Wednesday, 9 November 1983
Dáil Eireann Debate
endorses the action of the Minister for Health in not agreeing to the establishment of a consultant staffed obstetrical unit at Bantry Hospital and in seeking to ensure that the Southern Health Board make provision for scheduled consultant obstetrical ante-and post-natal clinics at the Hospital and for coping with any maternity emergencies which may arise.
Minister of State at the Department of Health (Mr. F. O'Brien): Last night I gave some figures regarding births at Bantry Hospital. Out of 823 births for the west Cork area, 191 were in Bantry Hospital and 533 were in Cork city. That is a clear indication of the position. It is unfortunate that this debate had to take place because irrespective of the issues involved some people see it as an opportunity to indulge in political points scoring. However, out of the whole unseemly argument perhaps there will be some good, because now that the matter is being discussed the facts will emerge clearly.
Since this controversy began and despite some efforts to cloud the issue it was clear to me that the only thing that mattered was to provide the best maternity services for the people of west Cork. That is what the debate is about. It is not about the retention of whatever services were provided in the hospital in the past or the ambitions of some people regarding  future developments in the hospital. The issue was and continues to be that it is accepted that there is a minimum standard of maternity services that we are obliged to provide for all our people. To say that second best might do some people might be all right when one is attempting to score a political point, but we must be seen to provide the best service for everyone. We must not think that certain sections of the community should get only a second-class service.
The location of the services must be such that they will serve the needs of the community. These needs are well-known and were spelled out in detail in this debate by the Minister. They are to ensure the best care for mothers and babies. It is strongly recommended that deliveries take place in units staffed by consultant obstetrician-gynaecologists, with back-up paediatric services. The people in whose name this motion is tabled will agree that such services are not available in Bantry. There is an element of risk there.
If a post is advertised giving the number of births, the question must be asked, will the best consultant apply for the job? The ambitious, highly-trained consultant will want to work in the busy hospital, not necessarily for the sake of remuneration but because he wants to ensure that his expertise is kept up-to-date. That is something that must be taken into consideration when talking about appointments, particularly in small units. I do not think we would get the best person for the job for the reason I have given. I understand the arguments advanced by speakers on the other side. I do not say they are arguing merely for the sake of argument. However, we must consider the medical aspect and the welfare of the patient. We must ensure that the service we provide is the best.
A number of allegations and dubious suggestions were made, but the most cynical were made by the Leader of the Opposition and the spokesman on health. In the face of medical advice they gave commitments in relation to services in Bantry Hospital. It is unfortunate for the people in the area that this was done without regard to the advisability of the  proposal or the ability to meet the commitments. It is easy to promise that one will keep a certain hospital open, but one must take account of the expert advice that is available. The people who made the commitment have a lot to answer for.
The commitments made by Fianna Fáil in relation to maternity services in Bantry Hospital are flying in the face of medical advice. Such advice should not be disregarded. There have been no counter-arguments from the opposite side of the House. All that has been pointed out are the circumstances of the west Cork community and the distance people have to travel unless a unit is provided in Bantry Hospital. I understand that argument, but it does not stand up when put to the test on medical grounds, and that is the only criterion that should be observed, namely, what is best from the medical point of view. I am aware of these factors — I am capable of reading maps and measuring distances — but in all honesty I do not believe that the upper solution, though it may be the easy one, is the provision of a second-rate unit in the Bantry Hospital.
I should like to hear arguments to the contrary, but until now nothing has been said that would alter the opinion that what we are doing is right and in the best interests of the mothers of west Cork. We have been putting forward the case that this sort of unit in Bantry could not be expected to cater for more than 300 births. My answer is that if we provide such a second-rate service we can have no doubt that the people concerned will go elsewhere. Figures indicate clearly that mothers in west Cork will not risk going to a hospital that lacks full maternity services.
Deputies opposite have been calling for what is nothing more than a botched-up job to keep the unit open. That is only a recipe for gross underutilisation of the proposed Bantry unit. We should never lose sight of our responsibility to serve the best interests of the people. We must ensure they will get the best.
Another factor to be taken into account is the economic one. I agree that  finance considerations should not be allowed to be the overbearing influence, but the economics of this proposal must be looked at. We are not all living in fantasy-land, and I hope we all have come to the realisation that when we are spending taxpayers' money we will get for it the best value, the best service.
