By order of the House the following time limits apply: each Senator will have no more than 15 minutes and the duration of the debate will be two hours.
Adelaide (Dublin) Hospital: Motion.
I move:
That Seanad Éireann compliments the Minister for Health on the categorical and positive assurances he has given to the Adelaide Hospital with regard to the continuation of its distinctive traditions and ethos in the new hospital at Tallaght and is confident that the excellent standards of patient care currently delivered at the Adelaide Hospital, the Meath Hospital and the National Children's Hospital, Harcourt Street will be maintained and strengthened when the transfer to the new Tallaght Hospital takes place.
I welcome the firm assurances, indeed reassurances, the Minister has given in this matter. As the motion states, categorical and positive assurances were given to the Adelaide Hospital with regard to the continuation of its distinctive traditions and ethos in the new hospital at Tallaght. I welcome those assurances. I welcome the fact that this motion has been put forward by all my colleagues on the Government side. I also welcome the initiative taken by Senators Norris and Ross in relation to the matter.
There has been considerable anxiety, understandable anxiety, in relation to this matter. The Tallaght hospital has been promised for a long time. There are those who imagined that the hospital would never come into existence or would never be built. We have reached the state of, hopefully, going to tender this summer. In a few years this hospital will actively provide the services currently provided by the Adelaide Hospital, the Meath Hospital, the National Children's Hospital and, indeed, some of the services provided by Dr. Steeven's Hospital.
It has been generally agreed for a long time, indeed, by the board of the Adelaide Hospital and by other parties concerned, that there should be a new hospital in Tallaght and that the nucleus of that hospital should be the Adelaide and Meath hospitals.
Nonetheless, it is understandable, now that we have reached the point of going to tender and the start of construction in a short space of time, that anxieties should arise. Many assurances have been given in the past regarding the very proud traditions of ethos which we associate with the Adelaide Hospital. I welcome this debate as a Senator, as chairman of the Tallaght Hospital Board, as a medical person, as someone who had relations treated in the Adelaide Hospital and as someone who has long had respect for and association with that hospital and the magnificent traditions it embodies. It is proper that we should have an opportunity to specifically reaffirm those assurances.
I have spoken of the tradition of the Adelaide Hospital and I would like to expand on that because these are truly great traditions. The history of the Adelaide Hospital was written and published recently by Professor David Mitchell. It is a fascinating story, a story not only of the hospital itself but, indeed, of medical life in Dublin over the past 150 years and in Ireland as a whole over that period. It was a brilliantly written and fascinating book. Those who are interested in the details of either the Adelaide Hospital, Dublin medicine, or Dublin over the last century, should look through this book.
I was a student of Professor Mitchell's when I was studying in the College of Surgeons. He was professor of pharmacology there. He was an excellent teacher, a first-class physician and a marvellous colleague. Indeed, he and his wife, who was also a doctor, embody in many ways in their persons the great traditions of the Adelaide.
The Adelaide Hospital was founded by Dr. Albert Walsh and, understandably, it creates a lot of emotion. The history of its founding is quite extraordinary. The idea was conceived by Dr. Walsh when he was a medical student. He pursued that idea after he qualified and at the age of 26 instituted the hospital itself. He continued his association with it. He was a senior surgeon at that hospital for 38 years and consulting surgeon for a further three years before his death. He founded the hospital in Bride Street, close to the Liberties. Subsequently, the hospital was transferred to Peter Street. He specifically founded the hospital in relation to the Protestant community and there was no apology about that. Indeed, reference was made to the excellent tradition of the Catholic community in the foundation of hospitals in Dublin.
Let us not misunderstand this in any way. A hospital for the exclusive use of Protestants would be quite an inaccurate rendering of Dr. Walsh's intentions and this was written a long time ago by Cameron in relation to Dublin medicine. Immediate assistance and treatment was given to all patients of whatever denomination. That was the basis on which he founded it but, nonetheless, relating it specifically, and rightly so, to the Protestant community.
Today, as is stated in the foreword to the story of the Adelaide Hospital — I am indebted to Mr. Bill Beasley, consultant surgeon at the Adelaide for a copy of this book — William Trevor rightly says "today it is a hospital for everyone". It has an astonishing tradition in many ways in that, in instituting itself and in its development down through the years, it has shown that it is capable and effective in bringing in many of the advances in Dublin medicine that we now take for granted. For example, it introduced the first psychiatric clinics. More than 130 years ago it introduced the first dermatology clinic. It introduced the first gynaecological clinics in general teaching hospitals. It introduced the first lady almoner, the first proper social services related to teaching hospitals. Recently, it introduced in Dublin the first intensive care unit. This was due to the initiatives of the health care people, the doctors, surgeons, nurses and people associated with the Adelaide, backed up by enormous support from the community and from the Adelaide Society. They often provided the finance for these innovations, including the introduction recently of the first intensive care unit. This is a tremendous tradition and the support of the community for the Adelaide Hospital is something which gives cause for great and deserved admiration and respect. Long may it continue.
The hospital, of course, has a tremendous tradition in relation to the individuals associated with it. Some of the outstanding figures in Dublin medicine, and international medicine, have been associated with the Adelaide Hospital. People such as Mayne who is outstanding in his field on the Irish and indeed the international scene. People in the present day such as Birkett, one of the outstanding medical scientists of the present era. The standard of care there, as those who ever had anything to do with it know is exceptionally high.
A particular part of this high standard relates to the nursing school. Again, a magnificient achievement. The Adelaide Hospital is a relatively small hospital, under 200 beds but the nursing school is certainly one of the best, not only in this country but internationally and is recognised as such. I am pleased that the Minister and prevous Ministers have given categorical reassurances that this tradition will be maintained in the Tallaght Hospital and that a number of places in the nursing school — I believe it will be 45 places — will be reserved for nurses who follow the tradition established in the Adelaide Hospital. It is only right and proper that that should be so.
Links between the Protestant community and the Adelaide Hospital are extremely deep and long-standing and they have continued to the present day. I must say the hospital board have taken appropriate steps to ensure that this is a hospital for everyone, that it preserves these traditions and this ethos. It is the sort of tradition and ethos we can rightly be very proud of, a pluralist tradition, not a sectarian one. We should be very glad that we have this and we are very glad we have this magnificent tradition. Indeed, one of the great things about the new Tallaght Hospital is that it will have the privilege of having as a fundamental of the hospital the ethos and tradition of the Adelaide Hospital.
May I use part of the time remaining to me to refer to the great traditions of the other hospitals involved, the Meath Hospital, over 200 years a hospital and the National Children's Hospital, the first children's hospital in Europe and, or course, the great traditions of Dr. Steeven's Hospital.
I am delighted the motion is on the Order Paper and I welcome the Minister's assurances. As it happens, ten years ago when I was in the Seanad the Adelaide Hospital took a step to affirm its commitment to the pluralist ethic while in no sense departing from its own ethos. Almost ten years ago to the day on 16 June 1980 an order in draft was placed before Seanad Eireann—Senator Honan was also present—entitled, the Adelaide Hospital Charter Amendment Order, 1980 and I had the privilege of moving that order. I concluded with the following words and I would like to finish up with them again today. I said:
the Adelaide Hospital has a very great and deserved reputation in this city and, indeed, abroad. We are privileged to have in Dublin the calibre of the consultants, the resident staff, the nurses, the students and the many people associated with the Adelaide Hospital, and not least the community concerned.
Indeed, the involvement of the Adelaide, the Meath and the National Children's Hospital, its association with the Trinity Medical School, and, indeed, the Royal College of Surgeons of Ireland is well known. I am delighted to see this affirmation. It is good to have it specifically stated in the House.
May I begin by welcoming my constituency colleague, the Minister, Deputy O'Hanlon, to the House. I want to say at the outset that I believe this debate has extremely important implications. First, it has implications for medicine and medical practice here. Secondly, it has implications for how the Protestant community will see themselves and view their own identity in a Southern Ireland State. Thirdly, it has implications for how Northern Protestants will see us and our State. For that reason, I submit that in direct contrast to some of the recent speeches in this House this is about one of the most important debates of the session.
I would like first to address the question of medicine, medical practice and the position of the Adelaide Hospital. The Adelaide Hospital has a distinct ethos. It has, as Senator Conroy pointed out, a 150 year history of serving the needs of an entire community of all classes, creeds and religious outlook and of providing comprehensive medical care. It prides itself in the special and confidential relationship that exists between the patient and the doctor.
I want to knock one erroneous concept in the popular mind that I know nobody in the House would share but it is thought outside of the House. There is no question of abortions being performed in the Adelaide Hospital. There is no question of illegal practices there. The Adelaide Hospital does perform — it is important that this goes on the record of the House — female sterilisations and male vasectomies. It is the last Protestant teaching hospital in this country. It is worth remembering that the Federated Hospitals, Dr. Steeven's, Sir Patrick Dun's and Mercer's Hospital, have now gone out of existence.
