Adjournment Matter. - Limerick Hospital Proposed Closure. – Seanad Éireann (18th Seanad) – Wednesday, 3 Feb 1988

Adjournment Matter. - Limerick Hospital Proposed Closure.

Mr. Kennedy

I am grateful for the opportunity to raise this matter on the Adjournment and to give my full support to the retention and development of Barringtons Hospital as an acute medical hospital with a vital and essential casualty and outpatient service. In doing so, I deplore and condemn the announcement by the Minister for Health, Dr. O'Hanlon, that acute services at Barringtons Hospital will cease early in 1988. I call for the immediate reversal of that decision. It was in 1829 that Sir Joseph Barrington-Bart, a name inseparably interwoven with the history of Limerick decided with his sons, Matthew, Daniel, Croker and Samuel, to found a charitable institution at their own expense for the relief of the poor of Limerick city and county. In 1830 under an Act of Parliament of George IV it was constituted as a hospital for the city and county of Limerick.

Barringtons Hospital was opened for the reception of patients on 5 November 1831. Ever since, Barringtons has been a life support machine for the people of Limerick, a place where doors never closed and where help was never failing. Barringtons Hospital is part of the tradition, the history and the heritage of Limerick and it symbolises all that is best in Limerick, treating rich and poor, old and young, alike without discrimination. Barringtons has played a vital and significant role in the provision of essential medical services to the people of the Limerick area for the past 160 years. I firmly believe that it must continue to do so, to ensure that the people of Limerick and the catchment areas of Limerick in Clare and North Tipperary receive the level of medical care to which they are entitled.

In support of the case for the retention and development of Barringtons Hospital I would like to emphasise the following salient and pertinent points. Barringtons has a basic bed complement of 84 beds, while an additional eight beds can and frequently are put up to cater for emergency admissions. There is additional scope within the hospital for a minimum of another 20 beds if the appropriate funding was available. I would also like to emphasise that an additional 50 beds could readily be provided by using the new nurses' home. This is a modern, three-storey building which was built in 1949. It is attached to the main hospital and is in first-class condition, having recently been upgraded and decorated. Limerick corporation have also designated land adjacent to the hospital for car parking purposes and this would also be available to Barringtons Hospital for the provision of car parking facilities and for other purposes.

The hospital itself is in excellent structural condition being built entirely of cut stone and all the floors are of reinforced concrete. A number of major improvements were carried out in recent years with the approval and funding of the Department of Health. In 1981 and 1982 the mechanical and electrical services were upgraded to meet the chief fire officer's requirements. The boiler house was re-roofed and the kitchen was renovated and refurbished and a new medical oxygen system was installed. The total cost of these works and the ancillary improvements amounted to £212,000. In 1983 and 1984, a new lift and a lift shaft were installed. A ward was converted and refurbished as an intensive care unit at a cost of £130,000. A suite of two totally enclosed, fully air-conditioned and pressurised theatres was completed in 1969. These theatres are equipped with every modern facility and are considered among the best in the country.

Since 1982 capital grants totalling £190,000 have been received for the purchase of replacement items of equipment. In addition to the above capital works, in 1986 the Department of Health approved and funded the purchase of two houses adjacent to the hospital at a cost of £60,000 to provide additional space for the development of the casualty and outpatients department. On 27 February 1987 in response to representations by me, I received the following letter from Deputy John Boland, who was Minister for Health before the present Minister for Health, Deputy O'Hanlon. Deputy Boland stated:

Dear Pat,

You were in touch with me recently regarding the proposals to develop the Out-Patient Department at Barringtons Hospital. The position is that the planning brief for the development is currently being considered by officers of my Department in consultation with the authorities of the hospital and this process is likely to take some time to complete. Of course you are aware that two adjoining properties have been purchased at a cost of £60,000 to make way for this development.

On 8 April 1987, the 1987 budget allocation for Barringtons Hospital was notified and this allocation of £1.897 million amounted to a reduction of 13 per cent on the 1986 allocation. Indeed, it was notified so late in the day that it amounted almost to a real cut of over 20 per cent in the remaining months. On 29 October 1987 the chairman of the board of management of Barringtons Hospital, in company with the chairman of the other voluntary hospitals, was invited to the Minister's office in Dáil Éireann to receive notification of the 1988 financial allocation. A sum of £1.6 million was allocated by the Minister for 1988, a reduction of £297,000 on the 1987 allocation.

On 1 December 1987 responding to Deputy Bernard Allen at Question Time, Deputy O'Hanlon, Minister for Health, stated:

I did not say anything contradictory. I said it was my belief that there should be no further acute hospital closures in 1988 other than those already in train.