That is what our proposals will give. At the moment the health services are costing £1,000 million, or £290 per man, woman and child. This money does not come from some bottomless pit but from taxation of the working people. When we look at these figures we must ensure that we will provide good value for that money, in other words the best service that can be made available so that the people providing the money will get a return for it. Daily we hear people talking about the heavy burden of taxation. We all admit it is a heavy burden, and that makes the responsibility a heavy one to get value for money. The sooner the people of the House and the country appreciate this the sooner we will get out of our economic mess.
I have no hesitation in saying that the funding of an obstetrics unit in Bantry to cater for 300 births could not be justified on medical grounds. God forbid that anybody would try to justify it on political grounds, though people are trying to do that.
The Minister has made it clear here and outside that he will not be dissuaded from the decision he has taken. Rather than prolonging an obviously futile argument we should be concentrating on the provision of appropriate arrangements to provide a proper service for the parents of west Cork. When I say “proper” I mean the best service, that the people can have confidence in, a service that will give them the same consultant services they would have in the best out-patient hospital. If the people get that kind of service they will be happy, satisfied in the knowledge that those in large urban areas are getting the same standard of service. They will have back-up services, they will have child care at a time when the life of the baby needs the best service.
This is entirely a matter of informing the public. We have been making an  over-riding case in favour of the mother and child. On reflection later I am sure we will ask why was all this heat generated in 1983 when now we are enjoying the best service that could be provided and that the people were entitled to.
Mr. J. O'Leary: I fully support the proposal to retain the maternity unit in Bantry hospital. As a representative of south Kerry I have particular interest on behalf of my constituents in preserving the maternity unit in Bantry. I notice from the records that of the 823 births in the Bantry catchment area in 1982 that 72 of them were from the Kenmare, Kilgarvan, Sneem area of County Kerry. I believe the proposed removal of the maternity unit from Bantry Hospital is the commencement of the downgrading of that hospital which will ultimately affect thousands of people in the Bantry catchment area including the part of south Kerry I have mentioned.
Kenmare is only 26 miles from Bantry and is 60 miles from Cork, Lauragh is 25 miles from Bantry and 75 miles from Cork. Kilgarvan is 25 miles from Bantry and 55 miles from Cork. Sneem is 41 miles from Bantry and up to 90 miles from Cork. If the maternity unit in Bantry is to be closed it will impose great hardship on many people in the areas I have mentioned if they have to travel to Cork instead. I intend to set out the reasons it will cause them great inconvenience and why it will affect these areas socially and economically.
Fianna Fáil believe it is necessary to have adequate maternity services available throughout the country even if the deliveries in such units are considerably fewer than the 1,500 per annum recommended by Comhairle na Ospidéal. I fully subscribe to the view that fundamental to maternity services is pre-natal care and pre-natal clinics. I see no reason why these cannot be provided in Bantry with a consultant obstetrician there.
Another prerequisite to the operation of these services is ensuring the safe delivery in emergency under supervision. This can still be provided in Bantry. We must ensure that there is immediate post-natal  care and also ensure that the infant is given the best chance of optimum health and normal development. This can be better done in a more localised institution than one over 100 miles away from the homes of the people concerned. There are some areas in south Kerry which I have mentioned which are up to 100 miles from Cork. Even when the new county hospital is opened in Tralee they will be still more than 60 miles away from that hospital.
We must bear in mind the social and economic situation in those remote areas. Those areas should get special attention and priority from health boards and Government Departments. We must also bear in mind the condition of the roads, the lack of services, particularly the absence of a good telephone service in those areas. I am talking about a good telephone service in the greatest number of homes or a good telephone service in the majority of townlands. We recently had a case outside Sneem where, following a fatal accident, it took two hours before the doctor, nurse and ambulance arrived on the scene. This was not due to any fault of the medical or professional staff involved but to the lack of telephone facilities, bad roads and proper communication services in that area.
It is difficult to understand the views of the Government and the Minister in this matter. How can the Minister be satisfied with having a woman in labour travelling 110 miles from Lauragh in County Kerry or from Ardgroom, Allihies, Eyeries, Castletownbere and the Beara peninsula of west Cork to a Cork hospital? I represented that area of west Cork from 1969 to 1981 and I knew how conscious they were of the facilities in Bantry Hospital and how they considered themselves lucky to have those facilities. The people in those remote areas deserve better than asking them to travel to Cork for such services. We must also remember that the roads in those areas are in very bad condition and that most of the travelling in maternity cases is done at night. The facts prove that most babies are born at night. There is a great medical risk to mothers and infants travelling long distances to and from a major maternity  unit. It is far greater than travelling the much shorter distance to a local hospital with an obstetrician in attendance.
