Seanad Éireann - Volume 117 - 28 October, 1987
Adjournment Matter. - Waterford County and City Infirmary.
Mrs. Bulbulia Mrs. Bulbulia
Mrs. Bulbulia: I am pleased to see the Minister of State here this evening but I am sure he would not think it invidious of me if I said I would have preferred the Minister, Deputy O'Hanlon, to attend because the matter I speak about is very serious and has grave implications for the health, welfare and, indeed, safety of the people of Waterford city and county. My sole motive in wishing to raise the matter on the Adjournment is to elicit some measure of understanding, comprehension and sensitivity from the Government. I know with absolute confidence that I speak on behalf of the people of Waterford when I say we do not feel that we have been met with that degree of understanding, sensitivity or comprehension. Nevertheless, I am pleased to see the Minister of State here this evening.
I am speaking at the eleventh hour because this hospital is due to close on 31 October 1987. I am conscious of the fact  that I speak about this hospital almost in the tones of a requiem. I am deeply saddened, as are the people of Waterford, by what has happened to this beloved hospital which is in the heart of Waterford city and in the hearts of Waterford people. It was built in 1785 and it was styled “the leper hospital” up to 1896. The closure has been caused by the decision of the Minister and his Department to cut funding by £300,000 in 1987 and by an appalling decision to withdraw funding totally in 1988. In other words, this measure to close the infirmary was forced on the board of governors who were not in favour of it but were left with no option but to make the painful decision to close, which comes into effect on 31 October 1987.
The hospital is a beloved institution in Waterford. I really cannot find words which are adequate to express the depth of feeling, warmth, reverence, affection and regard which the people of Waterford city and county have for this hospital and for all who have worked in it. It is redolent of memories for every single person in Waterford. There will be a day of mourning in the city on 31 October when that hospital finally closes its doors. Great praise is due to the matron, the staff, the present secretary-manager Mr. Jim Creagh, to the master and board of governors and to the ladies voluntary aid committee whose commitment to the County and City Infirmary knew no bounds.
The withdrawal of funds and the subsequent closure of this hospital has been greeted with what I would describe as cold anger in Waterford. A petition to keep the hospital open was signed by 36,000 people. I was with a group of nurses who travelled with that petition to Dublin and presented it to the Minister, Deputy O'Hanlon, who received it graciously. But it was to no avail. Approximately 85 staff have been offered redeployment, redundancy terms, or a five year career break. The dislocation to the staff, to all those who supply services and to suppliers, is enormous and will never be forgotten or forgiven by the  people of Waterford.
It is not merely to speak about the closure of the infirmary that I have raised this matter. I want to illustrate the ludicrous, ham-fisted, inept, unthinking, bizarre and extraordinary way in which the health care needs of the people of Waterford city have been handled in the past few months. It is a classic example of the bankruptcy of policy which is a hallmark of this Government.
The South Eastern Health Board were faced, as were the other health boards, with a horrendous decision on the management of their finances. Earlier in the year and long before any mention of the withdrawal of funding to the infirmary had been even whispered about, the South Eastern Health Board decided, of necessity — and they are dominated by the members of the Government party — to close 41 to 45 beds in Waterford Regional Hospital at Ardkeen. Waterford people always recognised that the South Eastern Health Board managed a tight ship and ran their affairs reasonably well. They were aghast that such a drastic measure was called for but stoically, recognising the dire national finanial situation, they accepted the painful decision that 41 to 45 beds should be taken out of Waterford Regional Hospital at Ardkeen.
However, no sooner was this done than the decision to close the infirmary was visited on the people of Waterford. That left the city and county denuded of acute hospital beds. The ratio of acute hospital beds is 3.7 to 1,000 of the population as I understand it. The city and county of Waterford has a catchment of 110,000 people and this large body of population was at that stage left with some 40 acute hospital beds which by any stretch of the imagination — you do not need to be a genius in health care, you do not need to be an expert, you do not need to have any knowledge of health care needs to know — was patently and totally absurd. There is no logic to what has happened: it is a disordered rout. It is panicstricken, ill-planned and badly handled. The South Eastern Health Board are engaged in a  ludicrous exercise of restoring the 41 to 45 beds taken away from the Ardkeen hospital earlier in the year. This is subsequent to the closure of the County and City Infirmary. What are people to think, I ask the Minister? I say they are, quite frankly, underwhelmed by all that has happened.
