Deputy Crotty has received permission to raise on the Adjournment the question of the threatened work to rule at St. Luke's Hospital, Kilkenny. I should like to tell the Deputy that only the work to rule element of his question can be discussed. The other element of the question has been ruled out because it would require legislation which cannot be taken on the Adjournment.
Adjournment Debate. - St. Luke's Hospital, Kilkenny.
I will only concern myself with the work to rule element because it is of vital importance. It is sad that I have to bring this matter to the attention of the House. It is the first time I have heard of the nursing profession threatening a work to rule. The nurses, at a meeting in Kilkenny last night, took this decision and I am sure it is worrying thousands of people in the constituency of Carlow-Kilkenny, which is served by that hospital. From midnight on Sunday the work to rule will commence with the result that only emergency cases will be admitted. I should like to tell the House that at present there are 300 surgical patients on the waiting list for that hospital but as a result of the work to rule that list will increase dramatically.
This is one of the busiest hospitals in the country and the work to rule will mean a deterioration in the services provided there. The hospital was built to cater for 132 beds but it is now catering for 174 beds as well as an average of 25 beds in the corridors at all times. Those beds must be accommodated in the corridors if people are to be catered for. Admissions to the hospital from 1977 to 1979 increased from 6,200 to 10,000, a dramatic rise. During that time only two additional nurses were appointed but from 1972 to 1979 the number of consultants was increased from four to eight. Surely that is an indication of the need for additional nurses. The people of Kilkenny are pleased to provide a service for their neighbours in Carlow but the need to do so has put an extra strain on hospital accommodation and on the staff. The result has been that St. Luke's has the distinction of having the fastest turnover of patients of any hospital. The number of days per patient is lower in St. Luke's than in any other hospital. That can be a dangerous situation. The medical profession feel that they have to send people home before they are quite ready for discharge because of the lack of accommodation. That can result in readmission or people's lives being in danger.
I understand that the nurses sent a letter to the Minister on 30 January setting out their staff requirements. They asked the Minister to consider this matter urgently. I was disappointed to learn that the Minister did not reply to those responsible people. I accept he is very active and is doing a good job, but he has not adopted the proper approach to this delicate problem which is causing great concern in the area. The work to rule will also mean additional work for the doctors because nurses are refusing, for example, to take blood samples. In the hospital blood samples are taken between 6 a.m. and 7 a.m. and dispatched by train to Ardkeen Hospital. I should like to add that the consultants at the hospital are behind the nurses in their demands and support their decision to introduce a work to rule. From midnight on Sunday patients being moved to the X-ray department will not be accompanied panied by nurses. The nurses have also indicated that they will not undertake any clerical work dealing with admissions and discharges and that will lead to difficulties in the administration section.
Three nurses must work the three wards on each floor. The accommodation consists of two eight-bed wards, a 15-bed ward and an average of five or six in the corridors. Those nurses must look after 37 patients at a time. A lot of those patients are elderly people who must be given special care. Because of a shortage of staff the nurses are not able to give them adequate attention. This situation is frustrating so far as the nurses are concerned and they are not prepared to continue to work in such conditions. Because of conditions at the hospital the turnover in nursing staff is very high. The nurses have been bringing the situation to the attention of the Department for some time so that the Minister has had ample warning of what is about to happen at St. Luke's. I understand that last week the Minister met a delegation from the South-Eastern Health Board who put the case to him very strongly. Today I was amazed to receive a reply to a written question that I had tabled in this connection telling me that while the matter is under consideration it is unlikely that extra appointments can be financed in the present year.
The people in the Carlow-Kilkenny area are not prepared to tolerate any longer the service provided at the hospital. They are not prepared to accept the reduced service that would result from the nurses adopting the militant attitude that they propose to adopt. I have spoken to the nurses at the hospital. They are doing a wonderful job in extremely difficult conditions but they have been provoked into taking the action that they propose to take now. It is only after very careful consideration that they have decided to take this militant action.
Perhaps the Minister will tell us where he intends providing facilities for patients if nursing services are not available at St. Luke's. Has he any plan to deal with a work to rule situation on the part of the nurses? Are not the nurses' demands justified? Are they not reasonable? I invite the Minister to visit the hospital with me in order to see for himself what the situation there is. The nursing staff must be increased. Even at this late hour I hope that good sense will prevail and that the extra appointments will be made. The nurses are intent on the staff quota being filled. They want a written guarantee that arrangements will be made within the next week or two to make the necessary appointments. In the event of their being given such a guarantee, they will be prepared to call off their proposed action.
At this twelfth hour and when every possible avenue has been explored by the nurses in their efforts to have this problem resolved, I join with Deputy Crotty in appealing earnestly to the Minister to take the necessary steps to avoid the action proposed by the nurses.