I have heard on a few occasions people who advocated centralisation of hospital cases, including maternity services, say that the helicopter service would be more readily available from a city based hospital. When we take into account that most of the babies are born at night and that helicopters cannot go out at night for maternity cases the helicopter service is out for those cases. In areas like south Kerry and parts of west Cork which are mountainous it would not be feasible for helicopters to traverse those areas most of the time. When one considers the human, social and economic factor in travelling to Cork city from the Bantry, Kenmare, Sneem areas one can see another reason for reopening the maternity unit in Bantry Hospital.
There is another problem associated with expectant mothers going to Cork. It is common nowadays for mothers travelling long distances from parts of south Kerry and from west Cork to which I have referred to arrive at the hospital to be told that they were not really in labour, having to book into a guesthouse and told to ring the hospital at a later stage. I have known a number of cases where expectant mothers stayed for two or three nights in bed and breakfast houses in Cork city awaiting admission to the maternity hospitals in Cork.
There are other cases in which expectant mothers may have to remain in hospital for a number of weeks prior to delivery. There are immense social implications in this regard such as visits by husbands and other members of the family. This is another reason why the maternity unit in Bantry Hospital should be kept open. I understand that the health board never decided that the unit should be closed. This a very important matter, and it would not be wise for the Minister and the Government to direct the health board to close down this unit even though the Minister and the Government could force the health board to do so by not approving the necessary staff appointments or the necessary finance to run the maternity unit in Bantry.  I ask the Minister not to go against the wishes of the health board in this case. I appeal to him to re-open the maternity unit in Bantry.
The remote rural areas which I have mentioned require very special attention for personal, humanitarian and compassionate reasons. This should apply in respect of any services being operated for the benefit of people from this area. Economic consultants and Government Departments generally are not inclined to differentiate between the situation in city and large urban areas and that in rural areas, especially remote areas, when they are assessing any proposition regarding viability or the importance of providing a service for a particular purpose. We could not support the application of standards for the setting up of services in city and large urban areas and not have the same standards applied to rural areas. There is no doubt that special provisions should and must always be made for remote rural areas and, the further away the rural areas are from the cities, the more attention should be paid to the setting up of good services.
We also know that the maternity units attached to the hospitals in Cork are heavily booked and that mothers are retained in some of these hospitals for the minimum period after the birth. It is necessary for them to go back up to Cork at regular intervals for a short period afterwards for post-natal care and to check on the child's health. This aspect should also be taken into account. The Minister should bear in mind that the principal demographic feature of west Cork is the relatively low density of population, and the same applies to the Kenmare-Sneem area of County Kerry. There is a small number of people scattered over a fairly large area. The implication of this is that it would be quite reasonable to modify certain criteria which might be very valid when applied to areas of greater population density. I suggest that the Comhairle na nOspidéal criteria of 1,500 births per year as the  minimum recommended number for a viable obstetric unit is a case in point. I am not suggesting that a unit would be required in Bantry on the same scale as one finds in the cities or indeed in a general hospital in a major town in a large urban area, but the Minister should approach Comhairle na nOspidéal to ascertain what modifications could be made to their normal criteria in order to cater for the special considerations which apply in the case of Bantry arising from the arguments which have been made for the retention of the maternity unit there.
An Leas-Cheann Comhairle: A suggestion was made to the Ceann Comhairle when opening that maybe Deputy Moynihan would speak for a couple of minutes to take up the 30 minutes allocated to the Opposition.
An Leas-Cheann Comhairle: Allow me a moment. There would be 25 minutes left for the Government side and perhaps the Minister of State and Deputy Sheehan could decide to divide the 25 minutes between them to allow the last speaker——
An Leas-Cheann Comhairle: Yes, between you, and the Opposition would have 15 minutes to conclude the debate at 8.15 p.m. Deputy Moynihan and Deputy Ormonde, I would advise you to finish at 7.50 p.m. if you are doing it between you. The time is slipping.
Mr. D. Moynihan: I support strongly the motion for the retention of the maternity unit in Bantry County Hospital. It is outrageous of the Minister for Health to give a blunt and callous “no” to the re-opening of this facility on the grounds of economic expediency.
