Seanad Éireann - Volume 103 - 07 March, 1984

Adjournment Matter. - Galway Regional Hospital.

Mr. Killilea: I put down this motion because it needed serious consideration and immediate action. I had not given much thought to who might be taking the question from the Government side, but I am delighted to see Deputy Donnellan, the newly appointed Minister of State at [390] the Department of Health, here tonight. He realises the seriousness of the problem. However, I am disappointed that the Minister, Deputy Desmond, is not here to hear my remarks on this most serious question.

This motion has nothing to do with the general motion by the Fianna Fáil Party. I want to make it quite clear that I am referring to the maternity unit and the general practices in the Regional Hospital Galway. I am a member of the health board. It is a most frustrating and difficult job to try to provide the services on the funds made available to the board, particularly this year, but although this is a serious situation there is an even more serious one.

About four years ago a contract for the extension of the maternity unit in the Regional Hospital Galway was completed. A beautiful new building costing approximately £4 million was erected. Part of that unit has been used to try to create some facilities for a hospital that is already overcrowded. The maternity wing is overcrowded for two reasons, first, the unit available to the community in Tuam closed and, second, the unit at the private hospital — Calvary Hospital — closed also. Immediately there was pressure on the maternity unit of the Galway Regional Hospital. The health board have asked for money to be made available so that staff can be appointed. From trainee nursing posts to senior posts, we need 75 staff appointed at an average wage of about £7,500 per annum. We have already bought some of the equipment and about £250,000 worth of extra equipment is needed, not all of it immediately but some of it quite urgently, to provide proper facilities at the hospital.

Three weeks ago last Friday, 70 expectant mothers arrived and were admitted to the already overcrowded hospital. That night there were at least five mothers in labour in the hospital corridors. This situation does not occur every day, but it has occurred more than once and is occurring more often as time goes on. The reason this is happening is that we have no other unit to serve the population of 125,000, with the exception of [391] a small unit in Portiuncula Hospital which serves Offaly, Roscommon, and Westmeath and only a small portion of our county.

We have begged and beseeched the Minister to give us the money required to make this facility — which was built at enormous expense — available to the public, but we have been consistently refused. Dr. Donnelly, to whom I listened at health board meetings, said that the Regional Hospital is the second best acute hospital in these islands. He compared it to St. James's Hospital in Dublin. At the most recent health board meeting he gave the following figures which show the bias that exists against the west of Ireland. The Regional Hospital cost £19 million to run last year; St. James's Hospital in Dublin — comparable in size, capacity and throughput — cost the State £25 million. The admission rate to the Regional Hospital for an expenditure of £19 million was 21,000 patients; for £6 million more the admissions to St. James's Hospital were 14,000 patients. We were giving almost double the value for money spent. This year our expenditure was cut by £4.5 million while the Eastern Health Board's expenditure was cut by only £3 million. We have 70,000 outpatients in the region; the figure for the Eastern Health Board area is almost insignificant. Last Friday a senior official from the Department of Health came down and asked us if we could cut the services to outpatients. People may make up their own minds about that suggestion.

We have a cat-scanner in the Regional Hospital which cost £500,000. They have a cat-scanner in St. Vincent's Hospital, Dublin. The Western Health Board asked for a staff of five to operate the cat-scanner. The request was refused; yet St. Vincent's Hospital have staff approval for seven. I do not begrudge them. That may be a decoy I do not understand but I do not see why a bias exists against us.

I make those comparisons because I want to point out clearly to this House and to the Minister of State present that the situation cannot and will not be tolerated in Galway. We cannot adjust any [392] more to facilitate the Department of Health. I am beseeching the Minister of State — who happens to be a Deputy for that constituency — to take this matter in hand and to give a favourable and proper response to the needs of our county.

Fine Gael and Labour, are working together in Government at present and any issue arising on the eastern side of this country is not alone well pressed, but efforts are made to ensure that in the event of any abnormality arising the Ministers responsible, or some of them who assume responsibility, will even test the efforts of the national television network to make the case.