It has been stated that an agreement existed between the Meath and Adelaide Hospitals to merge in 1980. The history to date is that the Adelaide Hospital set out its position to the then Minister in 1979. They agreed to be involved in the planning of Tallaght Hospital and they did not agree beyond that. The final decision about the Adelaide Hospital going there and happily taking part in the Tallaght Hospital, which my party are anxious to see under way and believe is a great social and medical necessity, could only be taken when its management received guarantees in respect of the preservation of the nursing school, the ownership and management of the hospital, and the whole ethical question.
It is worth putting on the record of the House — it is well known to many Members — that an agreement exists, and properly so, between the Department of Health and the Roman Catholic Hierarchy giving status to the Roman Catholic code of ethics in Catholic voluntary hospitals. The Roman Catholic code stands in those hospitals. What is at issue here is the desire on the part of people in the Adelaide Hospital to maintain a respected and honoured tradition of medical practice. They would argue, and correctly so, I submit, that a token 40 places, without any further commitments, are not adequate in the new nursing school. That is not acceptable on its own.
What is required, and I think it is a reasonable requirement, by the people in the Adelaide Hospital, is that the Minister — I am now asking him to do this — enter into negotiations with them as a prelude to establishing the kind of safeguards that they want in the Tallaght Hospital. It is not acceptable that we say that it is up to the Meath Hospital, the National Children's Hospital and the Adelaide Hospital to work this one out themselves. Because of their medical tradition and their minority status as a religious group, the people in the Adelaide Hospital have to be given the kind of assurances they are looking for. They have to be negotiated with in private and in a prolonged and reasoned fashion. That process should start after today.
It is also worth putting on the record of the House that by statute the much adversely criticised Stormont Parliament — we have all had occasion to criticise it — gave a special position to the Mater Hospital in Belfast. A Roman Catholic code of ethics, Roman Catholic medical practice and so on are facilitated in the Mater Hospital in Belfast, and that is how it should be. The issues the Adelaide Hospital are concerned with specifically are, who will constitute the board, how will the board be appointed and how will members be removed? Were we to accept this motion in its present form we could accept the bona fides of the Minister but there is no guarantee that if the Minister was bone fides in his position that future Ministers would be. It is reasonable for the Adelaide Hospital not to accept verbal guarantees. It is also reasonable for people in the Adelaide Hospital not to accept structures that do not ensure a continuation of their medical ethos. It is reasonable for people in the Adelaide Hospital not to accept a situation in which they cannot be guaranteed that their ethics and medical practices will be maintained.
I know many very reasonable Members will say that of course they will not thwart the traditions of the Adelaide Hospital, that a reasonable board will not attempt to infringe on their special code of ethics and that no civilised society would do that. That is platitudinous. There must be structures, negotiations and assurances. I made the point at the outset, and it is a very important point, that this debate is critical, firstly, to medical practice. As the first speaker outlined there is a tremendous medical tradition associated with this hospital. The minority community were at the forefront of the development here of hospitals and of medical science. There is a great and noble tradition to be maintained there. I also made the point that this debate and the outcome of it, and the attitude adopted by the House, will be central and critical as to how the Protestant community in the Republic will view themselves. That is the key issue. If it gives them a "ghettoised" mentality, if it gives them any sense that we are operating a form of apartheid, whatever our motivations, then it has dreadful implications for the evolution of our society. If it has those dreadful implications for the evolution of Southern society, it must have serious implications for the evolution of Northern society and the relationship between North and South. I am not loosely, or rhetorically, or in any other sense, making those points. I very sincerely believe those things.
I come, as the Minister does, from a Border county. We have a very mixed community in my county and, whether it is justified or not, some members of those communities feel threatened by these kinds of situations. I believe that there are many decent people who sincerely believe that without structures, without guarantees and without commitments all will be well but that is not an acceptable position to offer our minority community. I am submitting to the House that the motion is defective in its present form in that it makes a statement of commitment to the maintenance of the ethos but it outlines no specific structures, no specific administrative codes, no specific guarantees and no process of negotiation that will ensure them. That is very important.
I also believe that we would be the very first people — I would like to think I would be one of the first — who would, if a similar situation was pertaining in Northern Ireland, to shout about it, and we would be right to shout about it. This pertains in our own city. We should bear in mind that we will at the end of the day have the six super hospitals in Dublin. We must specifically maintain the Protestant ethos in that hospital which has been acceptable to many Roman Catholics and many people of no denomination. The majority of the medical staff and patients over the years have often been Roman Catholics. That is an important point to make. If we do not give assurances, if we do not set up structures, if we do not act with cautious prudence, with benevolence — and it is not so much benevolence as doing what is proper and right — then we will have six hospitals in Dublin and not one of them will the Protestant community, whatever our perception might be, in the eyes of certain liberal members of the Roman Catholic community, and in the eyes of many nondenominational people, completely identify with. That has grave implications.
The last thing I would say on this is that if we are not giving the assurances, if we are not giving the positive discrimination, the structures, the administrative network to facilitate what I have just spoken about, then the question arises, are we prepared to provide an alternative for those people? In the light of present financial circumstances that is unlikely. If we do not give the guarantees we are left with no option but to provide the alternatives for these people. This is an important debate and I hope it is a reasoned one. Many people outside the House will watch with great interest what is done here today.
Mr. Farrell
I support this motion. Indeed, I would like to congratulate the Minister who has come here to take this motion, on the assurances he has given to the Adelaide Hospital already. He is the one Minister who has never gone back on any of his commitments. That was very obvious at the Association of Health Boards Conference, of which I am chairman, which was held in Tramore recently. There was high praise for the way the Minister stood over his decisions and whatever he said he would do he ensured that those things were done.
The Minister has given very strong assurances to the Adelaide Hospital. It was the Minister who, first of all, made 40 places available for trainee nurses of the Protestant religion in the Adelaide Hospital, and he has assured them that that is going to continue. The Minister also placed the matron of the Adelaide Hospital on An Bord Altranais to ensure again that their ethos would be represented there when decisions would be made. Those are deeds; and by deeds all men are judged, we are told. The Minister has done all those things.
I am amazed that any emotive language should enter into this. I have been involved in the Association of Health Boards for 17 years and I have never seen religion, North or South, entering into treatment of patients. I have often said that if everybody was like the medical profession we would have no problems North or South, because the medical profession, North and South, think first of patient care. They think of their patient and the consultations between the patient and the doctor. I would like to pay high tribute to our medical professionals for the very high standard they maintain.
In 1973 the MANCH group was set up, comprising the Meath, the Adelaide and the National Children's Hospital. That group has worked very successfully. I would see the Tallaght Hospital as a continuation of that, but on a much bigger and broader scale. We all know that in Tallaght there is a population of 100,000, which is equal to that of Limerick city. They certainly require a full, proper hospital with all the services of a large general hospital.
In years gone by small hospitals did a great job. I would pay tribute to the many people like those who founded the Adelaide Hospital 100 years ago before modern technology and before State assistance. I think you will all agree that hospitals were really glorified nursing homes in those days. It is only in the last 40 or 50 years that we have started to develop hospitals in a big way. We had only infirmaries in every town and all they catered for really were operations like appendicitis — the first big operation I remember was taking out an appendix — and it is only since then that our hospitals have specialised in the various categories. Now it is high technology, where we can transplant hearts and livers and lungs and do things that were unheard of in years gone by. We all know that those type of operations cannot be performed in a small hospital. We can only do them in a very big hospital that has all the backup services. No one would deny the fact that Tallaght, with 100,000 of a population, needs a hospital of that standard.
The Adelaide is guaranteed that their ethos will be maintained. I believe that management arrangements should ensure that the best traditions of the three hospitals — the Adelaide, the Meath and the National Children's Hospital — are preserved. This can be done. We have a corporate body arrangement which has been tested and proved in the case of Beaumont Hospital and St. James's Hospital, the two most recent examples of where hospitals have been brought together on one site. We all agree they are working very successfully and giving a very good service. I am pleased that Michael McLoon from my own health board is now the CO of that hospital and is doing a very good job. It should also work in the case of Tallaght. It is flexible enough to provide——
The Chair would like to point out that it is not desirable that names of individuals should be put on the record, even in a complimentary way.
Mr. Farrell
Sorry.
Or canvassing, Senator.
Mr. Farrell
I was not canvassing. He is not a politician. It is flexible enough to provide for the general concerns of the three hospitals and at the same time guarantees the necessary level of public accountability. That is an important consideration when one considers the massive amount of public moneys involved.
We must have that in any big hospital today. It is a very big problem.
