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Seanad Éireann debate -
Wednesday, 4 May 1983

Vol. 100 No. 5

Adjournment Matter. - Sligo Hospital Extension.

I should like to wish the Minister well in his positions as Minister for Health and Minister for Social Welfare and I know that he will do his utmost to carry on the functions and the duties of that position.

I have raised the matter of the proposed extension to Sligo Hospital due to the decision of the Government to defer the building of that extension. The extension had been proposed by the Minister for Health of the previous Government, Deputy Woods. The commitment to provide the extension to the hospital was made in April 1981 at a prize-giving and presentation of certificates to nurses at Sligo General Hospital who had come from the training school there. We find then that everything proceeded as planned. Even in the 1983 Estimates as prepared by the outgoing Fianna Fáil Government a provision was made for the commencement of the proposed extension to Sligo General Hospital.

People may ask why Sligo Hospital needs an extension. This hospital serves a population of approximately 100,000 from Counties Leitrim, Sligo and South Donegal. For a number of years past a situation of overcrowding has been developing in the hospital. I know from personal experience that this hospital is totally overcrowded. During recent years a number of patients have had to be housed in beds placed in corridors. I feel this is a reflection on Irish society. We know that people have the right to get equal treatment under the Constitution, but the people of this area have not been receiving fair treatment with regard to the health services being provided. In the hospital at the moment there is a lack of diagnostic and treatment facilities. This, coupled with the overcrowding situation, make it a matter of urgency that something should be done to improve the facilities of the hospital. The only way this can be achieved is by providing the extension as proposed.

Let us consider the figures with regard to the number of people who were patients in the hospital in 1982. The medical unit, with a complement of 55 beds, treated 2,780 patients with an average stay of 7.6 days per patient, which left a bed occupancy of 105 per cent. In the surgical area, we had 3,149 people treated in a 69-bed unit. In a 30-bed maternity unit we had 1,813 people, which was 98 per cent occupancy. If we go through the other sections in the hospital we find that every section is shown to be overcrowded. We see that in the ENT section with 14 beds 1,149 patients were treated, with an average stay of 4.9 days which leaves a bed occupancy of 111 per cent. These figures are alarming. Coupled with the position there and the needs of the expanding population in the area, I feel that the Government have an obligation to continue the programme as proposed by the previous Government.

The Minister addressed Comhairle na nOspidéal earlier this year with regard to hospitals and capital expenditure in the years from 1983 to 1987. He stated as follows:

So am I now devising a medium-term capital development programme for submission to the Government for the years 1983 to 1987 with a major emphasis on schemes to which contractual commitment exists, developments involving the replacement of seriously sub-standard accommodation facilities, developments in areas where there is no service or where services are seriously deficient and developments which give rise to little increase in revenue expenditure. This must mean inevitably that some projects which may be at a very advanced stage of planning will have to be deferred or reduced in scale. The implications of this approach are that in the Dublin area Beaumont Hospital will be completed with an opening date of about mid-1985. The first phase of the development of the Mater Hospital will be completed, as will the development of St. James's Hospital.

In the rest of the country, the new hospital in Tralee will be commissioned and development at Mullingar General Hospital and Cavan General Hospital will commence. The programme will also include provision for a new surgical department at Wexford General Hospital, the provision of improved theatre facilities at Kilkenny General Hospital, as well as the provision of additional departments and facilities at the new Letterkenny General Hospital.

And to complete the picture of concentrating on at least one major development in each health board area in this period, the identification and planning of the areas of the Limerick Regional Hospital most in need of development will be carried out, as will the phased development of Galway Regional Hospital.

As I have mentioned, this necessarily limited programme means the deferment of a number of projects which are at an advanced stage of planning. Included in this list must be a number of projects such as the development of Castlebar, Sligo and Ardkeen General Hospitals.

Indeed, I am glad to note that since then the Minister has decided that the hospital in Castlebar should proceed. I would hope that after this evening's debate he would decide that the same should happen as far as Sligo Hospital is concerned.

As I said earlier, the Minister's health budget for capital expenditure this year at £55 million is reduced by £2 million to £53 million. It appears that of that £2 million reduction, £1.5 million is due to the deferral of the proposed extension to Sligo General Hospital. The Minister may feel that this is not a priority as far as the country is concerned, but for the people who live in that area it is a major necessity. We know that Sligo itself is approximately 140 miles from Dublin. That means that the hospitals in Dublin are not in a position to take up the overcrowding which is being caused in Sligo.

