Dáil Éireann - Volume 468 - 03 July, 1996
Health (Amendment) (No. 2) Bill, 1996 [ Seanad ]: Second Stage.
Minister for Health (Mr. Noonan, Limerick East) Michael Noonan
Minister for Health (Mr. Noonan, Limerick East): I move: “That the Bill be now read a Second Time.”
This is a short Bill to amend section 76 of the Health Act, 1970, and to amend the Hospitals Federation and Amalgamation Act, 1961. Section 76 of the Health Act, 1970, allows the Minister for Health by order to amend the charter of a hospital subject to the order in draft form being approved by both Houses of the Oireachtas following consultation with the Commissioners of Charitable Donations and Bequests for Ireland.
The principal reason for bringing forward this Bill is to allow me as Minister for Health to meet the wishes of the three voluntary hospitals who are combining to form the new voluntary hospital at Tallaght. These transferring voluntary hospitals are the Adelaide Hospital, the Meath Hospital, and the National Children's Hospital. I readily agreed to a request from the board of the Adelaide Hospital to amend the charter of the Adelaide Hospital 1921.
I have been requested to amend this charter because the three hospitals have  agreed that the legal basis for the governance of the new hospital at Tallaght will be in the form of an amended charter of the Adelaide Hospital. The hospitals submitted a draft of an agreed text to form the basis of the order amending the Adelaide Charter. However, in consulation with the Office of the Attorney General my Department has been advised that, in order to meet the wishes of the hospitals, certain amendments of a technical legal nature require to be made to both the Health Act, 1970, and to the Hospitals Federation and Amalgamation Act, 1961.
The Hospitals Federation and Amalgamation Act, 1961, created the legislative vehicle for seven voluntary hospitals in Dublin to form themselves into a group or federation. Provision was also made in the Act for eventual amalgamation of the seven hospitals, if they so desired. In practice only the federation provisions came into force. The seven hospitals included the Adelaide, the Meath and the National Children's Hospital who are now coming together to form the new hospital at Tallaght. The executive vehicle created for the federation under the Act was the Central Council of the Federation Dublin Voluntary Hospital. It is now necessary to provide, as is proposed in the Bill, that the provisions of the 1961 Act will not impinge in any way on the functioning of the new hospital at Tallaght.
In 1993, a number of issues relating to the new hospital at Tallaght were agreed by the boards of the three hospitals and approved by the Government. These included agreement on the board structure and other issues. That agreement represented the culmination of a very large amount of difficult work by the three base hospitals and it is to their credit that in the end a resolution was reached. That agreement is the basis on which the legal framework is now being proposed so as to finalise these matters.
The detailed legal framework now before the House has also been agreed by the boards of the three hospitals who are integrating and combining to form  the new hospital at Tallaght. At the outset the problems seemed insurmountable but with an enormous amount of hard work, goodwill and co-operation from all sides we have reached the stage which we are at today. We often hear of many different aspects of the health services but in my opinion, far too infrequently we hear about, and acknowledge, the enormous contribution which is made to our health services on a purely voluntary basis by a large number of people.
I regard this as a time to place on record my appreciation of the invaluable contribution, made on a voluntary basis, by the members of the boards of the three hospitals which are moving to Tallaght. In particular, I would like to acknowledge the work of the chairpersons of these boards, Mrs. Rosemary French, Mr. Gerry Brady, Mr. Salters Sterling, chairpersons of the Adelaide Hospital, the Meath Hospital and the National Children's Hospital boards respectively. It is under their leadership that final agreement has been reached on the detailed legislative basis now before the House.
The skills and commitment which these people and, their colleagues in many hospitals and organisations, bring to the health services, while always appreciated, are not often enough acknowledged. Since becoming Minister for Health, I have come to appreciate that an essential feature of our health services is the voluntary nature of many of our services and the contributions being made.
The process of bringing the hospitals together has received a strong impetus from the fact that building of the hospitals premises in Tallaght is progressing at a pace which means it is on schedule for completion. I express my appreciation to all those involved in this complex project but, in particular, I would like to thank the board responsible for the planning and building of this facility under the chairmanship of Professor Richard Conroy.
This Bill, and the motion approving the draft order, received unanimous  approval from Seanad Éireann on Wednesday 26 June 1996. In the course of the debate in the Seanad, it was acknowledged that, while the three hospitals were coming from diverse backgrounds, the emphasis should now be on what the hospitals have in common. They each have a long tradition of service to the people of Dublin and, indeed, to patients from throughout the country. They have a strong commitment to serve in the best possible way, those people who need hospital services. I have no doubt that this commitment to excellence and service will be continued at Tallaght together with the staff moving from St. Loman's Hospital who will be providing the acute psychiatric services at the new hospital. The hospitals will share a joint future in Tallaght where together they will, no doubt, create a further centre of excellence.
The point was made in the Seanad by the Minister of State, Deputy Currie, and others that Tallaght Hospital will not simply be an isolated hospital but will reach out into the community by close co-operation with the GP services and the continuing care services in its catchment area so as to provide a seamless service to the people of the region.
I am very glad as Minister for Health to bring these proposals to the House. The proposals reflect good news, compromise, co-operation and the commitment of the Government to put in place at the earliest date a range of major acute hospital services to serve the people of Tallaght and the surrounding area. This is a unique occasion where this House is being asked to facilitate the joining together of three hospitals with a proud history of providing health services to the people of Dublin and, indeed, to many people throughout the country.
