Dáil Éireann - Volume 372 - 21 May, 1987

Adjournment Debate. - Royal City of Dublin Hospital.

Mr. Quinn: I should like to express my appreciation of the decision of the Ceann Comhairle to allow me to raise this important matter. It is not the only hospital threatened with closure and, therefore, I am not saying that special consideration should be given to it. However, I want to highlight its specific problems, which can be averted if the Government exercise sensible, sane and rational decision-making, in marked contrast to the panic and chaos they have introduced to the operation of our health services since coming into office so recently.

The hospital was founded in 1832, it is 155 years old. It has 193 beds and approximately 350 staff. Last year it catered for 6,252 patients, with an average stay in hospital of 7.8 days. Between all the other services and procedures, including out-patients, casualty visits, X-ray examinations and physiotherapy attendance, approximately 90,000 transactions of one kind or another — 89,646 to be precise — took place in this hospital.

It is one of the seven federated voluntary hospitals which, under the FitzGerald plan and the revised plan of the Department of Health, was to be finally located with the current hospital services it provides in St. James's. That proposal was meant to come into operation in 1989 and it is now unclear if it will because of the effective 18 per cent reduction in this year's allocation. No one knows what the impact will be on the hospital as a result and what will be its future.

The purpose in my raising this on the Adjournment — I hope the the Minister of State will respond in a like spirit — is to see, in the panic and chaos surrounding the health services, if some secure rational programme for the future of the hospital can be negotiated directly [2832] between the people involved in the RCDH, the Minister and the Department of Health. It is important to stress this fact as these negotiations are on a one-to-one level between the hospital and the Department of Health precisely because it is a voluntary hospital. Any suggestions that this is a matter for the Eastern Health Board or members of the health board to try to take hard and difficult decisions do not apply in this instance. Neither can the Minister close the hospital as it is a voluntary one. It is the function and responsibility of the trustees to make that decision. They do not wish to close the hospital and it is not their intention to do so but, without an adequate level of funding — I am realistic about the funding they are seeking — they will have no option but to close it. The Department cannot legally force its closure but it can be starved into submission.

The closure of the hospital would be a mistake. The 1989 plan was part of an overall package that presumed in the first instance that St. James's Hospital would be in a position to accommodate and provide all the services currently provided by Sir Patrick Duns, Mercers and Baggot Street. That is not now the case. The timetable in St. James's is out of line and it will not be in a position to meet the projected delivery of services in 1989. From the very outset, the plan for 1989 is redundant or off course.

The trustees of the hospital, the board, the staff directly involved and the broader community which saw the closure of Mercers and Sir Patrick Duns and who were partly reassured that on the closure of Sir Patrick Duns many of the facilities for the community would henceforth be carried out by the Royal Hospital, Baggot Street, are now extremely worried about the imminent possibility of closure because of the substantial reduction in the money allocation from the Department of Health.

The provision of hospital services — as I am standing beside Deputy Barry Desmond and facing the Minister of State at the Department of Health I will not attempt to offer expert advice although [2833] much has been written in relation to them — the cost of primary hospitals with acute beds and the back-up of expensive personnel and equipment must be used in the most efficient way possible.

There is a clear role for a secondary hospital, like the hospital in Baggot Street, to provide back-up facilities and to take patients out of the acute expensive beds who did not need to be there in the first place and who are preventing acutely ill patients from getting the kind of medical treatment they require. The area desperately needs the retention of this kind of local community hospital. It covers Dublin 2, 4 and 6 and, because of the writings of a journalist who hails from the west but has chosen to live in Dublin, the connotation Dublin 4 has a very salubrious image which suggests considerable affluence. The reality is that many of the population in the catchment area of this hospital are not affluent. The area stretches all the way from the Iveagh Hostel to Ailesbury Road and there are large sections of inner city communities on very low incomes, with low skills and of an age that is twice the average of the old age level of Dublin city and county. The average percentage population across the city and county of people over 65 years of age and, therefore, more prone to need the services of a hospital and to be hospitalised is approximately 8.5 per cent. The percentage of the population in the area which I described, out of a total of 200,000 approximately, is 16.9 per cent, double the county average for the city and more than the overall city average itself.

