Seanad Éireann - Volume 117 - 29 October, 1987

Adjournment Matter: Baggot Street (Dublin) Hospital.

Mr. Doyle: I would like to express my appreciation to you, a Leas-Chathaoirligh for your decision to allow me to raise this important issue this evening. I would also like to thank the Minister for his attendance which I greatly appreciate.

The Royal City of Dublin Hospital was founded in 1832. For more than 150 years this hospital has provided a caring and effective hospital service. To the great credit of the hospital board the service and facilities were continually updated so as to provide patients with the best diagnostic facilities, treatment and care. Patients from an area roughly covered by the constituency of Dublin South-East constitute the largest geographical group [1066] of those attending the hospital. The cardiology and pulmonary units have given the hospital a national function.

At this stage I would like to briefly outline the activities of the hospital. In 1986 some 6,352 patients were admitted representing 19 per cent of an increase over a five-year period. The average length of stay for patients was less than eight days which compares very favourably with other general hospitals. Over 17,000 attended out-patients and specialist clinics in 1986. The attendance at the hospital's casualty department during 1986 amounted to over 22,000. Later, I will refer to the casualty department aspect of the hospital. During the same year the number of X-ray examinations carried out amounted to 33,000. I quote these figures briefly to show that the hospital has served the community well over the past number of years. I believe the closure of the hospital would be a mistake.

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

The trustees of the board and staff directly involved, and the broader community which saw the closure of Mercers and Sir Patrick Dun's hospitals, were partly reassured that on the closure of Sir Patrick Dun's many of the facilities for the community would henceforth be carried out at the Royal City of Dublin Hospital, Baggot Street. I am now extremely worried about the imminent and possible closure of Baggot Street hospital because of the substantial reduction in money allocated by the Department of Health.

The trustees of the Royal City of Dublin Hospital have submitted a proposal to the Minister. The board is [1067] anxious to develop a community hospital to provide secondary hospital care closely integrated with the community services in the area. This type of hospital would meet the requirements of the people of the area for general, medical and surgical services on an out-patient and in-patient basis. It would be ancillary to the major hospitals with high tech specialties. I understand this proposal was submitted to the Department of Health earlier this year and was followed by discussions between representatives of the Department and the hospital. I understand the Minister stated he was not in a position to respond at that time but would put the proposal on the table for further discussion.

The reason I have raised the matter on the Adjournment this evening is to find out the Minister's thinking in regard to the community hospital aspect. Living in the area I know, understand and feel that there is a clear need for a secondary hospital like the hospital in Baggot Street to provide back-up facilities and to take patients out of the acute expensive beds who do not need to be there in the first instance, thus preventing acutely ill patients from getting the kind of specialist treatment they require. The area need the retention of a local community hospital which at present the Royal City of Dublin Hospital provides. The south east part of Dublin city is often regarded by many as an area where people can provide for their own medical treatment. Many of those in the catchment area of Baggot Street hospital are not affluent, Many are on a low income. One of the striking features of that area is that a large portion of the population is over the age of 65 years. There are statistics to back up the fact that people on low incomes have a higher incidence of certain kinds of illness. We are then talking about a community that needs a hospital as an absolute necessity and not a luxury.

Subsequent to the submission of the hospital's proposal to the Department of Health, the Department have now advised the hospital of its financial allocation for this year. The allocation was [1068] 18 per cent short of the 1986 and 25 per cent short of 1987 figures. The hospital was advised of its allocation in April which effectively left eight months to achieve the necessary savings. Since then services in the hospital have been severely curtailed. Half of the wards have been closed since 1 July 1987. It was necessary to let go 40 temporary and locum staff. Following a series of meetings with the Department of Health, the board has been advised by the Minister that he intends to transfer the services at present maintained there to St. James's Hospital as soon as possible. Indications are that a transfer will take place before the end of this year.

On the proposed transfer of services, the Department of Health asked the board of the hospital to discuss with the Eastern Health Board the possibility of providing bed facilities for long term patients on a temporary basis until 1 April 1988 and also with regard to providing a health centre in Baggot Street hospital for a period of two years. In approaching the board with this proposal, it is clear that the Department of Health have put a knife to the hospital board's proposal in regard to a community hospital to serve the medical needs of the community, a hospital that could provide in-patient, out-patient and casualty services.