In recent weeks I heard the Minister who has responsibility for women in the Government, Deputy Fennell, on a programme talking about womanhood and motherhood. Would she tell the people of the west of Ireland and the people of County Galway in particular what she understands by womanhood and motherhood? Will she sit in a Government who refuse to give us the money and allow mothers to be in such a state on the corridors of our major hospital or could she twist the arm of the Taoiseach who might have a conversation with the Health Minister, Barry Desmond and ask him to release the money to us to stop this horrible performance? We are living in 1984 and this cannot be tolerated. There are important issues in this land but there is no issue as important as that. It is a serious situation in our county. No effort is being made by anybody in the administration in Dublin to come to our aid. Senator Michael Higgins knows exactly what I am talking about because he is a member of the board as well. I am sure he will concur with every word I say.

Mr. M. Higgins: I do, and I have also pressed this matter with the Minister for Health and hope for a resolution.

Mr. Killilea: And hope for it soon, and by “soon” I mean immediately, within the next two weeks. The Minister himself, Deputy Desmond, paid a visit recently to our city and went to our hospital to examine it. He saw it for himself.

[393] I am sure he did not close an eye when he was passing by the maternity unit. He could not because the situation prevailing is obvious to anyone. Then we have the Eastern Health Board. I do not want to make the comparison. How many maternity hospitals are in this city? There must be about 20. And we have but one hospital in the whole county dealing with a population of about 125,000 people. We cannot get a single penny to open a new maternity unit despite the fact that it is built. It is the most ludicrous, shameful, disgraceful performance by any Minister for Health, by any Government, I have ever witnessed in my life. I do not comprehend it. I cannot understand it. I do not understand why the Minister, Deputy Donnellan, is not thumping his fist on the table of the Minister to give expression to this matter because he knows about it too. I do not know whether the Minister, Deputy Barry Desmond, has him tucked away in a little corner and says, “come in today” and “go out tomorrow”. I do not know what the situation is with Minister Donnellan and his Minister. It is about time he made this demand on behalf of all the people, immaterial of what their politics might be. We will not and cannot tolerate such a situation.

I am ashamed to say that such a situation prevails in our community. I am ashamed, as a public representative, to think that we in the west and particularly in Galway are treated in such a manner, that the mothers of our county are left in such a predicament. It horrifies me to think that we claim, as public representatives, of one kind or another, to be looking after the needs of our people and we allow this intolerable situation to continue. I have only given a few instances but I could go on for hours. The point I want to make is that whatever about the other cuts and whatever about the medical cuts that may be made to the Western Health Board this is not a cut that can be tolerated any longer. I trust and hope that the Minister for Health now under pressure not alone from this House but from the Minister of State at the Department of Health, Deputy Donnellan, will give us what we need immediately and not have us coming to this city in deputation [394] begging and beseeching as if we were not entitled to treatment for our people. To quote the Minister of State, Deputy Nuala Fennell, we should appreciate motherhood and womanhood. Deputy Fennell's performance and her party's performance in our county is an absolute disgrace. Thank you.

An Leas-Chathaoirleach: Senator Robb, I think as Senator Killilea has finished a few minutes before his time and you have indicated you would like to speak, you could do so now.

Mr. Robb: I know very well how Senator Killilea feels. I moved from a large hospital complex to a smaller area about ten years ago and I found on arrival there that four girls working in the theatre were asked to do 186 operative procedures per month, of which 32 were major procedures. The theatre which I had left and in which there were ten non-medical people working did 86 operative procedures per month of which only 27 were major. It begged the question, as Senator Killilea has begged, whether centralisation of the services was necessarily more effective, more efficient, more econonomic, as we have been led to believe it was.

As regards the four unfortunate women who were having their babies in the corridor in 1984, I would venture to suggest that by 2084, if not a lot sooner, many women will be having their babies in their own homes.