Why is it not possible for the hospitals to get together, as has been done in the case of Cork? Their two hospitals have come together recently. They have put forward a management agreement to the Minister, he has accepted that and things are working out very well in that hospital. I would appeal to the management of the three hospitals to come out of the public arena and sit down around the table with the Minister, because in the final analysis that is where the problem has to be solved. I think you will all agree with that. I believe that if they sit down with the Minister they will find out that he will be more than forthcoming in facilitating them and ensuring that the ethos which they very much desire to have, and which all of us would like to see them have, will be maintained.
On "Morning Ireland" someone said that sterilisation was available in the Adelaide Hospital. I would like to point out that those operations are available now in most hospitals in Ireland. It is not just the Adelaide. In case people would think that other hospitals are not performing all those services, they are. It is no longer something that is particular to one hospital. I believe that the great doctor-patient care that has been maintained in the three hospitals down the years can continue and be continued in the new Tallaght Hospital, which we all know is so much needed in an area the size of Tallaght.
I believe all professionals will find it a much better environment, with much better facilities to work out there. I am fully convinced that, if they come together, talk with the Minister and put forward what they believe are the right proposals, our Minister will sit down and talk with them. The new hospital in Tallaght can be a great success, and the ethos of the Adelaide, so much talked about, can be preserved and maintained within that hospital.
Like Senator Farrell, I will be very brief. It is appropriate on a motion like this to take the opportunity of thanking the board of the Adelaide hospital, the medical and nursing staff, for the treatment they have given to many thousands of people who have attended both as in-patients and out-patients down the years. It is appropriate also to say that we are privileged to have in Dublin, and in the Adelaide in particular, consultants and resident staff of the calibre we have experienced down through the years. The people in the immediate area, who are predominantly Catholic, have been using that hospital for many years; so much so that there is, to some extent, looking at it the other way round, a bit of a hang-up there. It is very hard to get them to go to the Meath or somewhere else because they are in that particular catchment area. That is where they brought their children when they fell and bled, where they knew they would get wonderful care and treatment. Their faith was in that particular hospital.
One thing that disturbs me is this. It is a sad thing to stand up in any debate to say that we have Catholic and Protestant hospitals, or even to say that we have Catholic and Protestant schools. Yet that is the situation. In putting down an amendment we note what is in the Minister's motion. It might seem at first glance that the amendment is negative, but it is a positive one. What we want is the Minister to guarantee that the full range of services the Adelaide now offers will be available in the new Tallaght Hospital. We owe that to the minority community of this country, and they deserve that. The worry is that we would suddenly see a situation where the board is set up and, without any warning, something happens and they find restrictions are imposed on their medical practitioners and on the nursing staff, in particular on the options that are available to the patients. That is very important. Nothing should suddenly happen like that. That is why we need to hear a guarantee from the Minister.
The motion is not explicit in the sense of a guarantee of morals and ethics. I say that particularly so that people in our own community who are not Roman Catholics will continue to have a hospital they can trust. That might sound terrible, but I do not make any apologies for it. People are used to certain services in a hospital, particularly if they are in a minority community, and if there is the slightest threat of those services being taken from them they are entitled to say that they do not trust the new situation. They must have continuing trust in the hospital.
No matter how much we debate the North of Ireland in this House or in any other public forum, matters like this will have much effect on the people in the North. We could do a lot of talking about the North of Ireland, but if suddenly the Adelaide Hospital will pass out of Protestant control, that would be a very serious matter for the minority community. It would be very serious for the people in the North. People might think I am dramatising, but I feel that the Adelaide Hospital passing out of Protestant control might have a very serious effect on other traditions, both here and in the North.
If we are talking about a pluralist society we will have to be realistic and open about it. Somewhere, somehow, we will have to say openly and clearly that the full services will be available, that the minority patients' relationship with their consultants will still be preserved, no matter what happens on the amalgamation with the Tallaght Hospital. That is the real concern and that is why we have this amendment down.
Some people have the attitude that when the taxpayers are paying the price they can call the tune. Let us look at that. They are paying the price for a lot of things, but it does not mean that, when the mood takes you, you can impose anything you like on the taxpayer. That is not the way it works. We subsidise students, people who go to university, but we cannot impose something on them and say that is the way it is going to be. There is a very serious concern here and we should not try to escape from it.
Before I sit down I would like to quote from The Irish Times of 21 May 1990, which says:
"The Board of the Adelaide and, increasingly, members of the minority Churches and people who do not accept the teachings of the Catholic Church on medical matters are concerned that the new board should not be forced to comply with Catholic medical ethics which fall outside medical ethics under the law of the land. We want to be sure that people of our tradition——"
—— that is the Protestant people ——
"and many who think like us would not be denied medical procedures that are lawful and would be in accordance with their requirement," said one Church of Ireland clergyman.
That is the worry. If we want to talk about being a pluralist society we have to be open, above board and say to them — not in a vague way — that is the way you operate at the moment, that is your right and you will have that right after the amalgamation. Let us put it in layman's language.
I, too, would like to thank the Minister for coming here this afternoon. I support the motion because I feel it is very important that the assurances the Minister has given, in particular in relation to the Adelaide Hospital, are put on the record of the House. As has been evidenced by the reaction from all sides, there is great concern that the distinctive tradition and ethos of this hospital be maintained. We all know of the excellent reputation the hospital has enjoyed both as a teaching hospital and in its unique contribution to medicine in Ireland. There is also no doubt that when the transfer to the Tallaght Hospital eventually occurs we can confidently expect that the level of medical care will attain the high standards we have come to expect from not only the Adelaide but from the Meath and the National Children's Hospital.
That being said, we must ensure that we protect what can only be described as the Protestant ethos of the Adelaide Hospital. This manifests itself, as we know, in the special relationship between the patient and doctor. The decisions are taken on medical grounds without Catholic teaching being brought to bear through the ethics committees, it just cannot be subject to the separate ethos of Catholic ethical groups. The Adelaide Hospital is a very important symbol for Protestants, both North and South, because it was founded through the Protestant Churches and holds a very special place because of that in our society. We who concern ourselves with minority rights in Northern Ireland should be aware of the sensitivities of people who are in a minority in this part of the country and who, therefore, deserve to have their rights protected. It is doubly important, because it is a symbol to the majority community in Northern Ireland, and we must show respect to that symbol as evidence of our commitment to a pluralist society in, what I aspire to, a United Ireland, so that we can respect the different traditions.
In the Republic we have, justifiably, in the past criticised the alienation and discrimination against the Catholic Nationalist minority and we have a unique opportunity now to show that we, too, can be sensitive to the minority in this part of the country. We know that many eyes in Northern Ireland are focused on us in relation to this matter, even to the extent that John Taylor, MEP, has asked that the issue be raised at the Anglo-Irish Conference. I know from discussions with people in the North that they are very sceptical about our commitment to the acceptance of the Northern Ireland Unionist Protestant tradition. It is only by our actions we will be judged, because it would be illogical to make the argument that we will respect their separate traditions while at the same time being seen to engulf the traditions of the minority in the Republic.
It is not just because other eyes are focused on us that we should respect and protect the separate Protestant ethos, which is such an integral part of the Adelaide Hospital tradition; we should have the maturity to accept it because it is the right thing to do. When issues like this arise we are given the opportunity to question our own commitment and to realise that, if we aspire to unity of this country, we will have to make choices. I think that the Minister, in giving us the assurance we and others have asked for, is signifying that we do have that maturity to respect different traditions in the country. In mentioning John Taylor's concern about this, I refer to his desire to have it taken up at the Anglo-Irish Conference. It is ironic that this is the first of two separate issues which Northern Ireland unionists have sought to bring before the conference in recent times. This also has its own separate significance, which should not be lost on us.
Finally, I agree that there is a role for the Minister in negotiating what might be called acceptable terms relating to places allocated in the nursing school. I am confident that, were he to undertake that, all sides would be satisfied.
I move amendment No. 1:
To delete all words after "Seanad Éireann" and substitute the following:
"urges the Minister for Health to give a categorical assurance that in the reorganisation of the Dublin Hospital situation and the eventual absorption of the Adelaide Hospital into the new hospital in Tallaght the different ethical approach embodied in that hospital's tradition will not be overwhelmed by the dominant ethos of the Catholic ethical committees."
I would like to welcome the Minister to the House. It is important that the Minister for Health should be here, and I would like to thank Senator Conroy for his very gracious account of the traditions of the Adelaide Hospital.
I do not believe that the categorical assurances, of which we have heard so much today, have been given. I invite the Minister to lay before the House the papers in the matter so that Members of the House can see what exchange of letters exists between the Adelaide Hospital board and the Minister, because this will be an important advance in allowing us to understand the situation. I believe this could be done. I would like also to suggest that perhaps the Minister could give an indication that he will speedily arrange a meeting between himself and the board of the Adelaide Hospital to see if an accommodation can be made which will meet the particular sensitivities of the Adelaide Hospital.