I must outline to the House my recent experience of casualty services. My young son injured his hand playing football. His finger appeared to be fractured. Even though I only live one mile from Baggot Street hospital I knew there was no point in bringing him there as the casualty service closes before 6 o'clock due to the cutbacks. When I arrived at St. Vincent's Hospital I was informed that the casualty service for the catchment area in which I live was being provided that night by St. James's Hospital. Luckily I had transport and was able to drive from St. Vincent's Hospital to St. James's Hospital, — if I had been without transport I would have had to take about three buses from St. Vincent's Hospital to St. James's Hospital. When I arrived at St. James's Hospital at 8.10 p.m. I paid the required fee of £10 and I was shown [1069] into a waiting room. It was not until 12.25 a.m. the next morning that my son saw the doctor and it was 1.30 a.m. before we left the hospital. I had to get a taxi home. If I were unemployed and could not afford a taxi I just do not know how I could have got home from St. James's Hospital to where I live.

I make this point because it has been pointed out that the new provisions at St. James's Hospital will provide the necessary services for that catchment area. Here is an instance where, sadly, the service is being provided after a long wait. For the first time that night I had a glimpse of what I have now come to understand in Irish society as a two-tier medical system, those who can afford private medicine and those who have to depend on the State.

Hospital staff in all categories are affected by the changes which are taking place in Baggot Street. It is a major concern of the board to ensure that their interests are protected. It is very sad for them to see the acute services which have been developed in this hospital over many years and which were working very effectively and economically and are now being dismantled and transferred elsewhere, and shortly Baggot Street will cease to be an acute general hospital.

It is most regrettable since the board of the Royal City of Dublin Hospital believe that the hospital can be developed into a community hospital providing high quality and cost effective secondary hospital care for the south inner city. Because of its historic character and location it is uniquely qualified to do so. In addition, the development of the Royal City of Dublin Hospital as a community hospital provides an opportunity to explore the integration of primary and secondary medical care which would lead to an improvement in the overall quality of primary care, together with a reduction in the rate of hospitalisation.

In view of this, I ask the Minister to reconsider his decision on Baggot Street hospital. I further understand from a question the Minister answered in the Dáil, that the Eastern Health Board will take responsibility for the provision of [1070] the finances to allow Baggot Street hospital to continue a service in its new role. Would the Minister point out what that service and role will be? I hope that he will not say that it is just a possibility of providing some beds for long term patients on a temporary basis until next April and a health centre for the next three years. The catchment area of Baggot Street hospital deserves and expects more.

Minister for Health (Dr. O'Hanlon): The fact that this matter has been raised gives me the opportunity to explain to Members the short term difficulties that have arisen and the need to rationalise services in the Dublin area. It is estimated that there is a surplus of 1,600 acute surgically manned beds in the Dublin hospitals. I think we all appreciate that we must bring expenditure into line with what we can realistically support while ensuring that the basic fabric of our health services is protected. The point raised by Senator Doyle about his experience with his child going from Baggot Street hospital to St. James's Hospital raises the fundamental issue of how accident and emergency services should be provided in any city. It is not something new and it is not as a result of the cuts, in fact if the same happened last year Senator Doyle would have had exactly the same experience because there are only three accident and emergency units in south Dublin which rotate between St. Vincents, St. James' and the Meath/Adelaide which are part of the Manch group of hospitals. The problem is whether we want a high-tech accident and emergency unit in one major hospital or whether we want a number of smaller units around the city in various hospitals. Obviously, first there would need to be a population to justify a major accident and emergency unit. I believe that even though people have to travel a little further in the larger cities it is in their best interests that there should be well staffed major accident and emergency units. I will gladly pursue Senator Doyle's point about the long wait he had in St. James' Hospital because a long wait in a casualty [1071] unit does not necessarily result from savings in the hospital.