The main provisions of the Bill are quite straightforward. Section 2 enhances the powers of the Minister for Health under section 76 of the Health Act, 1970. Section 76 of the Health Act, 1970, empowers the Minister for Health  by order to amend the charter of a hospital subject to the order in draft form being approved by both Houses of the Oireachtas following consultation with the Commissioners for Charitable Donations and Bequests for Ireland. Section 2 of the Bill expands the Minister's powers under section 76 of the Health Act, 1970, as the present section does not allow for facilitating the legal arrangements now requested by the three hospitals. That is, it does not provide for the establishment of a new body corporate and the assignment of a title to it. Section 2 (1) (a) provides for this.
Section 2 (1) (b) provides for the application of a charter which is being amended to the new body corporate established under section 2 (1) (a). This allows for the charter of the Adelaide Hospital, 1921, as amended, to be applied to the new body corporate.
Section 2 (2) (a) provides for the transfer to the new body corporate of the functions, property, rights, liabilities and members of staff of the transferring agencies. This provision will allow for the integration of the three base hospitals, of the Tallaght Hospital Board established to construct the hospital, and of the Central Council of the Federated Dublin Voluntary Hospitals.
Section 2 (2) (b) allows for the conferral of such powers on the original body — in this case the Adelaide Hospital — as in the opinion of the Minister are necessary to enable it wind up its affairs or otherwise deal with any property, rights or liabilities of it. This is to ensure that on the disapplication of the charter to the original Adelaide Hospital that hospital will still have powers to take care of its residual affairs.
Section 2 (3) (a) allows the Minister on the application of the new body corporate — in this case the new Tallaght Hospital — established by an order under section 76 of the Health Act, 1970, to amend that order.
Section 2 (4) facilitates the circumstances of this particular case by  allowing for the simultaneous movement of this Bill and the draft order establishing the new hospital through the Houses of the Oireachtas.
Section 3 provides that, notwithstanding the provisions of the Hospitals Federation and Amalgamation Act, 1961, in particular the provisions of section 14 of that Act, the new hospital will be able to exercise all functions which are exercised by the Central Council of Federated Dublin Voluntary Hospitals in respect of the three base hospitals. This provision is required to ensure for the avoidance of doubt that the new hospital will be able to exercise those functions.
The three hospitals joining together to provide a major acute voluntary hospital at Tallaght have agreed that the governance of the hospital will be based on the original charter of the Adelaide Hospital, as amended by the draft order. The order provides for the necessary amendments to the charter to meet the wishes of the three base hospitals and to provide for a situation where none of the three hospitals will have a predominant status relative to the other two.
I understand that Deputies will be aware of the agreement of the three hospitals and of the urgency to provide the necessary legislative measures to give effect to that agreement. I have acceded to the request of the board of the Adelaide Hospital to introduce an order providing for an amendment to the Adelaide charter. I do so at this time to facilitate the putting in place of a unified management structure for the three transferring hospitals well in advance of the move to the new premises at Tallaght. This is of great importance as it ensures the integration of services and the smooth transfer of the hospitals to the new premises at Tallaght.
Earlier this year I facilitated the appointment of a board designate which has been functioning now for six months with the goodwill of the hospitals concerned but without the necessary statutory powers. The energy, capacity and commitment of the members of this board has been amply demonstrated  over the past six months. It is important to provide the necessary legal basis required for the board of the new hospital and to ensure that the board is established as quickly as possible.
The explanatory memorandum circulated with the draft order explains the amendments contained in the order. The order received unanimous support in the Seanad last week and I have no doubt this House will welcome it provisions in like manner.
I do not propose to refer to each section of the draft order but it is important to bring to attention some of the provisions of the order which would not be considered usual in establishing the necessary governance arrangements for a major acute hospital. These provisions have been included in the draft order to reflect the agreement which has been reached between the hospitals. These include section 4 which establishes a body corporate which will be known as the Adelaide and Meath Hospital, Dublin incorporating the National Children's Hospital. Section 4 applies the charter to this body corporate and provides for the original Adelaide Hospital to have such powers as are necessary to enable it to wind up or otherwise deal with its affairs. Section 5 is the principal section of the draft order and contains all the amendments to and deletions from the charter of the Adelaide Hospital.
Deputies will note that most of these amendments are substituting new clauses for the clauses in the original charter. These amendments are necessary to reflect the terms of the heads of agreement entered into by the three hospitals.
The new clause 5(c) of the charter as outlined on page 7 of the draft Order allows the hospital “to promote and secure the availability, as a matter between the patient and his or her doctor, of such medical and surgical procedures as may lawfully be provided within the State” without prejudice to the rights of conscience of staff. The new clause 5 (j) provides that the fundamental principle of the Adelaide  Hospital as an essentially religious and Protestant institution will be maintained, while guaranteeing rights of conscience and providing that the hospital will have a multi-denominational and pluralist character.