This situation goes back for quite a long way; it goes back to the 1950s and the Federation Act of 1961, when the various hospitals, particularly the Trinity Teaching Hospital, agreed to federate with a view to forming a joint voluntary hospital. St. James's Hospital was produced, a very fine hospital, but the amalgamation was not sufficient to accommodate the Adelaide and Dr. Steeven's Hospital and the National Children's Hospital in Harcourt Street. That situation remained as it was over a period until about 1979, when the Adelaide Hospital indicated once more its interest in this situation.
In 1987, the Minister, according to the reports I have, apparently intervened in an attempt at revising the composition of the Central Council of the Federation of Dublin Voluntary Hospitals. This was resisted on grounds of legality, particularly under the grounds of section 7, paragraph 12, of the Act, which says, that the Minister "at any time before the transfer day may, at the request of the council and with the consent of the boards of all the participating hospitals, by order vary the composition of the council and any such order may modify the foregoing subsections of this section". There was not prior consultation.
This was resisted by the Adelaide board and, subsequently the figures show very clearly that there was a very substantial drop in the allocations to the Adelaide. If you look at the figures for 1988-1990 and the percentage change in those years, the Meath Hospital changed from £9.8 million to £11.2 million, which was a change of 31 per cent positive; Portiuncula, 5.1 to 6.5, 27 per cent positive; St. James's, 34.3 to 41.8, 22 per cent; Beaumont also 22 per cent; the Mater, 23 per cent; Crumlin, 21 per cent; St. Vincent's, 21 per cent; Temple Street, 12 per cent; and then the Adelaide from 6.4 to 7.1, which was a third of the Meath at 11 per cent. That had particular results. It meant that the hospital was not able to keep all of its beds open. It was not able to function properly as a teaching hospital and considerable concern was voiced in the board of management report signed by D. Ross Hinds, the vice-chairman and honorary secretary, where he says:
The year 1989 was one of continuous concern for the financing of the Hospital. This was intensified by the refusal of the Minister for Health to make any financial allocation to the Hospital until half way through the year. During this period the Minister tried to pressurise the Board into handing over control of the Hospital to another body. The result was that 30 beds remained closed for the whole year, 40 beds were closed for a substantial period, and for a number of weeks, no patients requiring elective work could be admitted
This lies behind the concern of Mr. Hinds, reported in The Irish Times of 29 June 1989, where he expresses concern about “the Minister reassuring us about our traditions, then giving us less money”. This is a significant and important point to bear in mind with regard to the actual situation, because there has been a negotiating situation and there is no question of doubt whatever the record will show that the Adelaide Hospital board has been placed under the most effective pressure, and that is financial pressure.
I would like to turn now to the question of ethos because it is very important. I am very honoured that people should have spoken so flatteringly of the hospital and its tradition. It is important to understand what this ethos actually is and to seperate it from ethics. I quote from a sermon at the Adelaide Hospital Service in Birr, given by the Rev. Kenneth Kearan, Dean of Residence in Trinity College, Dublin, in May 1990, where he says:
The Adelaide tradition has always been to preserve this right to free and responsible choice as part of affirming the integrity of each person by upholding as normative the free decision of each patient and their medical adviser. The Adelaide ethos has not been to enshrine the thinking of any one church in its ethical code, but to respect the plurality of ethical opinion that exists in Irish society, by emphasising that in the final analysis the decision about any particular treatment or technique must be made by the patient according to his or her own beliefs and traditions.
He continues on to say:
The Adelaide doesn't enshrine Protestant ethics. It stands against enshrining any denominational tradition in its practices.
That is the cardinal and crucial point. I would not be able to stand over a sectarian hospital system, but I do stand for an ethical system that accommodates the individual.
I would like to have the time to speak in the same glowing terms about the other hospitals and, in particular, hospitals like St. Vincent's Hospital, where my late uncle, who was a distinguished Anglican clergyman, died in the care of the Sisters there and the love and attention they gave to him was very moving. However, this is a separate kind of hospital; and in the code of ethics from St. Vincent's Hospital we find item No. 7 which says:
Procedures which are judged immoral according to the teaching of the Catholic Church may not take place in any circumstances in a facility under our care. The contract of employment for all staff includes adherence and respect for the ethical code of the facility in this regard.
This is plainly the intervention of religious ideas into the medical area, of which Senator Farrell was so puzzlingly ignorant. I am not complaining at all about that. In fact, I would say from my discussions with the members of the Adelaide Hospital that they have repeatedly said to me that the hospitals with which they feel in closest sympathy are hospitals like St. Vincent's who come from the same pastoral, caring tradition. But the distinction is clear — the existence in the Adelaide Hospital of a tradition in which the relationship between the patient and the doctor is of a very special kind indeed and that medical procedures are decided upon entirely as a result of that relationship and that there is no referral to a committee of ethics which is either Protestant or Catholic. That is what seems to me to be a very important point.
Because, as a result of this point, it is perfectly clear to me that whereas the Roman Catholic point of view, the Roman Catholic ethos, can be perfectly comfortably accommodated within what is known as the Protestant ethos, it is quite impossible for the Protestant ethos to be accommodated at all within what is known as the Catholic ethical code. This has been made plain time and time again in issue after issue in this country, where the bishops of the Roman Catholic Church have made it clear that they adhere to an absolute moral law which extends to cover all citizens whether they are or they are not members of the Roman Catholic Church. I say this not to be controversial but to indicate why it is so vitally important that the dissenting community, the Protestant community, or the non-Roman Catholic community here, should be reassured on this occasion in a way that they have signally failed to be reassured in every major political controversy over the last 20 years. They have been listened to and then ignored.
I say this because it is very important to realise the level within the Churches from which this concern is being expressed. If, as the Government's motion which reverses the intention of my original motion states that we have to compliment the Minister on the categorical assurances given, I have to ask why it is that as late as April 1989 and as late as the Synod of the spring of 1990, the two archbishops have been expressing concern? If the assurances which the Minister states are categorical have not satisfied the archbishops and the leaders of the other Protestant Churches, why is this the case? We really require an answer.
The Archbishop of Dublin has indicated additional reasons for the Adelaide Hospital being important. He said in an editorial in the Church Review:
It is essential that the Adelaide in whatever future development may await it should not lose its distinctive ethos, nor its Nursing School which is world renowned. The Adelaide has had a long and intimate association with the Church of Ireland. There is hardly a parish in the Church of Ireland in the whole country that cannot claim at some time a nurse trained in its Nursing School, a patient who has been cared for in its homely, friendly wards. The future of the Adelaide is a concern to us all and may require our voices to be heard loudly, clearly and publicly.
I would like to quote also from the sermon of Archbishop Caird of 7 May 1989. He said:
What is essential is that the Adelaide must be allowed to remain as a distinct institution, a teaching hospital with a distinguished staff, a world-famous nursing school, and that it must continue to be given the opportunity to contribute from its own peculiar ethos expressing its own genius to the care of the sick in Dublin, and to the advancement of all branches of medical science.
I know that the board of the Adelaide, its staff, friends and supporters wait anxiously for an indication from the Department of Health and the Minister that the Adelaide will be allowed to continue the work which it has done so effectively, openly and with caring, into the future, either here in Peter Street... or else in Tallaght.
Why, I have to ask, is the Archbishop waiting patiently and anxiously? I may say anxiety in the Roman Catholic Hierarchy will be taken properly and very seriously indeed.
I must ask why is the anxiety expressed so consistently over the last several years by the leaders of my Church apparently regarded as having been so easily but so unsatisfactorily and unconvincingly assuaged? At the general Synod, the Primate of All-Ireland, the most Reverend Dr. Eames gave a short account of a meeting with the Taoiseach, Deputy Haughey. He said:
These efforts have been received with much sympathy by the Taoiseach. However we await definite decisions which would indicate what the Government sees as the future for the ethos and the contribution of the Adelaide to the health care of this community. Let me say quite clearly that this issue goes far beyond the immediate practical needs of a hospital which has for so long served the people of Dublin. How this question is dealt with will have an important bearing on how many view the role of the minority in the Republic and how far those outside the Republic will see the question of pluralism in the days to come in Ireland as a whole.
That effectively answers one argument.