The Minister stated that if he was to make an appointment for the unit the consultant appointed would not take up the job. Does the Minister realise that over 200,000 people are unemployed, and that for the Minister for Health, a member of the Labour Party, to give as an excuse that the appointee would not take up the job under those circumstances is stretching credibility too far? It is only a joke. In the west Cork area the Department of Agriculture and the county committee of agriculture recently appointed a county agricultural officer for west Cork and that person has taken up duty and is residing in Dunmanway in west Cork. I am glad that the Minister for Agriculture did that and was not of the opinion that the appointee would not take up the appointment or live in west Cork.
The other main argument that the Minister put forward for the abandonment of Bantry and the people of west Cork was that expectant mothers from the west Cork area would not use the maternity facilities in the Bantry hospital. To support his argument the Minister said that only a small percentage of the expectant mothers in the catchment area over the past few years had their babies in the Bantry maternity unit. This is downright dishonest of the Minister who knows only too well that no consultant obstetrician  was available over the years in Bantry. The argument which Fianna Fáil are putting forward is that when such an appointment is made the local GPs would refer their patients to Bantry and thereby a minimum of 500 to 600 births per annum would take place in the unit. The expectant mothers of west Cork want their babies to be born in west Cork in a fully staffed maternity unit. They want continuity of care through pregnancy and certainly during labour and delivery. They do not want to be bundled into the back of a car or a pick-up truck and expected to travel a difficult and dangerous journey to Cork city over a distance of 100 miles in all kinds of weather just to suit the Minister's economic plans for the area. The fact that such a large proportion of the families in west Cork are medical card holders makes it incumbent on the Minister to see that the best possible services are made available locally to the people of the area. I ask the Minister to consider this and also what he said last night, that privately the officials of the Southern Health Board are not in favour of reopening the maternity unit. I, as a member of the southern health committee, was at their meeting last May when a resolution was adopted requesting the Department of Health and Comhairle na nOspidéal to approve the appointment of an obstetrician-gynaecologist at Bantry General Hospital.
Dr. Ormonde: I am thankful for the opportunity of getting in on this debate. I have an interest by virtue of my association with Comhairle na nOspidéal. Let me say at the outset that, like my colleagues on this side of the House, I support fully the request to retain the maternity unit in Bantry. In the Comhairle na nOspidéal document, Development of Hospital Maternity Services, the objectives of health care in relation to maternity services may be summarised as follows:  monitoring and maintaining the health of the mother during pregnancy through regular ante-natal care, ensuring safe delivery under skilled supervision, and ensuring that through skilful attention the infant is given the best chance of optimum health and normal development.
The people of Bantry, west Cork and south Kerry are asking for no more and no less than that. I am amazed that the Minister, a Cork man, would allow a situation to exist whereby he is asking the mothers of the west Cork area to travel in excess of 100 miles in some cases to avail of specialised maternity services in Cork city. It is not quite true to say what the Minister said last night, that this is not a service they have had before now. They have had this service all along. They may not have had a consultant obstetrician-gynaecologist but they had a maternity facility and service in Bantry. Are we now to deprive them of this facility?
Dr. Ormonde: ——when I referred to the retiring of the old style county physicians. We were discussing Dundalk then and I suggested that the Department of Health must come up with a policy concerning the replacement of — I use this term advisedly and in a most complimentary way — these jacks-of-all-trades, because there is no doubt that the old-time county physicians were exceptional individuals. They provided three or four services which the present men are not in a position to provide. There is no doubt that the service they provided was fantastic. That is the situation in Bantry today. The county physician is no longer fit or able to provide the facility that the people have always had in Bantry. Should the people of Bantry now be deprived because the man is not in a position because of his health to continue with the services that he provided? I pointed out then to the Minister that this  problem would arise and I said that the Department of Health should come up with a policy in relation to these, that Dundalk was on the mat and Bantry was on its way. Bantry is with us now and the Minister has the problem.
In his summing up the Minister probably will refer to my involvement with Comhairle na nOspidéal and to the figures, particularly the comhairle's figures, which state that minimum scale obstetric units should cater for births between 1,500 and 2,000 a year. However, both the Minister and I know that many hospitals are below this level and are functioning exceptionally well. These are recommended figures but they have no basis in relation to the human and social aspects, particularly in relation to places like Bantry. These human and social considerations must override all other considerations particularly in relation to a place like Bantry.