The terms of the draft order provide for the composition of the board of the hospital as set out in the new clause 12 of the charter. This new clause provides that there shall be a board of the hospital which will have 23 members. Fifteen members of the board shall be appointed by the three base hospitals as follows: six from the Adelaide Hospital Society, six from the Meath Hospital and three from the National Children's Hospital. Eight members of the board shall be appointed by the Minister for Health, six of whom shall be appointed from among the persons nominated by the president of the hospital and two other members, one of whom shall be nominated by the Eastern Health Board and one of whom shall be nominated by the board of Trinity College, Dublin.
Also of note is the new clause 24 as provided for under section 5(s) on page 30 of the draft order. This establishes a college of nursing at the new hospital which provides that for student nurse entry purposes the Meath, Adelaide and National Children's Hospital will have separate constituent schools of nursing. Each of the schools of nursing will be autonomous for student nurse intake purposes and may take up to 40 entrants in the case of the Adelaide, up to 60 in the case of the Meath and up to 21 in the case of the National Children's Hospital.
The draft order also contains provision for industrial relations matters surrounding the transfer of services and staff to Tallaght to be addressed through a Protocol which has been agreed by the Department of Health and the management and unions representing staff of the transferring agencies comprehended by the draft order. This is to ensure that best industrial relations and personnel practices will be adhered to.
 In preparing the draft order, I and officials from my Department were very conscious that the hospitals transferring to Tallaght are three very different institutions, each having its own background and ethos. While it is important that we should focus on the common positive attributes of each of the hospitals as I mentioned earlier, it is also important that each of the three hospitals is enabled to enter into an arrangement where they feel that their interests and their honourable traditions are respected and acknowledged. I am happy that the draft order before us meets this difficult criterion for the integration of the hospitals.
While this legislation is essentially of a technical legal nature, it is most important. It is a necessary statutory measure required to contribute to the reorganisation and extension of the public hospital services. The immediate effect of the Bill will allow for the proper establishment of a much needed acute hospital at Tallaght. I commend the Bill to the House and I ask the Dáil to approve the motion in respect of the draft order which has been laid before the House.
Mrs. Geoghegan-Quinn Mrs. Geoghegan-Quinn
Mrs. Geoghegan-Quinn: Ba mhaith liom fáiltiú roimh an Bille teicniúil seo. Tuigim gur caitheadh an t-uafas oibre, dúthrachta agus díograis leis. Tá fuinneamh caite ag go leor daoine leis, go hairithe le roinnt maith míosa anuas.
Tá sé an-deacair i gcomhnaí ag ospidéil teacht le chéile go háirithe sa chás seo, áit a bhfuil ethos difriúil idir cuid na hospidéil. Tá sé an-deacair comhcheangal a dhéanamh i gcásanna mar sin. Dá bhrí sin ba mhaith liom mo chomhgháirdeas a ghabháil leo siúd a chaith a ndúthracht leis na deacrachtaí a bhí ag baint leis na cainteanna a oibriú amach.
The order and legislation before us have had a long and controversial history. I welcome the resolution of the difficulties. Good will has applied on all sides. I pay tribute in particular to Mr. Sterling, Mr. Brady and Mrs. French who, as chairpersons of the respective hospitals, played an enormous role in  bringing together the hospital administration and ironing out staff difficulties.
I am glad the concerns have been resolved and I hope the charter and Protocols that have been put in place will live up to expectations.
In some ways this is a sad occasion. Many unique institutions are coming to an end in their current format and are moving on to a new level. Those institutions have long and colourful histories. The Meath Hospital's history dates back to the end of the 17th century. The Liberties was hit by poverty following the collapse of the wool trade. Surgeons from the charitable surgery of Spring Gardens in Dame Street took up the plight of the poor local people and decided to establish a hospital in the Upper Coombe to treat the ill. The first hospital, I understand, was in the library of the home of the Earl of Meath.
The hospital moved from house to house until 1770 when the foundation stone for a new purpose built hospital was laid by Lord Brabazon in the Coombe. Completed in 1773, it continued as a hospital for 50 years until it was no longer adequate to cope with the numbers of patients. A new site was chosen for the Meath off Heytesbury Street. That land had originally been leased by Dean Swift and was known as the Dean's Vineyard. After some financial difficulty, the building of the hospital commenced in 1815 and was completed in 1822.
Throughout the 19th and 20th centuries the Meath Hospital has had a distinguished role in medical innovation. It has played an enormous role in the life of the city. The writers Brendan Behan and James Clarence Mangan died there, while Oliver St. John Gogarty was a surgeon there.
Equally, the Adelaide Hospital has a great and proud history. It was founded by Dr. Albert Walsh when he was just 26 years old. Its first premises was at Bride Street and it continued there until 1846. In 1858, it reopened at Peter's Street and developed a convalescent home there. The Adelaide has been a  general teaching hospital for many years and in the forefront of medical advances. Its charter dates from 1920 and appears to have been one of the last royal charters granted in Ireland.
The National Children's Hospital was founded as a hospital for sick children in 1821 by Sir Henry Marsh. It is considered to have been the first teaching hospital in Ireland and Britain. It moved to a number of different premises, settling finally at Harcourt Street in 1887. The two remaining constituent groups in this new hospital are St. Loman's psychiatric hospital and the Central Council of the Federated Dublin Voluntary Hospitals which was established under a 1961 Act and which, I understand, manages common contracts and pensions for the hospitals. As evident from the long histories and all the people involved, there is more to all of this than just bricks and mortar. Many different institutions, each with its own background and ethos, are coming together under the one roof. However, what is common to all the institutions is, as the Minister said, their strong and overriding commitment to the treatment of patients. That spirit will, I hope, continue strongly in the new hospital.