A geriatric assessment unit was constructed at Ardkeen hospital. It was impossible to open and commission it through lack of funding, so it sat there. It was decided to build it in the first instance because the needs of the geriatric patients in the region were quite clearly underlined. A geriatrician — one of the few in the country — was commissioned by the South Eastern Health Board on a part time basis to assess and review geriatric patients in this unit. They were then to have a health care programme worked out for them and were to be so treated.
The South Eastern Health Board, in order to make up for the closure of the infirmary, decided to open the geriatric assessment unit not for the purposes for which it was commissioned but for the surgical and medical needs of the region. This decision was described as disgraceful by a top medical expert, Dr. Ken Kelly, the recently retired director of community care in Waterford, a man who has no axe to grind, whose care, devotion and attention to the people of Waterford are above reproach. He went on record at a public meeting of the South Eastern Health Board saying it would be a sad day and would be a disgrace particularly with the cold winter months almost at hand if the elderly were once more to get the wrong end of the stick by being deprived of their assessment facility. In other words, the elderly in Waterford city and county are hostages to fortune and are subject to the maladministration, the poor thinking, lack of logic and the total absence of Government policy. Words practically fail me, I feel so very angry and furious at what has happened.
I speak with confidence knowing that my views are shared by the people in Waterford city and county. I am not into what I call shroud politics. I do not say  lightly people will die. In fact, I have never said that in any debate on health care issues because I actually believe that I know something about the matter. Mr. Gordon Watson a surgeon at Waterford Regional Hospital, Ardkeen, is not an emotional man, not a man given to headline grabbing, or a sensation seeker, but a quiet, dedicated, low key professional who was astounded at the extraordinary debacle which was taking place in Waterford city health care. He chose to go on record saying: that because of the reduction in surgical beds, both at Waterford Regional Hospital and the County and City Infirmary, the situation would worsen to such an extent that we would have no say at all despite putting strong pressure on the Department and that, in fact, people would die as a result of this decision. He asked: What about the poor?
It is said in Waterford city that this hospital will be taken over perhaps by the VHI, a consortium of consultants, or a British interest who will provide a private clinic in Waterford city. This hospital was specifically founded for the poor of Waterford city and county, and that is written in its charter. It is not a private Taj Mahal type hospital. It is a voluntary hospital for the poor of the city of Waterford and, come 31 October 1987, it will no longer be in existence. If that was not bad enough the Government published their Estimates. The amount of money on the capital side was reduced. I want the Minister to say — and I know he has a script ready — whether sufficient money has been made available in the Government's Book of Estimates to enable construction on Waterford's new regional hospital to continue. We are not like Cork where the North Charitable Infirmary can be taken away because the regional hospital is up on the stocks and running. At Ardkeen we have almost a hole in the ground with a little bit of building, some £2,500,000 of construction. I understand some £3 million is needed in 1988. We are left in an extraordinarily difficult position by virtue of the decision making that has gone on in  Waterford city.
The capital health programme has been reduced by some 28 per cent, or 31 per cent in real terms. In other words, a total of £43 million is being made available on the capital side. My understanding is that Waterford, Wexford and Sligo are in contention for this £43 million. I hope the Minister can say what the allocation is for each hospital. A contract has been signed with Waterford. I hope that means that contract can be honoured and the hospital building project can continue without any interruption. I would hate to think that it would be competing with Wexford and Sligo, deserving though their situations may be, for that scarce £43 million.
Work started on the new hospital on 26 January 1987 and so far £2 million has already been spent. I understand no contract has yet been signed for Sligo or Wexford and, therefore, there is no binding commitment to them. I trust the Minister will inform me that there is a binding commitment to Waterford.