Dr. Ormonde: Is it a fact that the birth statistics for 1976 published by the Minister's Department show that 25 per cent of all our births took place in units providing service for fewer than 1,000 births per year, that no fewer than 78 out of a total of 96 maternity units catered for fewer than 1,000 births per year and 67 of these units catered for births fewer than 500 a year? Are we now going to close down all these units as we closed down Bantry? Must they all suffer? Again I appeal to the Minister and to the Department of Health to retain these services which the people of Bantry had for so long and to which they are entitled.
Mr. Sheehan: At the outset I want to say a word of praise for the county physician who provided an excellent service in Bantry County Hospital for the past 22 years since the maternity unit was opened. Unfortunately, not being in the best of health, he could not continue the job. I am amazed that for the past 22 years, during the greater part of which a Fianna Fáil Government was in office, no effort was made to provide Bantry Maternity  Hospital with a fully qualified gynaecologist.
Mr. Sheehan: It is a wellknown fact that out of the 823 births that took place in 1982 in the Bantry hospital catchment area only 191 took place in the maternity unit there. What was the reason? It was quite obvious. It was because of the lack of an appointment of a fully qualified gynaecologist-obstetrician. Nothing more and nothing less. The fault must be placed on those people who failed to fill that post down through the years. The GPs in the area referred their patients to Cork to the maternity hospitals there where they could get the services of a fully trained medical and nursing staff. Fianna Fáil failed hopelessly to make the proper appointments all through the last 22 years. That is a wellknown fact.
Mr. Sheehan: It is a wellknown fact that numerous requests were made down through the years to have the post filled. It never was filled, and expectant mothers in west Cork were left without the services of a gynaecologist or obstetrician.
Mr. Sheehan: I have a right to speak. It is a wellknown fact an autonomous body was appointed, Comhairle na  n-Ospidéal, of which Deputy Ormonde is a very esteemed member. This body was established by the late Erskine Childers when he was Minister for Health. As a politician and citizen I had great reservations about an autonomous body being given powers to make recommendations. I maintain An Comhairle failed hopelessly in meeting the requirements of the people of west Cork.
Mr. Sheehan: As late as 20 October a reply to an inquiry from the Southern Health Board to An Comhairle clearly stated that, having considered the matter, the development of a properly serviced consultant obstetric unit would not be in accord with An Comhairle's policy. There it is. That was the reply from Comhairle na n-Ospidéal.
Mr. Sheehan: The people of south west Cork were deprived of a gynaecological-obstetrical service and have been so deprived for the past 22 years. No wonder the GPs were sending their patients to Cork. No wonder there were only 191 births in Bantry out of 983. I listened  carefully to Deputy John O'Leary telling us about the effect it had on the Kenmare peninsula. Now facts are facts, and out of 71 births in the Kenmare-Sneem area in 1982, 16 took place in Bantry hospital and 55 in Cork. How is it there was a bigger percentage of the Kerry births born in Bantry Hospital? That is where they should be. No matter what political talk there is commonsense must prevail. I know very well that every expectant mother in west Cork will have an obstetrical and gynaecological service she deserves. That is her choice. One cannot tie people's hands.
Now there was a first-class county physician in Bantry down through the years. That was not in accordance with An Comhairle's direction, which was that a maternity unit must have the services of a gynaecologist and obstetrician. But those services were denied in that area for the past 22 years. From 1977 to 1979 the Leader of the Opposition was the Minister for Health. He did nothing to fill the post. The unit would not now be closed were it not for the fact that the county physician was not allowed to continue. I know the hardships the people in the area are suffering. Parts of that area are over 100 miles from Cork city. We have five islands off our coast—Dursey, Bere, Whiddy, Cape Clear, Long Island and Sherkin as well. These are all in the Bantry Hospital catchment area. The Minister's opening speech last night pointed out that for the first time in 22 years these people will now have a fully qualified gynaecologist/obstetrician one day a week——
Mr. Sheehan: ——in Bantry General Hospital for pre-natal and post-natal services. There will also be an emergency service provided in that hospital. If these services are not successful, I shall be the first man knocking on the Minister's door to make sure that the people whom I represent will get the service that they desire.