I said earlier that, in some ways, this is a sad occasion and it is particularly so for Dublin's inner city. The last three hospitals are being lost to the south inner city. It will mark the closing of a chapter for many Dublin families whose grandparents, parents and children had been treated there. If the hospital walls of the Meath, the Adelaide and the National Children's hospital could speak, I am sure they would relate rich historical tales. I ask the Minister for Health to ensure that people from the inner city who have a long tradition in regard to these hospitals will still be able to avail of treatment in their local areas. I hope a special effort will be made to accommodate these people at the Mater, in Crumlin Children's Hospital and St. James's.
One of the unique elements of this plan agreed with all hospitals is that there will be a unified management  structure in place well in advance of the move to Tallaght. I will study carefully how this operates as it is certainly a radical departure. Normally, management is unified only after mergers which sometimes lead to teething problems.
There were many concerns before this rationalisation was finally agreed. The primary ones related to retaining ethos. I am glad these have been ironed out and I note that paragraph 5 (c) of the new order guarantees the availability of all medical and surgical procedures which may lawfully be provided without prejudice to the rights of conscience of staff. This issue was one of great concern to staff interests and I hope the new industrial relations Protocols and other procedures will realise all our hopes.
Many persons, including the Minister, have highlighted the pluralism and multi-denominational aspects at play in this joint venture. I welcome those aspects and I hope the manner in which anxieties were dealt with will become a blueprint for tackling other issues in this society. My one caution is that there should be no triumphalism on the part of any group, denomination or sector. It is not a time for triumphalism on anyone's part. The one suggestion I would make is that when the new hospital is formed, there should be a designated response unit to ensure that any Protocol difficulties are quickly ironed out and do not become a battle between groups that could tear the hospital apart.
I am glad that Trinity College Medical School will have a major role at the new Tallaght Hospital and that it will be a teaching hospital. Campus facilities will be developed at the hospital and I hope this has significant benefits for the Tallaght region. The proposal to establish links between general practitioners in the area with the new Tallaght Hospital is very welcome. This was again mentioned by the Minister when he addressed the House this morning. If one looks back on the past five years and sees the very serious difficulties in  almost every accident and emergency department of major hospitals — some of it resulting from lack of consultation and co-operation very often between general practitioners and accident and emergency departments — it is clear we can avoid such difficulties in future by putting in place the kind of response that has been put in place in St. James's, for example, relating to general practitioners. It is a response which has ironed out some of the difficulties at many national hospitals with the exception of one in my own area. I am glad there are proposals at this early stage to establish those vital links with the general practitioners which I hope will help to avoid the accident and emergency problems we have had in other hospitals.
On many occasions I raised with the Minister the fact that hospitals have a key role to play in communities. They are a vital facility after all but they need to be more consumer focused or customer oriented and they should give patients a role in their own treatment. It would be good for hospitals if consumer representatives sat on hospital boards as well as on health boards. Perhaps the Minister has plans in this area, and if so maybe he could outline them and give us details when he responds.
The Minister said that “building of the hospital premises in Tallaght is progressing at a pace which means it is on schedule for completion”. Perhaps the Minister could detail the timetable that he now envisages for the completion, equipping and commissioning of the hospital itself.
I would like to be associated with the Minister's kind words for the members of the interim board under the able stewardship of Professor Richard Conroy. The board has done a lot of work to bring this complex project to fruition.
Rumour has it that plans for the hospital have been somewhat scaled down. Tallaght is a huge area and this hospital will serve an even wider hinterland. Beaumont Hospital has a ratio of one bed for every 300 in the population  hinterland, but it would appear that Tallaght will have one bed for every 600 of the local population. We have all heard concerns about limited out-patient space and local transport infrastructure difficulties.
Tallaght has been neglected in the past. It has many health problems as shown in a recent Jobstowns survey which indicated high levels of ill health and disability in the area. Tallaght should not be short-changed now with this new hospital. I urge the Minister to ensure that the transport infrastructure for the hospital works. Transport facilities for the hospital need to be integrated with particular regard to the proposed light rail system which is to serve Tallaght.
As an enabling measure, I welcome this legislation. A generosity of spirit has applied in the lead-up to it which should be reciprocated here today.
Miss Harney Miss Harney
Miss Harney: I enthusiastically support the Bill. As the Minister said, it is a technical enabling Bill to provide the statutory basis for the establishment of a governing body for the new Tallaght Hospital. We have had a protracted debate on the establishment of a single board and a range of sensitive issues have finally been addressed relating to the particular needs of the three constituent hospitals; the Meath, the Adelaide and the National Children's Hospital. Following the enactment of this legislation we will have a single board and a designated interim board has been in place since last January.
Great credit is due to the boards of the three hospitals for the great maturity and common sense they have shown in their approach to this matter. I also compliment the Minister and his officials because two years ago I wondered if there would ever be unanimous agreement in this and the other House on the amalgamation of the three hospitals, so fraught with difficulties at that stage.