Yet on 10 December 1988 the Minister for Health informed the secretary manager of Barringtons Hospital that acute hospital services at Barringtons Hospital should cease early in 1988.

Indeed, the Minister's shock announcement came less than four weeks after he had strongly denied that he was planning to close any more of the country's hospitals. Responding to an exclusive report in the Irish Medical Times for Friday, 13 November 1988, the Minister told the Irish Independent of the same day that he did not envisage any more hospital closures other than those already in the process of being shut down or those which had already been notified that they would be closed.

Three weeks earlier the Minister for Health also assured the chairmen and the chief executive officers of the eight health boards at a meeting here in Leinster House that he did not anticipate the need for any further closures in 1988 other than those already in train. It is clear from these statements that Barringtons Hospital was not among the hospitals targeted for closure. The purported closure of Barringtons Hospital, in the face of such strong denials by Deputy O'Hanlon that he was contemplating shutting down any more hospitals, places a question mark over the future of every hospital in this country, other than the super regional hospitals. It also puts a serious question mark over how much reliance can be placed on ministerial assurances.

Barringtons Hospital is the heart of Limerick and it is the lifeline for over 90,000 of our people in Limerick city and county and in the catchment areas of Clare and north Tipperary. Barringtons, of course, has traditionally catered for the poorer sections of our community and this can be seen from the fact that over 80 per cent of all the beds in Barringtons are public beds.

I would also like to emphasise that despite what Deputy O'Hanlon publicly stated on Radio Telefís Eireann — that no health professionals took part in the march on 9 January 1988 — the Limerick city and county branches of the Irish Medical Association issued a joint statement deploring the purported closure of Barringtons Hospital. These doctors demonstrated their practical opposition to the closure when they marched under an IMO banner at the protest march in which over 25,000 took part. In their statement the local branches said:

We, the Limerick city and county branches of the IMO, including consultants, non-consultant hospital doctors and general practitioners, deplore the proposed and imminent closure of Barringtons Hospital. We view it as a major loss of facilities to care for the 46,000 patients who visit it annually, in its role as an acute hospital, as a casualty department and as a venue for the investigation of patients on an out-patient basis. In particular we feel that insufficient significance has been attributed to its very central location both in regard to its proximity to city patients requiring our urgent attention, and to its social and medical importance over many years to city patients.

Maurice Lenihan, the distinguished historian, in his history of Limerick dated 20 February 1866 stated:

In seasons of severe epidemic, as at the outbreak of the cholera morbus in 1832, Barringtons Hospital was of incalculable benefit to the citizens as it has also been in all cases of accidents, whenever immediate relief is demanded by the sufferer. It would be a great pity that so deserving an institution should decay or fail from want of spirited support.

In total, between out-patients, casualty, and in-patients, 50,000 people were treated in Barringtons in 1987 at a cost to the Department of Health of £1.897 million. By any standard of comparison this is a very efficient and cost effective delivery of service and offers value for money. The people of Limerick and the surrounding areas have shown, as Maurice Lenihan has said, spirited support and a determined and united approach for the retention and development of Barringtons Hospital. I therefore call upon the Minister for Health to reverse this decision so that this great hospital can continue to serve our people with the same dedication and commitment as it has done down through the years.

In conclusion, I call upon the Minister for Health to enter immediately into discussions and serious negotiations with the board of management of Barringtons Hospital so that a way can be found to prevent the closure of one of the country's oldest and most respected health care institutions.

Minister of State at the Department of Energy (Mr. Smith) (For the Minister for Health)

I appreciate very well the Senator's concern about the closure of Barringtons Hospital. In order to put the matter in a proper context I should perhaps outline the background and the sequence of events which have taken place. It is now well known that, shortly after I took up office as Minister for Health, I initiated a comprehensive review of the acute hospital system. The group which carried out the review held discussions with the management of all acute hospitals and met with Barringtons and St. John's in June and again in August of 1987. At these meetings it was pointed out to both hospitals that there was an apparent surplus of beds in the Mid-Western Health Board area as a whole. The health board had permanently closed a number of beds in its hospitals but it was clear that further rationalisation was still required.

The review group indicated to the management of both St. John's and Barringtons hospitals and to the management of the Mid-Western Health Board that the voluntary hospital sector in Limerick would need to be rationalised on to one site with about 100 beds. Both hospitals later put forward detailed submissions as to why each of them should be the hospital to be retained. It was very significant that neither submission suggested that both hospitals should be retained and it seemed that the logic of the situation was accepted by both hospitals.