The third point I would make is that it is high time we looked at the way in which power has been centralised and hoarded within the medical institutions. I would ask Senator Killilea, through you, a Chathaoirligh, while feeling sympathetic towards his case and indeed without knowing the details of what has happened in the west, particularly the way he has compared the scale of resources available in the east to that available in the west, whether Galway city itself may, at some time in the past, have been to some degree guilty of the very thing of which Dublin is guilty, in relation to Galway in relation to its own smaller communities. That is a point very dear to my heart, the [395] way in which Belfast looked at Ballymena, the way in which Ballymena looked at Ballymoney, and we were at the end of that line with no power and no access to the levers of power and felt, to a much greater degree than has been described by Senator Killilea, defenceless and indeed frustrated and angry.

In conclusion I would like to draw the attention of the House to a point I have made elsewhere and which I think needs to go on the record of this House. Professor James McCormick of this city has stated that 80 to 90 per cent of all ill-health should be within the compass of the appropriately trained family doctor — he emphasises “appropriately” — provided he relates positively to the other health delivering agencies in his community, relates positively as an equal and not as a prima donna. Rex Laurie, a distinguished consultant at Guys Hospital in London, at the end of his days, when he had left that hospital, stated that 80 to 90 per cent of all hospitalised ill health should be within the compass of the smaller hospital, and he included accident and emergency treatment also, provided the people serving those hospitals were appropriately trained. This, in effect, means that only 10 to 15 per cent of hospitalised medicine or 1 to 2 per cent of all ill health requires super technology and super specialisation. The question I pose and the question to which we should all address ourselves in relation to the problems posed by Senator Killilea is, why is almost all the power to determine undergraduate attitudes, post graduate training profiles and the patronage in relation to the placing of consultants in their final posts in the hands of those whose main concern is with that very important element in medical practice, the 10 to 15 per cent that does require super special, super technology medicine or the one to two per cent of ill health that requires it.

The important issue he has raised is part of a much greater problem as to how we look at the whole area of health and disease. We should ask ourselves if we have not become a little bit too obsessed with curing disease when there is so much [396] yet to be done and so many of our resources need yet to be put in the direction of prevention but to remind ourselves that we have barely started to look at the problem of promotion of health. Promotion of health involves communities looking at themselves and feeling confident that in the community in which people live there are indeed the resources to deal with the 80 to 90 per cent of hospitalised ill health that they require in their own community or the much greater percentage of total ill health.

An Leas-Chathaoirleach: Your time is up, Senator Robb.

Minister of State at the Department of Health (Mr. Donnellan): I would like to thank Senator Killilea and Senator Robb for their contributions. It would be fair to say that some of the points made by Senator Robb would be hard to disagree with. Some more of his expressions of opinion would be more appropriate to a debate on an Estimate for the Department of Health. Some type of opportunity such as that should be given to Senators so that they could go into broader areas.

Deputy Killilea was indisposed recently and I am glad to see him back on his feet. I wish him a long and healthy life. He referred to staffing ratios vis-à-vis Galway and St. James'. He could have picked some other hospitals that would show the direct opposite. There is no question about that.

Mr. Killilea: They are the two biggest hospitals in the country.

Mr. Donnellan: There are many other hospitals——

Mr. Killilea: But they are not of equal size.

Mr. Donnellan: I would like to outline for Senators the global position regarding the financing of the health services in 1984. A few days ago the Minister for Health moved in the Dáil an Estimate for Health in excess of £1 billion. This figure [397] represents about 7.3 per cent of GNP, a percentage incidentally which is higher than that of our nearest neighbour Britain. I should also mention that expenditure on the health services in Ireland has grown from £400 million in 1978 to an estimated £1,064 million in the current year. This represents an increase in a six year period of 166 per cent. In terms of percentage of GNP the growth over the six-year period was 6.2 per cent in 1978 to approximately 7.3 per cent in the current year.