Deputy Geoghegan-Quinn referred to the history of the three hospitals.  Although I had not consdered that matter when reading the Bill and listening to the Minister's speech, it is worth noting that in the development of Dublin there are three new towns, Tallaght, Clondalkin and Blanchardstown. Great planning mistakes have been made and the city centre is now doughnut-like, empty in the middle, with schools and hospitals closing down and enormous space capacity. Many demands are made for transport and so on as a result of people moving to the suburbs.
Although I represent two of the towns I refer to, huge planning mistakes were made in these cases, not only in planning but in terms of incentives for first time buyers. It is more attractive to buy a new house, for which a grant is payable to first time buyers, than to buy a second-hand house in the city, in which case stamp duty is payable and there is no grant. That is a matter about which I am very concerned. Although efforts have been made in recent times to attract people back to the city— it is becoming somewhat yuppified — it is a pity the services have gone. However, we cannot criticise the fact that services are being removed when the people have already gone.
In the inner city, three hospitals in the one constituency, Dublin South-East, will be closed. I do not know if Deputies in that area have expressed concern in that regard, but Deputy McDowell mentioned to me last night that three hospitals in his constituency will be closed. It should be noted that this is happening because of planning decisions which have resulted in the displacement of people over many years. While I cannot recall the exact figures, the population of the inner city has halved in 50 years, and that is a serious matter for many reasons other than the problems with population and facilities in terms of infrastructure in the suburbs. A capital city should be a living city with as many people as possible living close to the centre, as is the case in Galway. That city is a great example of people living close to the inner city.
This Bill smoothes the way for the  integration of the services which are essential for the transition to the new Tallaght hospital. The level of agreement augurs well for the future. I hope lessons have been learnt from the teething problems that occurred at Beaumont hospital, some of which still exist. Those problems have been damaging to the hospital. To a large extent they resulted from the bringing together of different traditions and institutions, with all the vested interests involved. Foremost in our minds must be patient care. We must ensure that the most appropriate level of health care is provided. Nobody's vested interest must be allowed stand in the way of that.
I hope the negotiations are over and that we will be able to meet the health needs of the people in west Dublin and the surrounding counties. This is a hospital not only for Tallaght — it is important that the public realise that — but for the region. As a Deputy in the area, I envisage that in future years I will receive representations about patients from Wicklow, Kildare and elsewhere.
The governing body of the hospital must ensure that the best standards of health care in terms of in-patients and out-patients are provided. All medical procedures that are legal in the State will be provided in the hospital, as in every publicly funded hospital. The services that are generally not provided, although there is only a small number of them, are those affecting women — for example, tubal ligation is not as widely available as I would wish. I understand that some hospitals will not agree to sterilisation unless a letter of consent is signed by the husband, which is totally inappropriate.
Great attention has been paid, in the context of the amalgamation of the three hospitals, to the special ethos of the Adelaide Hospital. It is right that that ethos is protected and promoted. The Catholic ethos is dominant throughout the public health service. In a republic we must ensure the rights of miniorities are protected. The Adelaide  Hospital is the only remaining Protestant hospital in the county and I am glad the Minister has sought to establish a single board by amending the charter of that hospital.
We must protect fully the special relationship that exists between patients and doctors. There should be no intervention whatever from any moral big brother. Although many of the sensitive issues that arose in our health service ten or 15 years ago no longer exist, problems remain with certain procedures. I am delighted the staff in Tallaght hospital will be free to exercise freedom of conscience. That is extremely important, just as in this House it is important that Deputies be able to exercise freedom of conscience in moral issues. I am aware that moral issues may extend beyond those relating to religion, but particularly in issues of religion or conscience, where people have genuine moral difficulties, the party Whip system is inappropriate. I forecast that within a decade it will no longer exist, as is the case in almost every other democracy, certainly in Europe.
The fact that staff can opt out of performing any procedure with which they do not agree should be a reassurance to those who have made representations to me and expressed concern about the matter. Sometimes these concerns are exaggerated and people anticipate they may have to do things that are wrong, but I do not envisage that will be the case in Tallaght. Nonetheless, it is important that it is clear to the staff from the outset that there will be no question of having to perform procedures with which they have moral difficulties.
It is sad that, while we live in a republic, there is much misunderstanding about the Protestant ethos. To a large extent that misunderstanding is based on lack of education and awareness and perhaps failure to communicate with different groups in society. I anticipate that when the hospital is established and the different sets of staff begin to work together they will realise  they have much more in common than they realised and practically nothing divides them. Many of the medical and consultant staff are common to the Adelaide and the Meath hospitals and when other staff down the line begin to work together they will equally realise they are not very different.
On the nursing college, I am pleased the autonomy of the three separate nursing schools will be protected. I welcome the Minister's statement that the Meath Hospital will take in up to 60 students, the Adelaide 40 students and the National Children's Hospital 21 students. The only way the ethos of the Adelaide will be protected in the new hospital is by ensuring it has a sizeable number of student nurses and the hospital is pleased that it will take on 40 out of a total of 121 students.
Tallaght hospital is on schedule and will be opened in August 1997. This project is the largest ever public project undertaken in the State. Given that it will be a state of the art hospital, one of the best in the world — I am aware of the demands on public spending and always shout when the Government overruns on budgets — an MRI scan is essential, particularly if there is to be a neurology division, a specialty which, I understand, will exist. That service is essential if the hospital is to be of a high quality and top grade in terms of design and facilities. I am not asking for a large number of specialities to be allocated to the hospital. I recognise that if public money is to be used efficiently, specialities must be organised in the most efficient way possible. There may be some areas where we should not provide any service and where we should fund patients to go abroad for treatment. That may be more cost efficient. If we are to have a neurology department, we should have an MRI scan.