Why should the three hospitals not meet together and come to a solution? That is unrealistic. To use a much hackneyed phrase, they are not on a level playing field. There is a substantial difference, with the greatest of respect to the honourable traditions of the Meath Hospital and the National Children's Hospital. They are two small Dublin hospitals. Many other hospitals have been absorbed or obliterated in a rationalisation process. The Adelaide Hospital is clearly a national institution of the most considerable importance, not only to the Protestant community of the South, not only to the rest of the community who wish to have access to certain procedures and so on, but also — this is what places it on the national level of significance — in the context of the situation with regard to the Northern community and developments there. I would like to say also that it is important to realise that in a situation where these signals are coming so clearly from the entire community and its leaders, it is necessary to listen with special sensitivity to them because as the old adage goes, if the shoe pinches, you do not ask the shoe, you ask the foot whether it is being pinched and what it feels like. The foot in this instance has very clearly signalled to the Minister that it has been pinched and that it feels that it is being pinched. It is simply no use whatever asking the shoe whether this is the case or not because the shoe will not be in a position to give a satisfactory or intelligent answer.
I ask the Minister to answer some of the questions I have raised. I would like in particular to add another one as I end this very important debate which I am very glad took place here and that is whether or not it would be possible for him to invite the Adelaide Hospital board to take a prominent, crucial role in the establishment of the new hospital at Tallaght? That is basically what the people that I have the honour to represent have been asking — a crucial determining role in the board because this is not an ordinary hospital, this is the last independent hospital with the Protestant ethos.
I must advise the Senator his time is up.
May I finish this thought and then sit down? It would be an act of courage and initiative but a necessary one, one that would be appreciated, and one which I believe the Minister and the Taoiseach, Deputy Haughey, who has taken such a personal interest in this himself, would be well advised to make.
Acting Chairman
Is the amendment seconded?
It is.
It is important in this debate this afternoon that we note the wording of the motion which states the Minister has given positive assurances to the Adelaide Hospital. All of us should be concerned this afternoon about every hospital in the nation. The Adelaide Hospital, to me, is equally as important as any other hospital. Senator Norris made reference to the special care provided in the Adelaide Hospital but I would argue special care is provided in every hospital in this country of ours. It worries me deeply that in talking about sick people and families with illness that once again we single out Protestant and Catholic. I freeze when I listen to this type of debate. I had the honour to be present in this House ten years ago — I am lucky to be still here and I hope to be here in ten years' time — when we debated an order introduced by a previous Minister. We are aware of the fact that this hospital as well as its nursing school has made a very special contribution to public health care in the Republic. Reservations and worries have been expressed and these should be allayed.
The Minister, Deputy O'Hanlon, has time and again demonstrated, in a very practical way, his commitment to preserve and protect the Adelaide tradition. He has publicly assured the hospital that his commitment to provide 40 places for student nurses will be honoured. He has protected the interests of the Adelaide by ensuring that the common selection procedure for student nurses will not be foisted on them. He has also appointed a matron of the Adelaide to An Bord Altranais. At another time a former leader of my party and I am referring here to the chief, the late Éamon de Valera, gave special concessions to the Meath Hospital. I am sure the Minister, Deputy O'Hanlon, will do likewise in the case of the Adelaide Hospital.
Tallaght was chosen as the site because of the projected population figures for the area. The intention, since the seventies, has been to relocate the Adelaide Hospital, the Meath Hospital and the National Children's Hospital in Tallaght Hospital. The three hospitals have been represented on the Tallaght Hospital board since 1980 and as such will be fully involved in determining the nature and size of the new hospital. Earlier today the question of when the people in charge of the Adelaide Hospital, and the members of the board would be consulted was raised. It is important to point out that the Minister has been in constant contact with them.
Not true.
When the Victoria Hospital in Cork, the only Protestant hospital in that city, was amalgamated with the Infirmary the ethos of the Victoria Hospital was protected in the articles of association. The management arrangements should ensure that the best traditions of the three hospitals, the Adelaide, the Meath and the National Children's Hospital, are preserved, which I understand will be the case. I get deeply worried when I hear claims that the ethos of the Adelaide Hospital will not be preserved in the new larger hospital because as I understand it their rights will be upheld.
Senator O'Reilly asked when talks would commence on the relocation of the Adelaide in Tallaght. I understand that discussions on that question with the Minister and senior officials of the Department of Health have been ongoing for some time. The Department of Health and indeed the Minister do not get mad when they see me coming. I have been of help to them, even though we have also met head on. The Minister, Deputy O'Hanlon, is anxious to ensure that the ethos of the Adelaide Hospital will be protected. The Minister for Social Welfare, Deputy Woods, in his address to this House on 22 October 1980 stated that he felt the good work performed over the years in treating many thousands of people would continue when the services of the Adelaide Hospital were transferred to the new hospital to be built in Tallaght and that representatives of the Adelaide board would be included on the new board when appointed by the Minister. I understand the Minister is to have discussions with the Adelaide board about the appointment of their representatives to the new board.
I have spoken to a former distinguished Senator of this House, whom I have the highest respect for, Catherine McGuinness, a personal friend of mine. Her request to us, in discussing this delicate matter, is that we be most careful not to make any comment or statement, which, though intended for the best of reasons, might harm the Adelaide Hospital, in negotiating the transfer to the new bigger hospital. It is important that I quote the former Senator Catherine McGuinness who is of the religious persuasion associated with the Adelaide Hospital. If there is one request I would make here this evening, it is that we stop giving the impression that only Protestant patients go to the Adelaide. It is my understanding that there is a far greater throughput of Catholic patients there than Protestants. Even Senator Harte, who knows the hospital far better than I do, being a long serving Senator and Dubliner, has paid tribute to the staff of the Adelaide. In paying tribute to them we should remember that we are only talking of a transfer of the hospital to the new complex. Surely the attitude we should adopt this evening is one of support for the Minister and the Government who have decided to build a bigger hospital with between 450 and 600 beds. Nobody on this side of the House or in Government has any intention of taking any power from the persons who serve the Adelaide Hospital and in saying that I would emphasise the need for us to be very careful.
Reference was made to John Taylor, MEP. It would be wrong for someone in the political field to take high ground for maybe the wrong reasons and use the future of the Adelaide Hospital as the subject but let me quickly point out that I am not saying John Taylor did not do so for the right reasons. Being a former Cathaoirleach, I know the rules and am aware that I should not make reference to him because he is not here to defend himself. We all need to be careful.
This is said to be a delicate subject but I do not think it as delicate as it might have been in the past. Senator Norris said in his contribution that both the Taoiseach and the Minister are anxious to reassure the board and the people who are concerned about the Adelaide Hospital that the service will be continued as required. That is what they are asking for. I can assure Senator Norris, as I am sure the Minister will — it is not often I give the Senator assurances——
They are always welcome.
——that both the Taoiseach and the Minister as are concerned about the future of the Adelaide as is anyone in this House.
I support the amendment. At the outset I ask the Minister for Health to outline the categorical and positive assurances he has given the Adelaide Hospital as regards the continuation, in the new hospital in Tallaght, in its distinctive traditions and ethos and to indicate when he gave those assurances. Was it today, last week or last year?
Senator Conroy gave an excellent and extremely informative account of the history of the Adelaide and paid tribute to it for the tremendous advances it has made in medicine. It is my understanding that the Adelaide Hospital has had a turbulent history since its foundation in 1839 and that it has had to make continuous efforts to preserve its Protestant ethos. It has had to labour continuously to retain something which should be given to it automatically if we believe in democracy, pluralism and rights for minorities. It is a pity that the question posed today is whether democracy extends to the minority within medicine. At the recent Church of Ireland Synod, speakers paid tribute to the State which is committed to democracy within education and the preservation of the Protestant ethos.
It is my understanding that there is no resistence within the Adelaide Hospital to the proposed merger with Tallaght Hospital, first proposed in 1979. Agreement was reached with several Ministers for Health and the board of the Adelaide Hospital agreed in principle to move to Tallaght on condition that its Protestant ethos would be safeguarded. In 1984, it was agreed that 40 places would be reserved in the nursing training schools to ensure that preservation of the ethos.
It should be remembered that the Meath Hospital and the National Children's Hospital in Harcourt Street will also be transferred. In 1951, when the voluntary board for the Meath Hospital was set up we witnessed another interesting intervention. One can understand the concern shown by the Adelaide Hospital because they spent 12 long years trying to put through an amendment to remove all restrictions on persons, other than Protestants from holding positions or entering as patients etc. Is it now going to take another 12 years to complete the formalities or are we going to witness on ongoing battle between the Minister for Health and his Department and the board of the Adelaide Hospital and the boards of the other hospitals involved, the Meath Hospital and the National Children's Hospital at a time when all our energies should be devoted to the efficient running of health services? That sadly has not been the case since the introduction of the health cuts which brings to mind the advertisement: "Health cuts hurt the poor, the old, and the sick". We in Limerick are still reeling over the demise of Barrington's Hospital. I hope the same road will not have to be trod by the Adelaide Hospital in seeking to preserve their position.