The redistribution of available resources towards primary health care and towards health promotion will mean a shift of resources to some extent from institutional care and a reduction in the number of beds in our acute hospitals. This change of emphasis and consequent redistribution of resources can only be achieved on a phased basis. I am satisfied from my own experience, from the many reports which have been completed on the subject and from the information available to my Department, that there is scope for a significant reduction in the number of acute beds. A major development programme in our general hospital system in recent years has resulted in the upgrading of some existing hospitals and the building of a number of new hospitals. The underlying rationale behind the programme is that a smaller number of larger sized well-equipped modern hospitals located in a major population centre is preferable, more efficient and more effective in responding to the needs of the population than a large number of small hospitals. It was always envisaged that the programme would result in the closure of a number of older hospitals to enable the new developments to come on stream.

The general hospital development plan for south Dublin provided for the development of three major acute hospitals, St. Vincent's, St. James's and Tallaght hospitals. A major capital development is currently being carried out in St. James's Hospital which is intended to cater for a population of approximately 200,000 people from the south central area of Dublin city and county along with the northern portion of County Kildare. The total development will cost in excess of £100 million, a considerable proportion of which has already been spent. It was always intended that acute services, particularly those of higher specialty such as cardiology, thoracic surgery and respiratory medicine presently located in Baggot Street hospital would transfer to St. James' [1072] Hospital. For a number of reasons, not least of which is the need to concentrate essential activities in hospitals which are medically viable and eliminate avoidable management and maintenance overheads, it is now necessary and appropriate to advance this programme.

While this acceleration has created difficulties for all concerned in the short term it is the best option available in creating an integrated rational cost-effective arrangement of services. It will enable all key services to be brought together under a unified management, leading to the elimination of unnecessary duplication of services and facilities. As Senator Doyle knows, it was intended that when the high-tech services would be moved out of Baggot Street hospital to St. James's Street Hospital, Baggot Street hospital would close but when I took office in March, six months ago, I looked at the situation and because I am aware, as Deputy Doyle has pointed out, of the structure of the population in that area and particularly having regard to the number of people over 65 years of age, I decided that we should not close Baggot Street hospital.

The transfer of the acute services which is due for completion on 31 December 1987 and which, with the co-operation of all parties, will be possible to effect with minimal disruption of service and without imposing hardship on the staff. Obviously, at this stage it was necessary to see how the existing facilities in Baggot Street hospital could be used. Discussions are ongoing between the hospital board, the Eastern Health Board and St. James' Hospital with a view to ensuring that the optimum use is made of the resources which will become available after the transfer of acute services from Baggot Street hospital. The hospital board have agreed in principle that the following services will be provided at the hospital: accommodation for a number of longstay patients, a community health centre, a minor casualty service staffed by local general practitioners. It is intended that these services will be fully intergated with all other health and welfare services provided in the area. The proposal that the [1073] hospital board have made to be about continuing as a community hospital is the subject of detailed examination in my Department and we will be responding to this suggestion as soon as this examination is complete.

I would like to put on record my thanks for the co-operation which may Department have received from the board of management of the hospital. I agree with Senator Doyle as to the excellence of the work that was carried out in the Royal City of Dublin Hospital in Baggot Street since it was built in 1832. I would like to pay tribute to the medical consultants, the nurses and all the staff involved in planning and carrying out what has been a difficult exercise under considerable constraints. I have no doubt but that the services transferring from Baggot Street will continue to be held in very high regard in their new location and I am satisfied that the services that will be provided in Baggot Street hospital will then [1074] cater for the needs of the people in the area.

Mr. Doyle: May I ask the Minister a question?

Acting Chairman (Mr. J. Daly): Yes, one question.

Mr. Doyle: The Minister has outlined briefly the future role he sees for the hospital, but have the local general practitioners discussed that with the Department?

Dr. O'Hanlon: Discussions are on going between the hospital board, the Eastern Health Board and St. James' Hospital and it would be a matter for the Eastern Health Board to have discussions with the general practitioners.

The Seanad adjourned at 6 p.m. until 2.30 p.m. on Tuesday, 3 November 1987.