The construction and opening of the Tallaght Hospital is the final piece in the infrastructural jigsaw in the Tallaght area. In the space of a decade a large community of 70,000 people with virtually no services has grown into a city with services second to none. The  people in the Tallaght region have been given a great boost by seeing the hospital proceeding so rapidly and knowing it will be opened on schedule.
On the question of staffing, I acknowledge a Protocol has been agreed by the Department, the managmement and the unions in relation to the transfer of staff to the Tallaght Hospital but great effort should be made to ensure that non-medical staff are recruited locally. If facilities such as this exist in a community, and if there is not some local input where jobs are concerned — Tallaght is an area of very high unemployment — the hospital will not be as respected and as well received as it might otherwise be.
Canteen, security, cleaning and other non-medical staff, will have to be newly recruited because there is insufficient staff in the existing hospitals and many of them live locally and may not want to move to Tallaght. Whoever is responsible for recruitment should ensure that as many of the new staff as possible are recruited from the Tallaght area.
A young Tallaght man, Bob Byrne, died tragically five weeks ago from a terminal illness. In 1991 he was a candidate in the local elections campaigning for the Tallaght Hospital. He was to the forefront of the campaign in Tallaght. Many people in Tallaght would like to see some part of the hospital, perhaps a ward, dedicated to his name. I ask the Minister and the board to examine that possibility because many community leaders in Tallaght have raised this matter with me and with other Deputies in the area. Such a dedication would be a fitting tribute to a wonderful man who died so tragically. When I visited him just before he died he spoke about Tallaght Hospital and how pleased he was that it would be opened next year.
There is much local interest in who will man the shops in the hospital. I do not want to go into that now, other than to say the units should be put to public tender and there should be a fair competitive procedure. Any facilities that have to be provided in a hospital of this size should have as much support from  the local community as possible. If people believe arrangements are being made behind closed doors and they have not had an opportunity to tender for some of these services, that is not appropriate as far as public projects are concerned and it is unwise from the point of view of the hospital, its reputation and its future.
I commend the Minister for the manner in which he has been able to smooth out the various difficulties and the speed with which he has done that. It augurs well for the management of the new hospital that agreement has been reached on the manner in which the hospital will be governed and the amendment of the charter of the Adelaide Hospital. The fine traditions upheld in all three hospitals in the city centre will be upheld in Tallaght because of the commitment, maturity and common sense shown at this early stage.
I speak for all the representatives in the constituency who have campaigned for this hospital for as long as they have been Members of this House; many of us wondered if we would ever see it. There was a time when we did not believe Tallaght Hospital would be built. Many sod turning ceremonies took place; every time we had an election a sod turning ceremony would be held. I am pleased this Minister has not engaged in ceremonies of that kind and I pay tribute to him for the contribution he made to ensuring the hospital is established quickly and efficiently and with agreement from the three constituent hospitals.
Mr. Lenihan Mr. Lenihan
Mr. Lenihan: I was glad to hear Deputy Harney refer to the huge demographic changes which have taken place on the western side of our city. We will now have three cities, each with a population approaching 100,000 people, within the next ten years. They are Tallaght, Lucan-Clondalkin and Blanchardstown. Deputy Harney has the privilege of representing one of those areas and part of another. I have the privilege  of representing Blanchardstown and the Lucan half of the second city.
I am delighted the Minister has resolved the difficulties and I congratulate him on that. I wish the new hospital well but I would like to put in a plea for Blanchardstown before I address the measure. As the Minister is well aware there is a hospital in Blanchardstown, an old sanatorium, which requires considerable physical modernisation. There is currently a proposal before Fingal County Council to dispose of some lands within the ownership of the hospital. There is a view that it is unfortunate that a development not envisaged in the county development plan must take place to finance improvements in the physical structure of the hospital. I do not want to stray any further on that subject other than to make a plea to the Minister to commit the necessary funds to secure improvements at that hospital.
Enormous demographic changes have taken place in the western side of the city and whether we talk about public transport, the provision of town centre facilities, hospital facilities or regional colleges, the infrastructural jigsaw to which Deputy Harney referred is of great importance in that part of the city. While we have population decline in many parts of the country, this is a region which has a massive population increase.
I support the Bill because it will give legal effect to the proposed charter for the new hospital at Tallaght. The Bill provides a sound foundation for the future of medicine in western Dublin, in Dublin generally and in Ireland. Each of the three hospitals that have combined into this one hospital has been part of the great history of Dublin medicine.
The Meath Hospital, whose origins are in the 1750s, the National Children's Hospital, founded in 1821 and the Adelaide Hospital, created in 1839, contributed to what is known as the golden age of Dublin medicine and formed the Dublin school of medicine.  That was done in partnership with Trinity College, the Royal Colleges of Physicians and Surgeons and with other hospitals of equal age in this city. Throughout the 19th century Ireland, particularly Dublin, led the world in advances of all kinds in the practice of medicine. The teaching and research in medicine conducted in Dublin acquired an international reputation and received international acclaim.