The hospital concerned is one of the finest and best in the country. It has earned this good reputation as a result of the dedication of the staff at all levels but because of the inadequate staffing at the hospital there is a great risk of some tragedy occuring which, apart from being tragic for the patient concerned, would result in the hospital getting a bad name unjustifiably.
In my appeal for the appointment of the necessary additional nursing staff at the hospital I am being as earnest as was the Taoiseach when he went on television before Christmas to appeal to those in employment to have regard to industrial peace. The staff at St. Lukes have shown every regard for the patients but they have also the utmost regard for industrial peace. However, their dedicated work has not been appreciated bu the Department. Because of the attitude of the Department the nurses are being forced to take industrial action. This is most regrettable but in their action they have the full support not only of all the other staff at the hospital but of the people of Carlow and Kilkenny who realise that the demands of the nurses are justified.
The Minister should heed the appeal of the Taoiseach in regard to management and workers to take every step possible to avoid confrontation. The matter rests now with the Minister and his Department. They must do everything possible to avoid the serious situation threatened for next week.
This hospital caters for a population of about 100,000 people. One notices often that when property, for instance, is in danger every effort is made, whether by way of making available additional gardaí or otherwise, to protect that property but sometimes when there is a question of danger to human life, there would appear to be insurmountable problems in so far as the Department are concerned in regard to meeting the requirements of the situation.
The case in question has been documented fully in correspondence both to the Minister and to his predecessor. Both Deputy Crotty and I represent this area and we are both members of the South-Eastern Health Board. We are doing everything possible to persuade the Minister to allow for the provision of the necessary additional nursing staff for this very busy hospital. If our efforts are not successful the Minister and the Department will have to accept whatever may be the consequences because there is nothing more that the staff can do the meet the situation.
I have been aware for some time of the representations made by the nursing staff at St. Luke's Hospital, Kilkenny, regarding conditions. The two points at issue are overcrowding in certain areas of the hospital and the need for additional nursing staff. Officers of my Department have been in regular contact with officers of the health board in the matter and I understand that the programme manager of the health board has discussed the matter on a number of occasions during the current month with representatives of the nurses.
I received a deputation from the South Eastern Health Board, including the Chairman, on 11 February and one of the matters discussed was the position of St. Luke's Hospital. The deputation explained the position regarding the overcrowding at the hospital and the need for additional nursing staff. Deputy Crotty referred to the appointment of additional consultants at the hospital. The position concerning the appointments was that in 1977 one obstetrician-gynaecologist, one house officer, one ward sister, five nurses, one dark room technician and two grade II clerks and one porter were approved. In 1978 one consultant physician, one ward sister, eight staff nurses, one porter and one domestic were approved.
Did this cover outpatients?
These are the actual appointments of consultants and additional staff. I mentioned them as a matter of fact.
I undertook to consider the position as sympathetically as possible having regard to the current budgetary position. As regards overcrowding, there is no immediate solution to this problem. The demand on the available hospital beds continues to increase and this places a strain on the staff and on the existing facilities in the hospital. As has been suggested by the Deputies, this is due in part to the increasing number of people coming to the hospital because of the extra consultants there.
However, work on an extension to the hospital which will provide an additional 14 maternity beds has commenced and these should be available next year. In addition to this development I will be informing the health board shortly that provision is being made in the capital programme for the current year to enable planning of a further 14-bed unit to be undertaken.
The overall development of the hospital is also under consideration by a project team comprising officers of the health board and of my Department who recently completed the planning brief for the development. A design team is at present drawing a development control plan which will be available later this year. This will enable the development of the hospital to meet the needs of its catchment area to be pursued in an ordered manner as funds become available.
As regards the additional nursing staff sought by the health board, as I indicated in my reply to the Deputy's question earlier today, this matter is under consideration in my Department but it is unlikely that extra appointments can be financed in the present year.
The House will be fully aware from recent Government statements and from the current budget discussions that constraints on expenditure will be necessary this year. This is a fact which must be faced in all sectors of the public service and it will not be possible to provide for expansion in the health services as in recent years.
The measures to be taken locally in relation to the action proposed by the nurses is primarily a matter for the South Eastern Health Board. I understand the board have the matter under active consideration and are keeping in close contact with the situation. I received a letter of 30 January from the representatives of the Irish Nurses' Organisation at St. Luke's Hospital which gives details of their proposed plan of action. I will be replying to this letter shortly.
I appreciate the difficulties for the hospital staff and I am confident that even in taking the action which they propose the nurses will continue to look after the patients in a humane and considerate manner. I trust that the health board and the nurses will find it possible to reach a solution in the matter, allowing for existing financial constraints.
May I ask——
No additional questions may be asked.
Is it possible that the Minister cannot make the necessary finance available to employ a few extra nurses in this hospital and that he will let them go on strike?
The question is finished.
The Dáil adjourned at 5.25 p.m. until 2.30 p.m. on Tuesday, 4 March 1980.