Excellent relations exist between the members of the boards of the three hospitals despite the use of some divisive tactics. The cutbacks put the Adelaide Hospital in a very difficult position financially and it was feared it might have to merge with the Meath Hospital. However, agreement was reached and debts to the value of £900,000 were paid. None of these matters has been mentioned today. There is little difference in the number of beds at both the Adelaide and Meath Hospitals. At present there are 230 beds in the Meath Hospital while there are 180 in the Adelaide. If the Adelaide is to be merged successfully with Tallaght we need more than categorical and positive assurances. What they want, and this should be discussed, is a majority based representation inclusive of the Adelaide and National Children's Hospital which is also liberal in its outlook and which, like the Adelaide, values its independence. The chairman of the board of the Adelaide has stated there has to be a significant representation from the National Children's Hospital on the board. Pressure will mount from the Eastern Health Board to retain majority representation but it must be remembered the hospital has patients coming from the four corners of Ireland, and 85 per cent of the patients are not Protestant but, as Senator Honan pointed out, Catholic, which is interesting. This begs the question of why do so many Catholic patients wish to go to the Adelaide Hospital. Obviously, the patient-doctor relationship must be the attraction. If we are serious about seeking a pluralist society to which I am sure we all ascribe we would grant them the representation they are seeking.
Senator O'Reilly referred to the need to defend the rights of minorities, not just within the Twenty-Six Counties but on the island as a whole. Whether we like it or not it will be difficult to hammer out an agreement between the three boards and because of this the Minister might think in terms of appointing an independent arbitrator or ombudsman to resolve the problem and, instead of giving categorical and positive assurances — words that I do not like very much — to define clearly the structures he has in mind. As I said, perhaps the best course of action would be to appoint an independent arbitrator or ombudsman. I ask the Minister to define very clearly what the role of the Adelaide will be in the new Tallaght Hospital. A statement will not be sufficient.
I will end by quoting the chairman of the board who said "Our medical care is based on the premise that it should be available and accessible to all."
I emphasise once again the very special relationship between doctor and patient which is in keeping with the spirit of the Hippocratic oath. I look forward to hearing what the Minister has to say. He has been asked to provide very specific details today, not categorical assurances. May I share some of my time with Senator Avril Doyle?
Acting Chairman
At present, five Senators are offering. I have to call on the Minister in 15 minutes. May I suggest that we give three minutes to each Senator? Is that agreed? Agreed.
This is an ongoing problem, going back to 1976. At that time there was broad agreement during the term of office of the Minister of the day, the former Deputy Corish, that there be three hospitals on the north side and three on the south side. I make this point because there seems to be a perception that this is a new problem. Since 1980 since agreement was reached to build a major acute hospital at Tallaght to replace the three hospitals — the Meath, the Adelaide and the National Children's Hospital in Harcourt Street — events have moved quickly. They have made an excellent contribution to the medical welfare of the citizens not just of Dublin but of Ireland over a long period of time. Many of my best friends have been patients in the Meath and Adelaide hospitals where they found the quality of patient care and the staff to be excellent.
During the past ten years the three hospitals have been active in the planning of the new hospital in Tallaght which will involve massive State investment in both construction and running costs. It was never suggested that one of these hospitals should stand alone. The plan has always been for all three to be merged into one hospital unit. The Minister for Health, Deputy O'Hanlon has inherited this plan. It appears that this problem had only arisen now as the date for the commencement of construction comes nearer. These three hospitals have been represented on the Tallaght Hospital board since 1980. As such, they have been fully involved in determining the nature and size of the new hospital to be built at Tallaght. There was no question of coercion in 1980 when the Tallaght hospital board was established. Neither is there any question of coercion now: the three hospitals are involved in the planning of the new hospital by their own choice. It is not as if they were coming together for the first time. They are what are known as the MANCH Hospitals — the Meath, the Adelaide and the National Children's. There is, if you like, a federation there. It is nothing new that they should be in a joint situation.
I fully understand and appreciate the concern of the Adelaide Hospital but, knowing the Minister, Deputy O'Hanlon as I do, I can certainly assure the board of the Adelaide that their distinctive traditions and ethos in the new hospital will be continued. There is a precedence for this in Cork. We have the South Infirmary which has its Catholic ethos; we have the Victoria, which has its Protestant traditions. Both agreed to come together and recognise each others traditions and their ethos.
There is some concern that procedures at present being carried out in the Adelaide may not be permitted in Tallaght in the area of sterlisation and — vasectomy. This is not the case. The management arrangements for Tallaght can guarantee that gynaecological and obstetrical procedures as practised can be continued. Going back to the Cork situation, when the Victoria Hospital in Cork, which was the only Protestant hospital in the city, amalgamated with the South Infirmary, the practices of the Victoria Hospital were protected in the articles of association. That arrangement followed discussions with the parties and was sanctioned by the present Minister for Health. It has worked very well. There is no reason why such an arrangement cannot work and prevail in this situation.
I have a feeling that the Minister is in some way being portrayed by the media as somewhat insensitive to the special concerns of the Adelaide. I would totally dispute this. Time and again, he has demonstrated in very practical ways how committed he is to preserving and protecting the Adelaide tradition. He has publicly assured the hospital that the commitment to provide 40 places for student nurses from the Adelaide tradition will be honoured. He protected the interests of the Adelaide by ensuring that the common selection procedure for student nurses was not being foisted on them. He appointed a Matron of the Adelaide Hospital to the nursing board.
The future management arrangements of the Tallaght Hospital should present no problems. The management arrangements should ensure that the best traditions of the three hospitals, the Adelaide, the Meath, and the National Children's are preserved. That system has worked well and has been proven in the case of Beaumont and St. James's. It should certainly work in the case of Tallaght. It is flexible enough to provide for the general concern of the three hospitals while at the same time guaranteeing the necessary level of public accountability.
I referred to the massive amount of public moneys involved. Why is it not possible for the hospitals to get together, as they did in Cork, and put forward agreed management arrangements to the Minister? I would urge all three to come together, prepare their management proposals, meet the Minister and put those proposals to him. There should be no worries there.
I have no doubt that the Minister for Health will ensure that all that is best in the great traditions of all three hospitals will not be lost but greatly improved in the one-hospital situation at Tallaght.
As time is very short I shall try not to repeat comments which were made from this side of the House. I support the comments made in this House to ensure the continuation of the ethos of the Adelaide Hospital which is under discussion this evening and the maintenance of their traditions in the new hospital in Tallaght. I endorse all that has been said about the splendid work done by the medical school, the nursing school but, above all, the service the Adelaide Hospital has given to the inner city community of all denominations, and that must be stressed.
I also would like to say how important it is that Tallaght, with a population of 100,000 people, should have a hospital. It is long overdue. It is scandalous that there have been so many people living there for so long with very poor facilities.
I also understand the arguments put forward that modern technological advances, the need for highly expensive equipment, etc. require that there should be an amalgamation of hospitals. I do not argue with that. I understand the need to centralise some of this highly expensive acute equipment. I also hear a lot of talk about community medicine, but there is more talk about that than actual commitment to it. Going back on the history of hospitals, I think St. Vincent's Hospital was the first that left St. Stephen's Green. Sir Patrick Dun's and Baggot Street hospitals, which were in my area, closed down while I was a public representative. I can think of very few happenings that have caused such distress in the locality as the closure of those two hospitals. It is relevant to what we are saying today. It is fair to say that individual hospitals have distinctive personalities. They have a distinct relationship with their patients. It is not only the Adelaide Hospital who have this problem. It may be a different type of hospital but it is part of a large problem. Jervis Street Hospital and the Richmond went out to the new Beaumont Hospital. There were severe problems out there with the board. It is right that the Adelaide, the Meath and the National Children's Hospital get things sorted out and that they do not have problems once they are out there and difficulties start to emerge. I am not at all in favour of the present hospital situation. I understand that the Eye and Ear Hospital is going to close down soon. What is the future of Temple Street Hospital?
I recognise that the buildings in the Adelaide Hospital are from the nineteenth century. I understand the need for these hospitals to amalgamate but I would like to make one new point which has not been brought up here; was it not possible for these three hospitals to amalgamate where they are, where they can continue to give the service which they have been giving so splendidly for 250 years, as was outlined so beautifully by Senator Conroy? There is space there.
There are huge sites around them, including the Jacobs site. I see no reason why that could not have been done. The Government has put enlightened emphasis on the need for urban renewal policies. There are the designated areas. This is having a splendid effect. We are trying to encourage people back into the city and at the same time the Department of Health, the Department of Education and everything else going out of the city.
In conclusion, as my time is up, it does not seem to be beyond the Minister's considerable powers to meet with the board and to get this matter thrashed out. It is difficult for us to know here whether the assurances being given are adequate or not. A reasonable outcome can be brought about if the Adelaide Hospital get the sort of representation on the board which they feel they need to safeguard their ethos in the new hospital.