We are talking about a population who use the hospital on a local basis, who need its services and who are statistically more likely to need them than other sections of the community. In addition — our statistics in this country are not as developed as they could and should be — it is clear that lower income groups have a higher incidence of certain kinds of illnesses and that lower income inner city groups have a particular combination of illnesses, many of them of a respiratory nature, because of pollution. Any TD who conducts a clinic for that kind of [2834] population will confirm that this is so and I am sure you, a Leas-Cheann Comhairle, will agree.

We are talking about a community that needs a hospital as an absolute necessity and not as a luxury. Having seen the way that Sir Patrick Duns Hospital was closed with a promise that the services would ultimately be in St. James's and on an interim basis in the Royal Hospital in Baggot Street, people are now looking at the reality of the commitment to provide services which was properly and responsibly given by the former Minister for Health. It is not now capable of being honoured because the Department of Health have chosen to effectively reduce, in real terms, the allocation for 1987 by 25 per cent as against that for 1986.

I sought to raise this matter by way of an Adjournment debate because I want to do something constructive in regard to this hospital and because I want to suggest a constructive course of action to the Minister of State at the Department of Health. He does not need to get any more barraging than he is already getting and I do not believe in indulging in the negative opportunistic politics of the kind Fianna Fáil indulged in when in Opposition. Regrettably for themselves but much more unfortunately for the community at large, they are reaping a very bitter harvest now that they have assumed Government — perhaps, under false promises.

Something can be done about this hospital but it can only be done by the Minister. This is the awesome responsibility of the power which the Government sought so hungrily in January and February of this year. Assuming that the Minister has the will to act I suggest that the way to proceed has been outlined in a most informative and detailed document which is both properly referenced and researched and prepared by the board of the Royal Hospital. The title of that document is “A New Future” and I understand it has been made available to the Department of Health and that a preliminary meeting has already taken place between both sides. I have been [2835] informed that a further meeting is due to take place.

Since I sought to raise this matter by way of an Adjournment debate I presume the Minister of State has been briefed by his officials. If the Minister of State is not in a position today to do so, perhaps he could come back at a more convenient time to give me an assurance on behalf of my constituents who depend on this facility, who through no fault of their own happen to have low incomes, and live in a polluted part of the city and who consequently happen to be more unhealthy than someone who is better fed and better housed. The people I am concerned with this evening need the continued existence of this hospital. I am asking that the new programme for survival and for the casting of future for the Royal Hospital be met sympathetically by the Minister and his Department officials.

As I have said, the Royal Hospital is 155 years old. It has seen many changes and many medical systems. It has come through economic recessions and depressions. Its staff have provided an excellent health service and have an extremely good internal and industrial relations record. They have the will and the commitment to provide a service which, when we look at the comparative figures for other hospitals within the broad framework of the health services, is more economical and efficient and which therefore delivers the better value for money service to which the Minister for Health referred in his speech before I rose to speak on this debate. The hospital is good value for money for the Department of Health and the taxpayer and is an essential lifeline for the community of the area. If the Minister responds to my request, it will mean also that the 350 staff will get an indication and some assurance of what the level of their job security is.

It is because the Government have created an air of panic, crisis and chaos that perhaps more fears and anxiety than was necessary have been aroused. Therefore, by giving a confirmation of allocation the [2836] Minister of State can make a positive contribution to allaying the fears of not only those involved in the delivery of the health services in the hospital but also to the many general practitioners who use this hospital to service the needs of their patients. I have already given the facts and figures.

There is another and most important dimension to this argument. It is one which the Minister of State himself will share with me because I think I know something about his attitude to social politics in this country. There is some class of obscenity stalking this land in 1987 when we can have the opening of super de luxe hospitals for the rich in places like the Blackrock Clinic and the new Mater Clinic which from the day they were conceived in the minds of the hungry and greedy consultants who financed them were never once thought or envisaged to be open to the sick and the poor. They never featured in that kind of consideration. We are living in a time when those hospitals are seen to thrive at the expense of voluntary hospitals such as this one. These voluntary hospitals have built up a record and a reputation of dedication and service to the poorest sections of our community.

Is this really The Better Way we saw on every boarding and every poster from here to Roscommon? If this is the better way, is it the kind of society we are trying to create in the last 13 years of the 20th century? I do not for one moment think the Minister of State feels that this is a better way — I know he does not. I would put it to him that the board of the Royal Hospital, a hospital that has through 155 years been responsible for the delivery of medical services, have found a better way, have documented a better way, have costed a better way and are now seeking to have the Minister of State and the Department of Health implement it.

