street Hospital is at risk of closing down. If that unit closes what will happen? That is the very big question. All the people who can be and are being treated there will be thrown back on to the acute hospital list. To give an idea of the figures involved, prior to its reorganisation this hospital treated 20 patients a week as in-patients; now they can treat 100 a day, 70 in day care and 30 as in-patients. The hospital has affected a 30 per cent reduction in its running costs while dealing with four times as many patients.
I am aware of the commitment from the Minister and the Department to institute a review of health services. I suggest that it would have made much greater sense to have had the review before the cuts. We have a classic example here of how cuts can lead to the demise of an innovative idea. What is the point of having the review afterwards when this innovative idea and practice have gone? A subsequent review will not really be very relevant when a unit such as the one I am speaking about, which exists in Hume Street, has died from lack of funds. That is why I would like to impress upon the Minister the importance of giving this hospital the small extra allocation they need in order to allow them to continue their work.
There are splendid people involved in this unit who firmly and sincerely believe in the work it is doing and I would like to pay tribute to them all. They have worked as a team to establish the psoriasis unit and to ensure that it works to maximum efficiency. They show great care and kindness to those attending it and they are battling to keep this treatment centre open at all costs. They cannot do it without departmental support and without official understanding of this work. I appeal to the Minister to review the reduction for Hume Street in the coming year and I have every confidence that with the first-hand experience that the Minister for Health, who is himself a doctor, has of this complaint he will find the small funding necessary to ensure the continued operation of this very important unit.
An Leas-Chathaoirleach
I call on the Minister of State at the Department of Health. The Minister has ten minutes.
First, I would like to acknowledge the Senator's concern in regard to this issue and I welcome the opportunity on behalf of the Department to explain the present position. I am also delighted to see the matron and the secretary-manager of the hospital here this evening as well.
Hume Street Hospital specialises in the treatment of dermatological conditions, most notably psoriasis. It operates on an out-patient basis with a back-up number of five-day beds. In 1985, the hospital established a women's screening clinic on the basis of funds provided from voluntary sources for a two year trial period. Hume Street Hospital has received an allocation of £0.796 million in the current year. The hospital is at present implementing measures to enable it to provide the service to patients within the available funds. These measures include the termination of the women's screening clinic at the end of June. I would like to mention at this point that this clinic was established at the hospital on the basis of private funding. I regret that these private funds are no longer available to the hospital to enable the clinic to continue but I fully understand the position in this regard. With regard to the daycare facilities including the services for psoriasis patients, I am aware that the hospital is considering further measures in order to live with its approved allocation. However, the hospital has not yet made any firm decisions on the extent of these measures or on their timing.
In conclusion, Senators will be aware that on 19 May last the Minister spoke in the Dáil about the drawing up of a national plan which would have regard to the streamlining of the acute hospital systems throughout the country. He pointed out in that Chamber that officers from the Department would, with assistance from Comhairle na nOspidéal, commence discussions with management of health boards and voluntary hospitals to devise a plan for each health board area. This consultative process is now well advanced and will be completed in a matter of weeks. Bearing this in mind, I do not think it appropriate that I should comment on any individual hospital until such time as the review group have completed their task and reported to the Minister.
I appreciate the work being carried out at Hume Street, which is very useful indeed and I regret the very difficult times that Hume Street may be experiencing. Hopefully, when the review is completed a further discussion can take place.
Will the officials of the Department be contacting Hume Street Hospital with regard to their difficulties in the context of the review?
Yes. I can assure the Senator and the officials from the hospital, that my officials will be available for consultation with the hospital to see what can be done.
The Seanad adjourned at 8.30 p.m. until 10.30 a.m. on Thursday, 25 June, 1987.