The serious problem which arises from the increasing cost of providing and delivering our current level of health services is a source of major concern to the Government and to the Minister as well. We have now reached the point where further improvement in the health services can only be brought about by a critical scrutiny by all parties involved of the existing pattern of services. Changed circumstances may render some services of less relevance than they were before. Emerging priorities must be honestly faced up to and recognition given to the fact that resources may have to be diverted to areas of high priority. Above all those responsible must resist the temptation of calling for more money and more heads of staff in a situation where the public purse can no longer accommodate such demands. I should not have to bring these issues to the attention of Senators but unfortunately the seriousness of the present situation where it is no longer possible to plough more and more funds into health, has not yet sunk home in certain quarters.

The present situation at Galway is that the new maternity unit provided at a cost of approximately £4 million is now fully complete. The unit comprises 23 maternity beds and 8 gynaecological beds together with a delivery suite, a neo-natal unit and an outpatient department. To date part of the delivery suite and part of the neo-natal unit have been occupied and put into use by the redeployment of existing staff. The Western Health Board has sought 75 extra heads of staff to commission the whole unit. However, I am fully convinced — and this is the line which my Department has taken with the [398] board — that the entire unit can be brought into use by redeployment.

It must be pointed out that the number of births in the area has not at all increased to the extent which the demands for additional staff would imply. There are indications in Galway as elsewhere of a levelling off of the number of live births. I should stress that what is available in the new unit in Galway are very much improved facilities to cope with a service which is being provided at present. While I concede that the design of the unit is such as to demand somewhat more staff than are currently engaged at the existing maternity unit I do not believe it is beyond the ingenuity of the board and their management team to divert staff and resources from areas of lesser priority to enable the unit to be commissioned.

Mr. Higgins: I am afraid I must agree with Senator Killilea, and I support Senator Killilea.

Mr. Killilea: Even Ulick Burke can say the same thing.

Mr. Donnellan: I know that recently the board have been seeking my Department's approval for the suppression of a number of posts in order to facilitate the creation of posts to cater for other services in the board's area. The board tell me that the opening of the maternity unit is their top priority. It logically follows that they should be willing to make the necesary adjustments to enable the unit to be utilised. I am aware that conditions in the existing unit are far from ideal. However, the board must tackle the problem. They have already been notified of a revenue allocation for 1984 of £93.7 million. There are simply no extra funds available to supplement that figure at present. In the present situation the Cabinet have had to make extremely tough decisions. The Minister for Health has made hard decisions and those decisions he has made he intends to stand over. It is now up to the Western Health Board and their officials to so manage their affairs that the improved facilities [399] at Galway can be made available to the mothers of the area.

Mr. Killilea: I do not and cannot and will not accept that civil service jargon that has been pumped out to me here tonight and to the Seanad by the Minister of State, Deputy Donnellan. It is an absolute fallacy. What the civil service are telling the Minister on this issue is untrue. I beseech and beg Minister Donnellan to make a visit to the Western Health Board to examine the situation himself. He has been told a bag of lies by the civil service. We were insulted on Monday by a letter from the Assistant Secretary of the Department and it certainly is time the Minister took it in hand himself.

Mr. Donnellan: It would be rather hard to insult the Senator anyway so it must be a bad letter.

Mr. Killilea: Ask Senator Burke or Senator Higgins about the contents of a letter that was sent down from the Department on Monday. The whole board, of every political persuasion, including the members of the medical [400] profession who were there, were shocked. They took it as an insult to the integrity of people who serve the public to the best of their ability. This tonight is more of it.

Mr. M. Higgins: I would just ask the Minister of State to bring back to the Minister the feeling of many of us in the Seanad that this matter should be reconsidered.

An Leas-Chathaoirleach: I wonder could I have an indication from you, Senator Dooge, as to what——

Professor Dooge: In regard to the business of the House, a Bill in regard to dentists will be circulated either overnight or tomorrow in the Seanad as a Seanad Bill. I should like to give notice that it is proposed to take that Bill on Wednesday next.

Mr. Killilea: We are not able to pay for what we have.

The Seanad adjourned at 8.50 p.m. until 2.30 p.m. on Wednesday, 14 March 1984.