Two hundred and two years of existence and of serving the people of Waterford city and county comes to an end on 31 October. The closure of the infirmary leaves an overall reduction of 66 per cent in surgical beds. I am sure the Minister will acquaint me with the fact that I have already brought to his attention that there is a measure to open beds that were already closed some months earlier in Ardkeen. The Department of Health officials, despite lots of questioning, were reasonably evasive on the subject. They talked about facilities being opened and strengthened at Ardkeen. I want to know how, when and where.
Cutbacks to the South Eastern Health Board's budget will be some three times greater next year than this year. Ardkeen will find it very difficult to cope with the increased volume. I remind the Minister that Ardkeen is a collection of largely prefabricated flat roofed buildings. It was originally a TB sanatorium and if one were to drive in there today one would still think it was a TB sanatorium. It is not a modern hospital. It is not able to cope and it will not be able to cope with  this increased volume of patients. I understand that the capital programme is under review. I want the Minister to be very specific about what exactly is planned and exactly what the allocations will be.
As far as I am concerned what has happened in Waterford is just about the most insensitive thing that could happen in health care. I have seen a most blatant display of ineptitude and inequality. It drives home the message that there are two tiers of health care opening up. Anybody who has money or is sufficiently well insured can have any item of health care delivered on a plate when, where and how they like. Anybody who is totally dependent on public health care must queue in the line. Apart from emergency and casualty service decisions in the main are taken on your length of time in the queue, not on the medical, surgical, paediatric or geriatric priority. That is disgraceful.
I merely want at this stage to reiterate my feelings of anger and frustration at what has happened to the health care services in Waterford. I accept the broad figures which the Government are coping with in the overall financial situation, as do my party. I am totally unconvinced that there has been any sensitivity, any thinking, any consultation, and any awareness of the actual situation on the ground as I know it to be in Waterford. There has been a debacle, and a disgraceful situation obtains which I am deeply unhappy about. I mourn the passing of the infirmary. I salute all those people who down the 202 years have worked there with dedication, caring, love, conviction and concern for and on behalf of the people of Waterford. I hope this period of Government which is devoid of hope, optimism or a basic thought-out policy will merely be a passing phase in the history of this country.
Minister of State at the Department of Health (Mr. Leyden) Terry Leyden
Minister of State at the Department of Health (Mr. Leyden): First, I have taken careful note of the contribution made by Senator Bulbulia and I welcome this opportunity to reassure the people of the  Waterford area that an excellent medical and surgical hospital service will continue to be available to them. The restrictions of the difficult current budgetary situation have resulted in both Waterford County and City Infirmary and the Waterford Regional Hospital, Ardkeen, making such reductions in services that it makes little economical or medical sense to maintain both hospitals. However, the closure of the infirmary will allow resources to be transferred to the Waterford Regional Hospital where they can be used more efficiently to maintain the level of hospital services in the area. Indeed, the hospital services will not only be maintained but will be developed when the new regional hospital currently under construction at Ardkeen is completed. I want to reassure the Senator that the Ardkeen hospital project will continue to completion as planned.
As all the Senators will know, when the Government took office they were so impressed by the seriousness of the country's financial situation they realised that drastic measures were necessary. One of these measures is the restriction of public expenditure and this necessarily places limits on the amount of money which can be spent on the health services and the hospitals. In order to contain expenditure within the 1987 financial allocation of £1,065 million, the County and City Infirmary had to make significant reductions in the level of services it provided. It had to close 35 of its 76 beds leaving only 41 beds. It was also necessary to let 15, and then a further 32, of its 98 staff go. It had to cease employing locum staff and restrict its casualty services to between 9 a.m. to 5 p.m. Mondays to Fridays. The hospital also had to make arrangements for the South Eastern Health Board to take responsibility for the education of its 35 trainee nurses. Similarly, the South Eastern Health Board have found it necessary to close 45 of the beds at Ardkeen Regional Hospital also in Waterford city in order to live within its 1987 allocation.