We know also that hospitals which provided reduced medical service, such as Manorhamilton, were downgraded. I might make reference at this stage to the Minister's commitment to the provision of the orthopaedic unit and remedial facilities in Manorhamilton, which is to be welcomed as a development for the north-western area. It still leaves the general medical field in that area very short of necessary facilities. Even in the local press recently there appeared photographs of patients in corridors in the hospital, patients in overcrowded wards and staff trying to provide facilities which were beyond them due to the lack of working accommodation.

No doubt the Minister will produce various statistics showing that there may be greater need in other parts of this country for the provision of extra facilities. He may say also that the necessary capital and finance is not available for the running of this unit, should it be provided. The North-Western Health Board recently, I believe, made a request to the Minister to allow the proposed hospital scheme to continue on a phased basis over a number of years. I would ask the Minister to consider allowing this development to be carried on because if the necessary finance is not available in full at least the commencement of the work should be set about. The Minister was requested by the health board in early March to consider that phased development programme.

He recently met executives of the North-Western Health Board and officials of his Department had discussions with them during the past fortnight. They explained to the Minister and to his officials the need for this development as a matter of urgency. I do not know whether the Minister has had the pleasure of visiting the hospital since he became Minister, but I have no doubt that if he were to visit it and see the problems and the conditions under which staff there are trying to carry out their duties he would treat it as a matter of urgency.

I believe that the dropping of the project until after 1987, as would appear to be indicated by the Minister's statement to Comhairle na nOspidéal earlier this year, would cause major problems to the North-Western Health Board and to the hospital authority in the coming year. Not alone that, but with inflation the proposed project at £25 million in 1982 Estimates would cost possibly in the region of £50 million to £60 million. I fear that if it is allowed to be deferred indefinitely the net result could be that the proposed extension will never materialise. The Minister has a duty and I know he is well aware of his duty to the population and to the people of this area, as well as to the North-Western Health Board, to provide this facility.

I would hope that the Minister, as a result of the discussions which his Department have had with the North-Western Health Board and with the personnel from the hospital, would now be in a position to reconsider the future of the extension and allow it to go ahead. The possibility that somebody has said — and I am not saying whether this has come from the Department or not, but it is alleged to have come from it — that the plans are not in order is being used as a camouflage and as a delaying tactic. We have all seen it used by various Departments and the fact that plans may not have been totally detailed has caused the deferral of programmes of development.

I would ask the Minister to give us a commitment that his Department will proceed as quickly as possible with the development of the extension to Sligo General Hospital. I would ask him to give this commitment in the light of the commitment which he recently gave to Castlebar. The problems at the moment in Sligo are more acute than those in Castlebar. I would hope that it would not need a television programme to force the Minister to make a decision to allow the extension to Sligo hospital to proceed.

Therefore I am asking the Minister, as a matter of urgency, to authorise his Department to proceed with the proposed extension and to ask the Minister for Finance, if he has not already done so or if he cannot do so from within his capital allocations, to make available to his Department the necessary finance to allow this project to continue. If it does not, we will at a later stage have major problems with regard to this hospital and the danger which I can see is very real. There is a danger that we could have an outbreak of fire within the hospital which would pose a major threat to life. This is something which the Minister must consider. Anybody here can well imagine the pandemonium that would be caused if there were to be an outbreak of fire in a hospital which was totally overcrowded. I am asking the Minister on behalf of the people who use the facilities of this hospital to make available the necessary finance to allow the project to proceed.

I thank Senator Ellis for giving me the opportunity to outline my position regarding Sligo General Hospital. The proposal which the Senator has raised is for a further major development of Sligo General Hospital. As we know, stage four planning of that project, that is the preparation of detailed working drawings and the final building specifications for the hospital, has been completed. The relative magnitude of this scheme and the understanding I have of a lack of absolute priority in terms of essential needs is an obstacle at this stage to further progress on this proposal. The current restrictions to which the Senator quite rightly alluded, on the availability of capital and revenue resources for the health services demand that the most careful consideration be given to development decisions which carry with them very major financial implications. The implications of the proposal I have before me now are very major indeed. The sum involved is not £25 million, as the Senator mentioned; it is £34 million at 1983 prices, which includes cost of equipment and the inevitable fees related to such projects. Admittedly, the £34 million cost at 1983 prices would be spread over five years but nevertheless it is a very substantial sum of money.

Last year it cost the Department £8.8 million to run Sligo hospital. In 1983 over £9 million will be spent on the hospital and if we were to provide the additional 150 beds the revenue implications would be that it would cost £13 million to run the hospital. That is the magnitude of what is proposed. The proposed project would cost £34 million at 1983 prices and my total capital budget for all hospital development this year is £53 million. If a project is started in 1983 it must be completed in five years since there is not much point in having contractors on the site and the cost to the Exchequer would be quite enormous. It is a very major project which would involve the building of a large eight-storey block to the east of the existing hospital with an interface link building.