To be given three minutes to contribute to this type of debate is an insult. My interest in this is both national and, I must admit, parochial, representing as I do on Dublin County Council the Stillorgan area where St. Bridget's and St. Laurence's parishes — I will let you figure which is Roman Catholic and which is Protestant — work together in harmony and peace and can do so. I was asked by many of my Protestant constituents to come in here and to actually attack the Minister or at least to berate him for closing the Adelaide Hospital. Fortunately I did a little research before coming in here, and I think it is worth a few facts before I put some questions to the Minister.
The Adelaide Society, which a High Court charter founded and appointed, was to maintain the fundamental principle for which the Adelaide Hospital was established, namely, that the society should be and remain an essentially religious Protestant institution. They have managed to do this even though at the present time the majority of their consultants are Roman Catholic, the majority of their patients are Roman Catholic and, indeed. Mass is held there on Sundays for Roman Cathoics. However, as Senator Jackman is talking about democracy, it is also worth mentioning that the only institution in Ireland where religious affiliation is still regarded as an entry requirement is the Adelaide school of nursing which normally admits Protestant students only. In 1984, the then Minister for Health, Deputy Barry Desmond, agreed that that should be maintained. The Minister here, who has been attacked and perhaps berated in some ways, should in fact be lauded for his attitude towards the Adelaide Hospital. One of the first steps he took when he came to office was to agree to maintain that 40 places for the Protestant students. Secondly, when An Bord Altranais, under the 1984 Nurses Act, were going to set up their own central bureau for trainee nurses selection, he asked them to rescind that decision. Those two actions can hardly be the actions of a man who is opposed to the ethos of the Adelaide. Thirdly, when a situation became vacant on An Bord Altranais, he appointed the Matron of the Adelaide.
Fig leaves.
Ignore him.
I am sorry — a squeak from the background. When the Adelaide got into financial difficulties, who did they go to for money? They went to the Minister. Did he let them down? No, he did not. The Adelaide need not have any fears that the Minister will not given them guarantees that will help them maintain their ethos when they move to Tallaght. This move was agreed by the Adelaide many, many years ago.
They have two options as far as I can see. One thing we do not want is another Beaumont, a white elephant sitting there for four or five years and nobody in it. The Adelaide can remain where they are and retain their ethos or move to Tallaght and accept the Minister's guarantees. I am sure, the best minds of the Minister, of the Department of Health and of the representatives or the Adelaide can work it out in a peaceful and harmonious fashion and ensure that the Protestant ethos is maintained as the Adelaide requires.
Ever conscious of the sensitivities of this issue and the need for all of us, both in this House and outside indeed to be non-combative and unprovocative in anything we say, also with the minorities in the Republic, in the North of Ireland and indeed in the UK watching how this issue is handled, we must urge the Minister to accept the amendment to the motion. It is not combative. It just asks the Minister to give a categorical assurance. The Minister and his colleagues say he has given that assurance. We are asking him to reiterate a categorical assurance. Please, accept our motion. I do not want us to vote and split on this if at all possible today because, when all is said and done, we are all together and in step on this. I urge the Government side to consider the non-combative wording of the amendment and perhaps we could agree on this in the best interests of the Adelaide Hospital, which I think we all have at heart.
I will say two sentences to the Minister and I am conscious of his political background when I say this. Let us recall to mind the words of the Proclamation. Let us remind ourselves of the spirit of a true Republic and what the world really means. Let us, for goodness sake, be in a position to cherish all the children of our nation equally. Let us, above all else, be in a position to guard and protect the interests of minorities, so that no group of any description or denomination feels threatened in our society. Having said that, I ask the Minister for an assurance on the record of this House that in the articles of association of the new hospital in Tallaght the ethos, the ethics, and the excellent nursing and medical traditions of the Adelaide Hospital will be protected in the articles of association and in any management arrangements. That is all we are asking, and that is all the Adelaide Hospital is asking.
The vast majority of patients in the Adelaide Hospital are Catholic. It does not matter what is their religious persuasion. They have gone to that hospital because of the ethos and the ethics and because of the treatment they will expect to get there. It is in all our interests that we protect the very special nature of the ethos of the Adelaide. I urge the Minister to put on record confirmation that the articles of association and the management arrangements will protect what we are asking the Minister to protect today. Above all else, in the spirit of a true Republic with the eyes of minorities in the South, in the North and in the UK watching how we handle this, let us move together and support the Minister as he from now on makes the efforts we have requested of him here today.
I am very glad that the Seanad has given me an opportunity to speak on the question of the future role of the Adelaide Hospital in the management of the new hospital at Tallaght. Indeed, I would like to thank all the Senators who contributed for what has been a very constructive debate. I do not think there has been any great divergence between the Senators who spoke in relation to what we want to achieve and I might come back to that later. However, there is, I believe, a high level of misinformation, misunderstanding and misrepresentation on the issue and I am happy to be able to clarify matters.
I am concerned that some people are led to believe that the Adelaide Hospital, which is providing an important acute hospital service at its present location, is suddenly, without warning, being coerced into joining with two totally strange hospitals and being moved to Tallaght. Nothing could be further from the truth. No one is being coerced. What is happening was ongoing long before I became Minister in 1987, as has been outlined by many of the Senators here.
As Senators will be aware, we have embarked in this country over the past 15 years on a major development programme in our general hospital system. This has culminated in the up-grading of many hospitals and the building of a number of major new hospitals throughout the country. As far back as 1968 the Fitzgerald report outlined how acute hospital services should develop in Dublin.
In designing the future plan for hospital services particular attention was paid to the movement of the population in the urban and suburban areas of Dublin. As Senators will be aware, this has shown a gravitation towards the suburbs and a marked decline in the inner city areas. Consequently, the needs of the new expanding suburbs had to be catered for.
The plan that emerged provided for six major hospitals for the greater Dublin area — three on the northside, Beaumont Hospital, the Mater Hospital and Blanchardstown Hospital and three on the southside, St. James's Hospital, St. Vincent's Hospital and the new hospital at Tallaght. The plan also provided for the relocation of services of a number of older hospitals to enable the new developments to come on stream.
The rationalisation process has been taking place throughout the eighties. Successive Governments have deemed it both necessary and appropriate to press ahead with the programme in the interests of improving the quality of patient care and, in the process, eliminating avoidable management and maintenance overheads.
Mercer's Hospital was the first of the city hospitals to transfer its services to St. James's in 1984. In 1986, Sir Patrick Dun's also transferred to St. James's. In 1987, the Richmond and St. Laurence's transferred to the new hospital at Beaumont. In the same year the services of Dr. Steevan's Hospital and the acute services of Baggot Street hospital were relocated.
An integral part of the original plan was that the Meath, the Adelaide and the National Children's Hospitals would form the nucleus of the new hospital at Tallaght. These hospitals, otherwise known as the MANCH group, have been closely associated since the move to Tallaght was first mooted. All the consultants' contracts in the three hospitals are with a single authority — the Federated Dublin Voluntary Hospitals. This was done to facilitate a smooth transfer of consultant staff to Tallaght.
The Tallaght Hospital Board were established in 1980. The board are responsible for the planning and building of the new hospital. It includes representatives of the three hospitals which will eventually move to Tallaght. The Adelaide Hospital, through its representatives on the board and on its various projects groups, has contributed fully to the planning of the new hospital.
I understand that in planning and architectural terms, the modular design of the new hospital will ensure an efficient working unit, built to high technical standards. In its design, the needs of patients have been kept to the forefront. I am confident that the finished hospital will provide effective patient services of the highest possible standards and I compliment the Adelaide, the Meath and the National Children's Hospitals for their contribution to the development.
As I said at the outset, I am very glad that Senators have raised the issue of the role to be played by the Adelaide Hospital at Tallaght and I am pleased to avail of the opportunity not alone to place on the record of the House my appreciation, and the Government's appreciation, of the distinctive and valuable contribution made by the Adelaide Hospital to Irish medicine but also to reiterate my commitment to ensure that, whatever arrangements are put in place, that they protect the traditions of the Adelaide.
The Adelaide, as an independent voluntary hospital, has a long and distinguished tradition of service to the people of Dublin, as outlined by Senator Conroy. The hospital has played a major role in the lives of Dublin people over the last 150 years. And not just the people of Dublin, but people from throughout the country. Anyone who has been associated with or touched by the hospital thinks not just of a high level of professional medical care but of personal individual care, a care that shows a respect and concern for the patient.