I want to remind Senator Kennedy that he would seem to be ignoring these developments. When the Minister first invited Barringtons and St. John's for discussion, which was long before October, it was clear to both sides that one or other of the two hospitals would eventually be closed. The option, therefore, was given to both sides to submit, in a substantive way, their views as to the future developments of either hospital.

In deciding which hospital should be retained I had careful regard to the outcome of the meetings with the Mid-Western Health Board and management of St. John's and Barringtons Hospitals. In addition, I obtained an architectural report on the suitability of both hospitals as to their future participation in the public hospital health service in the area. All of the evidence from the outcome of these meetings and the architectural aspects pointed towards the retention of St. John's rather than Barringtons. Having carefully examined all of the evidence before me, I decided that St. John's Hospital should be the site on which the voluntary hospital services in Limerick should be located.

There are a number of reasons for this. First, St. John's has a more spacious site. Secondly, the building of St. John's is in better condition due mainly to the fact that £500,000 was spent on improving the fabric of the building in 1986. Thirdly, St. John's is more readily adaptable to the changing emphasis in the practice of acute medicine. For example, it has a unit which is extremely suitable for day hospital services containing, as it does, an endoscopy room, two five-bed rooms and an area for the theatre. There has been a considerable shift in emphasis recently from traditional in-patient care to treatment on a day basis. Fourthly, the mechanical and electrical services are superior to those in Barringtons Hospital.

I might add that I arrived at my decision purely on the basis of the physical facilities and the management cooperation of the two bodies concerned. Since I announced my decision I have been accused of inconsistency in view of the statement I made in the Dáil that there should not be any further hospital closures other than those which had already been announced or were in the process of being closed. I would like to make it clear again that detailed discussions regarding the future role of the two voluntary hospitals in Limerick have been in progress since June 1987. Therefore, as the process which led to my decision had been under way for a number of months, in full consultation with the managements of the hospitals concerned, there is no conflict whatsoever between my statement in the Dáil and my subsequent announcement about Barringtons Hospital.

Since I announced my decision many people have expressed great concern about the effect the closure will have on hospital services in Limerick. First of all, I want to point out that at the start of 1987 acute hospital services in the Mid-Western Health Board were being delivered from nine different locations, five of which were in Limerick city. Clearly this was not a sound basis on which to build an efficient hospital system and while subsequent bed closure by the health board reduced the number of locations to seven it was clear that further rationalisation was required. It is more economical to effect these closures in one hospital rather than having them spread over a number of centres.

Some fears have also been expressed that the casualty service in Limerick will be adversely affected as a result of the closure of Barringtons Hospital. The position is that in a city the size of Limerick we simply cannot afford to have two 24-hour casualty services available seven days a week. Indeed, it is worth mentioning that a place like Tallaght, which has a population of roughly the same as Limerick, does not have a casualty service of its own and that in Dublin as a whole there are only two hospitals in the accident and emergency rota after 5 p.m. It is clear that a significant proportion of the casualty cases which attend at Barringtons Hospital are of a minor nature and should properly be dealt with by general practitioners. Moreover the number attending at night time is relatively low, about 14 per night.

The closure of Barringtons Hospital will require some improvements to be carried out in the accident and emergency departments at Limerick regional and St. John's hospitals and plans for this work are already well under way. A casualty service will be available in St. John's Hospital and considering that it is only 400 yards from Barringtons Hospital the new location will not present any difficulties. This service will operate on a day time basis from 8 a.m. to 8 p.m., since, as I have already said, it is simply not viable to maintain two 24-hour casualty units within a few miles of each other. This change will not present any difficulties since the number attending at Barringtons Hospital outside these hours is quite small. As already announced, it is the Government's intention that the in-patient facilities will transfer to St. John's and the regional hospitals, as appropriate, by 31 March 1988.

In summary, the logic of the situation is that one of the two voluntary hospitals in Limerick has to close. This was an extremely difficult decision for me to make but in the end I am satisfied that I made the right one. I am also satisfied that, with the necessary improvements at Limerick regional and St. John's, the two hospitals will provide a very adequate general hospital service for the people of Limerick.

Mr. Kennedy

First, I wish to thank the Minister of State, who, like myself, is a member of the Mid-Western Health Board, for coming in to read the Minister's speech this evening. I certainly believe a bad decision has been made and that there is no real basis, medical, economic or social, for the closure of Barringtons Hospital.

Seanad Éireann díospóireacht -
Wednesday, 3 Feb 1988