In conclusion, it is the unique responsibility of the Department of Health because of the legal structure of this hospital and its one-to-one relationship as a voluntary hospital with the Department of Health. If the Minister wants to, he can do it. The figures set out in the [2837] tables that have been presented to the Department of Health fall within the realm of the reality which confronts him and his colleagues in Government. What is needed now is a rapid response so as to reassure those who work in the hospital, those patients and the population who depend on the hospital, that this hospital can survive in the new future which has been put forward by the trustees for the Minister's consideration.

Minister of State at the Department of Health (Mr. Leyden): I am glad Deputy Quinn has raised this matter as there appears to be some misunderstanding concerning the overall plan for the development of general hospital services in Dublin. The hospital rationalisation plan was drawn up as a response to the growing concern that the haphazard development of the hospital system could no longer continue and that an overall planning framework should be devised to ensure the delivery of an efficient and effective service at the most modern standards available. Many of the existing hospitals, because of their age and condition and because of thier location, will not be in a position to respond to the needs of the total population for modern acute hospital facilities. The underlying rationale behind the programme is that a lesser number of larger sized well equipped modern hospitals located in the major population centres is preferable, more efficient and better able to respond to the needs of all the population than a proliferation of small hospitals.

Deputies will be aware that the general hospital rationalisation plan for south Dublin provides for the development of three major acute hospitals, i.e. St. Vincent's, St. James's and Tallaght hospitals. The State is investing considerable resources in this development programme and I am satisfied that this network of major acute hospitals will be more than adequate to meet the needs of the total population of Dublin both in the inner city and suburban areas.

In relation to the particular hospital referred to by Deputy Quinn, a major capital development is currently being [2838] carried out in St. James's Hospital which is intended to cater for a population of approximately 200,000 from the south central areas of Dublin city and county along with the northern portion of County Kildare. Services at present provided by Baggot Street and Dr. Steeven's Hospitals, other than orthopaedics, will be incorporated into St. James's Hospital. To date the development of St. James's has cost £31.8 million. The major phase of this project will be completed in 1989 when the hospital will have over 800 acute beds. The developed St. James's Hospital will have approximately 1,200 beds and the projected cost is put at £100 million.

I am aware that Baggot Street Hospital submitted proposals to my predecessor on continuing as a community hospital after cardiology etc. have transferred to St. James's Hospital. Some discussions took place between my Department and the hospital on this proposal and the original proposals have been elaborated on. These talks will be resumed in the context of the review already announced by the Minister. However, I feel I should remind Deputies that the intention of the rationalisation plan for acute services in Dublin was, and is, to provide effective services in an efficient and rational fashion. More than ever we must be aware of the cost implications of the decisions which we make on services. The service and financial strategy underpinning the development of St. James's Hospital has had as a basic assumption the eventual closure of Baggot Street Hospital and Dr. Steeven's Hospital. The retention of Baggot Street Hospital in any role changes these assumptions and additional resources would have to be found to fund it.

Obviously the nature and extent of hospital services in south Dublin will be examined as a matter of urgency as the Minister announced on Tuesday evening and the future of Baggot Street Hospital will be examined in that context. I would like to say to the House that I do not intend to discuss the roles of individual acute hospitals until such time as the review has been completed. This whole [2839] process should be completed by the end of July.

The Deputy should be aware, as a member of the previous Government, of the position regarding this hospital. I presume he supported the policy pursued by his ministerial and party colleague, Deputy Desmond. We shall be looking at Baggot Street Hospital with St. James's Hospital and Dr. Steeven's Hospital. This will have a very high priority in our consultations. Every effort will be made to ensure that all those involved, including the staff, will have a very clear picture as soon as possible of what is going to [2840] happen in the short and long term. The proposals which have been put before the Department by the board of Baggot Street Hospital are being very thoroughly considered. They do, however, raise major issues about the future shape of hospital services on the south side of Dublin. At this stage I should like to await the result of the consideration of the review before any further statement can be made.

The Dáil adjourned at 5.25 p.m. until 2.30 p.m. on Wednesday, 27 May 1987.