The Adelaide stands high with the many other Dublin hospitals who over the decades gave Dublin its high medical esteem throughout the world, a tradition that has contributed, and still contributes today, to the welfare of our people as a whole. The Adelaide is playing, and has played for the past 150 years, a distinctive role in Irish health care, a role in shaping Irish medicine, a role in caring for the health of Irish people, a role in training past and future generations of nurses and doctors. The Government respect and value the tradition of the Adelaide and are committed to ensuring its continuance.
The Taoiseach has already assured Protestant Church leaders, whom he met in September last, that he is very anxious to have arrangements agreed for the management of the new hospital at Tallaght which will enable the Adelaide and its ethos to continue as an integral part of the public hospital system.
Also, Senators will be aware that I have on many occasions stated publicly my respect for the independence and traditions of all the voluntary hospitals. Despite what Senators may have read in some newspapers, I am acutely aware and particularly sensitive to the concerns of the Adelaide in relation to the preservation of the Protestant tradition in Irish medicine. I fully understand their concern and wish to respond to it in a positive way. Indeed, successive Ministers for Health have acknowledged these concerns. In 1984 my predecessor gave an assurance to the hospital that 40 places would be reserved for student nurses of the "Adelaide" tradition. That assurance still stands as I have publicly stated on many occasions.
The other Dublin hospitals involved in the move to Tallaght are the Meath Hospital and the National Children's Hospital — two distinguished institutions which have also contributed in a very significant way to the development of Irish medicine.
The challenge which faces us in relation to the arrangements for the management of the new Tallaght Hospital, therefore, is to ensure that all that is rich and valuable in the tradition of the three hospitals is not lost but rather nurtured and cherished under the arrangements for a unified management.
The Taoiseach's preference and my preference at this stage is for the establishment of a health corporate body under the 1961 Health Corporate Bodies Act to manage the new hospital. It would provide for appropriate representation from each of the hospitals as well as from the Eastern Health Board. It would be a matter for that body to develop and sustain the culture of the new hospital taking account of the separate traditions of the hospitals involved.
The corporate body approach I am suggesting works very well in the case of Beaumont and St. James's and allows for considerable independence and flexibility while at the same time ensures a satisfactory degree of public accountability, which Senators will no doubt agree is absolutely essential in the light of the very high cost of the project.
In the case of Tallaght it will, I believe, ensure that the traditions and practices which the Adelaide and the other hospitals wish to see protected will be protected. Concern has been expressed that certain medical procedures now practised at the Adelaide would not be available at the new hospital in Tallaght. This is not so and I want to reiterate to this House my categorical assurance on this point and in the ongoing discussions I will consider with the hospital the most appropriate way to allay any fears in this regard.
My priority is to ensure a first class acute hospital service at Tallaght is in place for the people of south-west Dublin. I want to see the Adelaide tradition, which I recognise as very important, maintained at Tallaght and I believe that this can be done and that an acceptable board of management can be established which will accommodate the traditions and rights of the three hospitals.
Within the context of a corporate body approach, I am open to suggestions from the hospitals concerned and will look sympathetically on any agreed management arrangement put forward by the Tallaght partners. As I said, no one is being coerced. The three hospitals have been working together for the past ten years planning their hospital. I am anxious to continue the discussions on the management of the hospital with each hospital and hope to meet them in the near future.
Senator Norris did bring up the question of funding for the Adelaide — the only Senator who did. I think it is appropriate to deal with this because the suggestion has been made that the Adelaide Hospital has been less favourably treated than other hospitals and accusations have been made that funding restrictions have led to a downgrading of the hospital services. I would like once and for all to put these allegations to rest. It should be clear even to the most blinkered critic from the examples I will set out that the rumours and innuendos are unfounded.
Between the years 1987 and 1990 the original allocation for the Adelaide rose from £4.885 million to £7.1 million, an increase of 45 per cent. This occurred in a period when the services provided by voluntary hospitals and, indeed, all health agencies had to be looked at in the context of what the country could afford and in the context of a re-examination of health services generally. Far from any diminution of services in the Adelaide, we can see that the hospital has fared exceptionally well when we compare their allocation, an increase of 45 per cent to an increase of 22 per cent for all comparable voluntary hospitals in the same period. As Senators are aware the Adelaide Hospital is one of the three hospitals due to transfer to Tallaght and the combined original allocations for these three hospitals — the Meath, the Adelaide and the National Children's Hospital — rose by 32 per cent for 1990 over 1987. It is plain to see that the Adelaide hospital has done well.
Again, I want to thank Senators for providing me with an opportunity to reiterate my commitment and that of the Government to ensuring that the Adelaide traditions and practices continue as an integral part of the public hospital system. Indeed, listening to the debate here this afternoon, there is consensus among all Senators on a number of points. There is consensus that there is urgent need for a hospital in Tallaght, in south-west Dublin, to cater for the needs of the 100,000 population in the immediate vicinity and others beyond; there is also a consensus of sensitivity to the particular ethos of the Adelaide Hospital, the recognition of a need to ensure a continuation of the tradition of the Adelaide in Tallaght and an assurance that all the present medical practices in the Adelaide will be protected when the hospitals move to Tallaght. There is also a recognition of the need to respect the rights of the Meath and the National Children's Hospital.
I have an open mind on how we achieve that. As I have already stated, I will have continuing discussions with the hospitals involved in the coming weeks and months to ensure that we get an agreed position that will do what we all want, that is, to respect the rights of the three hospitals and to ensure that the great traditions of the hospitals are protected and maintained in Tallaght. Whatever it takes to do that, I am prepared to it. If it takes legislation in the Houses of the Oireachtas, so be it, we will do that. We want to achieve a first class hospital in Tallaght and to ensure that the rights of the three hospitals and the existing medical practices and great traditions are maintained in Tallaght.
The situation in relation to the Adelaide has been ongoing for ten years; it is not new this year or last year. We are fully committed to honouring all assurances given in the past. We want to ensure that the individual traditions of the three hospitals are preserved. We have already given an assurance that 40 places will be reserved for nurses of the Adelaide tradition and a guarantee that all medical procedures now available at the Adelaide will also be available at Tallaght. Our priority is to build a modern acute hospital in Tallaght which will provide the highest possible patient care for the people of south-west Dublin.
I would like more specific assurances from the Minister regarding what structures will exist, what the corporate body will be——
An Leas-Cathaoirleach
The Minister has replied.
I have no problem with that. As I have stated quite clearly, a corporate body similar to St. James's board or the Beaumont board is what we consider at this time. I have stated very clearly that it will be the subject of ongoing discussion and negotiation with the three hospitals involved. If the three hospitals come up with something, I will be very sympathetic to it. The hospital will not be open for another four years. As Senator Hederman said, quite rightly, what we would like to do is to have agreement in place and not have a Beaumont situation where the hospital was built for four years before it was open. There is nothing hard and fast laid down at this stage. It is the subject of discussion because we want to accommodate the three hospitals that are going to Tallaght.
A final question as a follow-up to that.
An Leas-Chathaoirleach
Sorry. It is 4 o'clock and in accordance with the order of the House I must bring the debate to a conclusion. Is the amendment withdrawn?
I have listened carefully to the Minister and I must say that I am more concerned at the end of the debate as I was at the beginning.
An Leas-Chathaoirleach
Is the amendment withdrawn?
No.
Question put: "That the words proposed to be deleted stand."
The Seanad divided: Tá, 26; Níl, 14.
Tá
- Bennett, Olga.
- Bohan, Eddie.
- Byrne, Sean.
- Cassidy, Donie.
- Conroy, Richard.
- Dardis, John.
- Fallon, Sean.
- Farrell, Willie.
- Finneran, Michael.
- Fitzgerald, Tom.
- Foley, Denis.
- Honan, Tras.
- Hussey, Thomas.
- Keogh, Helen.
- Kiely, Dan.
- Kiely, Rory.
- Lanigan, Michael.
- Lydon, Don.
- McCarthy, Seán.
- McGowan, Paddy.
- McKenna, Tony.
- Mooney, Paschal.
- Mullooly, Brian.
- O'Keeffe, Batt.
- Ryan, Eoin David.
- Wright, G.V.
Níl
- Cosgrave, Liam.
- Doyle, Avril.
- Howard, Michael.
- Jackman, Mary.
- McDonald, Charlie.
- McMahon, Larry.
- Manning, Maurice.
- Neville, Daniel.
- Norris, David.
- Ó Foighil, Pól.
- O'Reilly, Joe.
- Raftery, Tom.
- Staunton, Myles.
- Upton, Pat.
Tellers: Tá, Senators Wright and Fitzgerald; Níl, Senators Norris and Howard.
Question declared carried.
Amendment declared lost.
Motion put and declared carried.
An Leas-Chathaoirleach
When is it proposed to sit again?
It is proposed to sit at 2.30 p.m. on Wednesday, 6 June 1990.