The charter I support today makes provision for an institutional arrangement between this new hospital and Trinity College. There will be a representative of the college on the board of the hospital. Much work has already been done to give form and substance to the relationship between the college and the hospital. A clinical sciences building is planned in association with the education building at the hospital. That building will provide research and teaching accommodation for the medical and dental staff and their students as well as the staff and students in dietetics and nutrition, occupational therapy, physiotherapy, social work and speech therapy. There will be academic departments of clinical medicine and surgery, paediatrics, psychiatry, community health and general practice.
As well as general professorships in these areas, there will be named Chairs beginning with the Henry Marsh Chair of child and adolescent psychiatry to be followed by the Denis Burkilt Chair and the Robert Graves Chair. These chairs honour medical men of great clinical distinction in the 19th and 20th centuries. Many of these developments have been undertaken by Trinity College and the hospital in association with the Eastern Health Board.
The college has already begun work in Tallaght. The professor of general practice is already attached to a practice in the area. His department has given substantial support to the community health group of the Jobstown integrated development project which the Minister of State, Deputy Rabbitte, recently acknowledged when he launched its report. This activity is indicative of the  way in which community health must be a central focus of the provision of health care in the west Dublin area.
I dwelt at some length on this aspect of the charter and the role of Trinity College in the new hospital because it is of great importance that the people of Tallaght should get the best. They have waited long enough for this facility and a teaching hospital is one way of ensuring that the best is provided. I hope we are laying the foundation this morning for a revival of Dublin medicine and that it will achieve even greater world renown in the next century than it did in the last. It is important to establish a complementary partnership of health care between this new hospital and St. James's Hospital which is also part of the planning of Trinity College as far as its contribution to this project is concerned.
Minister for Health (Mr. Noonan, Limerick East) Michael Noonan
Minister for Health (Mr. Noonan, Limerick East): I thank the Deputies who contributed to this debate. I also thank them for their strong support and welcome for the statutory provisions we are putting in place to underpin the board designate of Tallaght hospital and allow it to operate on a firm legal foundation.
Deputy Geoghegan-Quinn raised a number of points. She asked for assurances that treatment will be available for people in the areas where the existing hospitals are located. I assure her there will be no deficiency in the service to local people. There has been great movement of people, as she, Deputy Harney and Deputy Lenihan mentioned. One would not plan the services now in such a way that there are three hospitals in the constituency of Dublin South East. People still need services and there are good hospitals not too far away. We are conscious that any diminution in the level of services to local people must be avoided and we will take every measure to ensure there is no deficiency in the service provided.
Deputy Geoghegan-Quinn asked for a designated response unit to avoid the growth of conflict in the hospital. I  would be happy to put unified management structures in place prior to the move to Tallaght. The committed support of my Department will ensure that we do not have a repeat of the situation which occurred previously, particularly in the transfer to Beaumont Hospital.
The board, which will be on a statutory basis and which is already informally in place, will not only have the task of organising the move to Tallaght and subsequently managing the hospital in Tallaght, it will be the unified board for the three existing hospitals in the meantime. It will have the authority to make the necessary arrangements and will fulfil two functions. It will replace the three separate boards of the existing hospitals and it will run the three hospitals. What impressed me most when I visited Oxford for the first time was the university buildings scattered throughout the town. This is similar in that it will be one hospital with three different locations from the time the board is appointed and then the movement will be organised in one location. I accept the Deputy's point. We will monitor the situation to ensure that the seeds of conflict are not sown before the movement to Tallaght because when difficulties get into the a system, they take a long time to iron out.
Deputy Geoghegan-Quinn also asked for a consumer representative on the board. It is a voluntary hospital with a model in what we are authorising for the appointment of the board. I have an appointment function, but I am appointing on the basis of nominations made to me by the president of the hospital. I hope the constituent nominating bodies listen to the views expressed here because the consumer, whoever that might be, should be represented on the board. Either one of the hospitals or the president of the hospital, all of whom have either appointment or nominating functions, should listen to the good advice given here.
Deputy Harney said there should be GP representation on the board — advice which could also be taken on  board. If we want a hospital in Tallaght which seeks to give a similar service in terms of primary and secondary care, then a suitable representative of the local cohort of GPs would be an appropriate person. I do not have the power to appoint a GP or a consumer to the board, but I am happy with the people who have been nominated so far. They are members of different professions, including many medical people, and they will form part of the designated board. There will be other opportunities in future to make changes and the advice given here could be taken into account at that stage.
As regards the argument which flares now and again about whether the services will be adequate, particularly in terms of bed provision, it is wrong to make comparisons with Beaumont Hospital. If I recall correctly, Beaumont Hospital was put in place quickly in response to the needs of north Dublin. At that time, Mr. Charles Haughey decided that rather than incurring further delay by planning the new hospital, he would use the design of the Wilton in Cork and with some modifications it was put in place. The Wilton must have been planned in the late 1950s or 1960s. At that time and until recently, if one was trying to measure the workload of a hospital, one would probably do so in terms of the number of beds. However, that is not the way any more. There is now a massive movement towards day care and the proper way to measure hospitals is on an inpatient and day clinic basis. In that context there is a difference in the comparative figures of beds per capita to the catchment area.