Senators will no doubt agree that it makes little economic or medical sense to maintain two acute hospitals within a  few miles of each other when in Ardkeen 45 beds have been closed and in the infirmary there are only 41 beds open. The public should be aware that both hospitals are within a relatively short distance of each other. This inefficiency would be particularly inexcusable at present when the resources available to be spent on the health services are necessarily limited and the best value must be obtained from every pound spent on health care.
In the light of these circumstances in which all the options were fully explored at a series of meetings between the hospital management and officials of my Department, I felt that, regrettably I had no other option in principle but to inform the County and City Infirmary that the hospital's funding could not be continued beyond this year. I can assure the Senators that this decision was taken only after full and careful consideration of the situation and with a very real sense of regret. I can only express my admiration and respect to the board and staff of the hospital who have made such a contribution to the health services in the Waterford area throughout its long history. That decision was taken reluctantly by the Minister, Deputy O'Hanlon. The board of governors deserve great respect for the dignified manner in which they faced up to reality by deciding that on financial grounds the hospital had to close by 31 October this year.
I would like to take this opportunity to assure Senators that the majority of the remaining 51 staff in the infirmary will be redeployed to the South Eastern Health Board and will take up employment either in Ardkeen Regional Hospital, Waterford, where additional beds are being provided, or in other vacant posts in the area. I understand that approximately ten staff will be availing of the early retirement-redundancy package and discussions with the relevant trade union regarding redeployment and early retirement-redundancy are at an advanced stage. The retirement-redundancy package is very generous in the present difficult economic circumstances.
This regrettable loss of the infirmary  will not affect the level of hospital services in the Waterford area. The infirmary's closure will allow resources to be redeployed to Ardkeen Regional Hospital, Waterford, where they will be used more efficiently to provide additional beds there. Officials of my Department have recently met representatives of both the South-Eastern Health Board and the infirmary to ensure the smooth transfer of responsibility to Ardkeen Regional Hospital, Waterford. It has been agreed that additional medical and surgical beds will be provided at Ardkeen from 1 November and that existing accommodation will be adapted to provide an additional operating theatre there. Perhaps some of the views which the Senator has quoted may have changed in the light of the decisions which have been made in relation to Ardkeen.
In addition, a new extension will be built to the existing out-patients department at Ardkeen to cater for the increased demand. In this way, the level of hospital services in Waterford will be maintained and the best possible value for money achieved. In addition, the completely new regional hospital which is currently under construction at Ardkeen at a cost of £52 million will further develop health services in the area. I must re-emphasise that the Ardkeen hospital project will continue to completion as planned and the people of Waterford should be very pleased at the commitment of my Department to the medical interests of the people of Waterford.
This development will increase the total number of available acute hospital beds in Waterford city from 437 to 470. The new hospital will provide the southeast with a full range of regional hospital specialties in new integrated accommodation which will enable the medical care to be of the highest standard.
In conclusion, I would once again like to express my appreciation to the board of governors and staff of the County and City Infirmary. This hospital which was formerly a leper hospital was established by an Act of Parliament in 1896 and since then it has continued to provide an excellent service to the Waterford area.  Officials of my Department will be available at all times to discuss any issues which may arise from the board's decision as to its future. Information in my Department states that the existing building is an actual fire hazard and it would cost approximately £125,000 to make it safe. Again, I thank the Senator for raising this matter and I hope that our reassurance on health services will be accepted by the people of Waterford.
Mr. O'Shea Mr. O'Shea
Mr. O'Shea: Will the building programme at Ardkeen continue as per schedule next year?
Mr. Leyden Mr. Leyden
 Mr. Leyden: I have stated what the situation is, Senator.
Mr. Ferris Mr. Ferris
Mr. Ferris: Is it a fact that you will put £3.5 million into the Ardkeen hospital project next year?
Mr. Leyden Mr. Leyden
Mr. Leyden: The project will continue on schedule.
The Seanad adjourned at 8.30 p.m. until 10.30 a.m. on Thursday, 29 October 1987.
Seanad Éireann 117 Adjournment Matter. Waterford County and City Infirmary.