I accept that there is a degree of overcrowding but it is no greater than that in a number of other hospitals. The 93.7 per cent occupancy figure quoted by the Senator is accepted but St. Vincent's Hospital nearby has a 97.0 per cent bed occupancy and Castlebar has over 100.7 per cent bed occupancy. The situation is not satisfactory and there is a degree of overcrowding in the medical, maternity and the ENT departments but overall in the context of overcrowding in hospitals generally it is not exceptionally out of the ordinary. I cannot give a definite indication regarding Sligo until I complete my review of the revenue implications of the project itself.

We have to look at Sligo also in the context of hospital developments generally in the North-Western Health Board area. There has been considerable progress in the area and this is universally accepted. In recent years there have been very significant developments in Letterkenny where a major extension is almost completed and where further developments are under way. At Manorhamilton the health board have commenced the development of a major regional rehabilitation unit. We have also approved the creation of a post of consultant group rheumatologist. In Sligo it is important to point out that an orthopaedic unit was opened in August 1981, with 52 beds in that unit alone. I would be surprised if anybody would suggest a prospect of fire hazard in a building two years in existence. I have not heard any such report.

In Letterkenny less than two years ago a five-storey tower block was completed and this building now accommodates 250 beds together with theatres. The existing hospital is now being refurbished and this work should be completed within the next few months. By that stage the total bed complement in the hospital will be increased by 140. The ancillary facilities in Letterkenny include the OPD and radiology departments that are being planned at present. Therefore the capital cost of works so far completed in Letterkenny is £11 million. On the ancillary facilities in Letterkenny another £3 million has been expended.

On a point of order, the Minister is referring to Letterkenny. It was the matter of Sligo General Hospital that I raised.

I am referring to it in the context of overall expenditure in the health board area. There has been considerable development of general hospital services in the north-west in recent years. Those factors have to be taken into account when planning the capital programme.

Having said that and entered those fairly rigorous strictures in relation to the situation in Sligo, the North-Western Health Board are aware that, having regard to these developments in their own area and the cost of the health services generally, they cannot reasonably expect that the full development of the Sligo General Hospital can be permitted to go ahead at present. Consequently a revised proposal has been prepared and submitted by the health board for a limited development of the hospital which will cater for the facilities under greatest pressure and which will have few or no revenue consequences.

It is a marked feature that what hospitals need, apart from medical and nursing staff, is space. The more beds provided the more they are occupied, irrespective of need. The propensity for hospital beds to be occupied is amazing. For every bed one must provide additional nursing staff — not just one nurse per bed — and additional ancillary staff. The cost is phenomenal. Therefore the greatest care has to be exercised because the propensity of consultants, general practitioners and referral agencies to have beds occupied irrespective of whether people should be in those beds is very considerable. That is why we are now spending £750 million a year on institutional care. Seventy-five per cent of the health budget goes in that direction and a great deal of the money goes on acute hospital care.

The Senator can be assured that a revised proposal has been prepared and submitted by the health board. We are carefully checking the revenue implications for the capital programme. As recently as the past few days preliminary discussions on this proposal took place between officers of my Department and officials of the health board and the hospital staff. The various options open and available for the phased development of the hospital will now be considered in detail and the relevant costings determined. The outcome of this examination is awaited. When it is completed I will consider seriously the possibility of allowing a phase of the development to proceed within the context of the current medium-term capital development programme for the health services. I will be in Sligo meeting the CEO and his programme managers on 16 May and the Senator can be assured that I have the highest regard for them. I will have to ask very direct questions in relation to Sligo hospital and any phasing of developments which we propose for the hospital.

Meanwhile I have received many thousands of petitions and a large number of letters from public representatives in the area. I appreciate the Senator raising the matter tonight and his concern will be taken into account.

I conclude by saying that a revised proposal has been prepared. One is never amazed at this stage to receive so many revised proposals from so many health boards about so many proposed projects which start out at anything ranging from £30 million to £50 million. When one really gets down to what the actual needs are and what can be done in the context of existing needs, these turn out to be necessary and often reasonably modest projects which are capable of being fulfilled. That has applied in relation to the South-Eastern Health Board, the Western Health Board and now the North-Western Health Board. We will work it on from there. I can assure the Senator that there will be no delay in my advising him and his fellow public representatives of my decisions in this matter.

The Seanad adjourned at 8.30 p.m. until 10.30 a.m. on Thursday, 5 May 1983.

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