Some 513 beds are being provided as follows: standard ward, 54 single private rooms, 279; children's units, 17 private 12 day beds, 67; intensive care, ten; coronary care, ten; age related 30; day care adults 61. This gives a sub total of 457. There will be 56 beds in the psychiatric unit, which brings the total to 513. The total bed provisions was derived from the 1992 review of the Tallaght hospital project carried out by the Dublin  Hospital Advisory Group which included in its composition clinicians from a number of Dublin hospitals. The report of the advisory group formed the basis of the Government's decision in 1992 to proceed with the construction of the hospital. The Department's position has consistently been that the total of 513 beds is fixed and that the transferring hospitals agreed to this when they accepted the planning brief as part of the May 1993 agreement to transfer to Tallaght.
We are estimating it will cost £123 million, which is a huge investment. It will be funded by the European Union to the value of £31.6 million — 25 per cent — and by the taxpayers, who will provide 75 per cent.
Miss Harney Miss Harney
Miss Harney: What was the original estimate?
Mr. Noonan (Limerick East) Mr. Noonan (Limerick East)
Mr. Noonan (Limerick East): I do not have that information to hand. While some amounts are in contention, we are not involved in any major overruns and the extras represent normal inflation during the planning and construction stages. Certain matters have been notified to the board, which is handling them before it proceeds with further consultations with the Department. I am not sure how that will work out, but I am happy that things are in fairly good order.
Studies have been conducted between the Department of Health, the Tallaght hospital board and the Eastern Health Board. They have collected in a number of analyses designed to examine the bed designation. The results of the analyses are not being made public. However, overall indications from the latest studies suggest that adequate beds are provided to meet the needs of the hospital's catchment area. It has also been agreed that speciality bed designation will be a matter for the board designate and its successor body. The assignment of beds by speciality will need to take account of rapidly evolving patterns of practice in acute hospital  medicine, including the continued development of day surgery.
Regarding the timetable for completion of the building of the hospital, I am advised that part of it has been completed and handed over to the commissioning board. The building of the hospital is on target, but I am not sure of the scheduling date. I am advised that the best strategy is to designate one day for moving. Moving people on an instalment or rota basis is a recipe for disaster. We will try to pick a date on which there will be a low level of hospital activity.
Miss Harney Miss Harney
Miss Harney: The August bank holiday weekend.
Mr. Noonan (Limerick East) Mr. Noonan (Limerick East)
Mr. Noonan (Limerick East): August would be a good month as there would be a low level of hospital activity.
Miss Harney Miss Harney
Miss Harney: When the politicians are on holidays.
Mr. Noonan (Limerick East) Mr. Noonan (Limerick East)
Mr. Noonan (Limerick East): Another possible day would be St. Stephen's Day, but that would put back the move. There would be a low level of hospital activity on that day.
Miss Harney Miss Harney
Miss Harney: What will be the estimated running costs of the new hospital?
Mr. Noonan (Limerick East) Mr. Noonan (Limerick East)
Mr. Noonan (Limerick East): We might be negotiating to form the next Government at that time and I might arrange the move in an acting capacity, but I hear the Tánaiste will not have an election until late that year. I hope I will be there in August 1997 and I will invite all the Members along.
Miss Harney Miss Harney
Miss Harney: I did not think the Minister would let the Tánaiste decide everything.
Dr. Woods Dr. Woods
Dr. Woods: I set up the first board a long time ago.
Mrs. Geoghegan-Quinn Mrs. Geoghegan-Quinn
Mrs. Geoghegan-Quinn: We want an invitation.
Mr. Noonan (Limerick East) Mr. Noonan (Limerick East)
 Mr. Noonan (Limerick East): We will have a big day out on the opening of the new hospital as it has been such a long time in gestation.
The specialty breakdown within the new hospital, including radiology, will be one of the first issues that will need to be addressed by the board of the hospital having regard to the overall provision of services in Dublin and throughout the country. I am sure the new board will bear in mind Deputy Harney's comments about the recruitment of staff from the Tallaght area. While initially staff recruited to new factories come from a widespread area, as time passes the staff become localised. During the past ten to 15 years Limerick Regional Hospital has tended to draw staff from the western end of the city. Assurances have been given to the staff of the existing hospitals as to their security of tenure. Initially the medical and nursing staff will transfer and I would not see many changes in those areas, but I do not know whether all or some of the support staff will move and if they will want to stay permanently in the hospital because of the dislocation factor of which we are very much aware. We hope the industrial relations Protocol will provide the necessary support to facilitate a smooth changeover. There will not be any major recruitment in the locality initially because of commitments to the staff of the existing hospitals, but over a period of time I envisage there will be significant employment in the new hospital.
I noted Deputy Harney's comments on the late Mr. Bob Byrne and I thank her for bringing the matter to my attention. People who voluntarily give up their time to initiate projects, get them under way and fight the battles when frequently many people were not too interested, should be given recognition, especially in the circumstances of the early death of Mr. Byrne.
Deputy Lenihan has given us a good insight into the role that will be played by Trinity College in this major teaching hospital and the links with Trinity College are very valued. The fact that the  link with Trinity College will be maintained and strengthened in the manner outlined by Deputy Lenihan in the designation of professorships and chairs of medicine for persons of expertise attached to the hospital will give further assurance of the quality of this new centre of excellence.
Question put and agreed to.
Dáil Éireann 468 Health (Amendment) (No. 2) Bill, 1996 [ Seanad ]: Second Stage.