Mr. Sheehan: ——it was turned down. Suddenly it seems to be coming alive now. Unfortunately for the people of west Cork, they have not been provided with that service down through the years, but at least they will now have a service provided by——
Mr. Sheehan: ——to Deputy Rory O'Hanlon referring to a locum consultant. What does he mean by that? Is that the kind of service that his party are going to give again? That is what the Deputy said last night — a locum consultant.
Mr. Sheehan: If the Minister's scheme for Bantry area does not work to perfection, I will be the first man at his door knocking on it to ensure that a proper service will be maintained in the Bantry area.
Minister of State at the Department of Foreign Affairs (Mr. J. O'Keeffe): There is some hope of that. It is indeed unfortunate that Bantry Hospital has been turned into a political football by Fianna Fáil and those associated with them. The display of some Members of the Opposition reinforces the view. May I say that I exempt entirely from those remarks my colleague in the constituency, Deputy Joe Walsh, who has been consistent and reasonable in his approach at all times and who, like Deputy Sheehan and myself, has presented a fair and reasoned case on behalf of the people of west Cork to the best of his ability.
As I was saying, Deputy Walsh, like the two Government Deputies here, at all times presented the case on behalf of west Cork to the best of his ability. Why? Because all three of us are genuinely interested——
Mr. J. O'Keeffe: ——unlike those who would attempt to make a political football out of this issue. It is not just those on the other side of the House. Others have used or abused this issue purely and solely to embarrass the Government. This is quite clear from the degree of selective and biased publicity over a period of months which clearly indicates the designs of these people. It is a pity, indeed, that those of us who are genuinely interested in west Cork and in the Bantry area should have our efforts damaged by that type of approach. Let me say clearly to those who would make a political issue of this, who would attempt to manipulate the people of west Cork, that I know them well enough and long enough. They can see through that type of thing.
Mr. J. O'Keeffe: The objective of these people in attempting to embarrass the Government and to reduce their support, which has been evident over a number of election campaigns, will not reach fruition. The other aspect which it is important to mention in this connection deals with the politics of promise. There was a deputation to Deputy Charles J. Haughey, presently Leader of the Opposition, who without the slightest hesitation, as I understand it, was able to say that of course they would provide maternity facilities for Bantry hospital. He gaily ignores the fact that when a request was made to the Government on a number of occasions during the time that he was Minister such a request for consultant obstetric and gynaecological  facilities in Bantry was refused. At that stage when he was in power he could not meet that demand. Now that he is in opposition, going around the country, whether it is in Cork or Bantry area, he says that there is plenty more money. He tells the taxpayers that they can cut tax.
Mr. J. O'Keeffe: What are Fianna Fáil proposing at this stage? That is the problem for those of us who are genuinely interested in the Bantry Hospital issue. The Fianna Fáil motion calls on the Government to provide maternity facilities at Bantry Hospital. The Opposition spokesman on Health drafted that motion carefully because he omitted to ask for fully staffed consultant gynaecological facilities. There are maternity facilities available in many units but they do not have consultant facilities. In my home town of Skibbereen maternity facilities are available at the local cottage hospital. It is clear that in the years ahead, perhaps in 20 years' time, when the Opposition may get an opportunity to form the Government and we have to reach back for this motion, Deputy O'Hanlon wants to have himself covered. He has not included consultant facilities.
Mr. J. O'Keeffe: In the course of his reply Deputy O'Hanlon should tell the House his position in regard to the extra facilities to be provided by the Government. Does he agree that the facilities announced by the Minister for Health will represent an improvement? Does he agree with the proposal to have the anti-natal and post-natal clinics provided in Bantry, a service that was not available before? The Opposition spokesman on Health is a medical practitioner and I should like to get confirmation from him that the proposals represent an advancement.
Mr. J. O'Keeffe: With regard to that motion, Fianna Fáil should tell the House what they mean by “maternity facilities”. Obviously, they are providing an out for themselves in the unlikely event of their being elected to Government. Unfortunately, because my time is short, I will not have an opportunity of going into this situation in detail.
Mr. J. O'Keeffe: We want the best facilities for west Cork and Bantry Hospital and we have made that clear at all times. In recent months I have had meetings and discussions with the Minister for Health and his Minister of State on at least 12 occasions. I strongly argued the case for a fully staffed consultancy unit in Bantry and presented all the arguments in regard to location and so on. While I will not be scoring an own goal with the political football created by the Opposition on this issue, I should like to stress that I will continue to argue the case for Bantry Hospital with the Minister. I will be watching carefully to see if the extra facilities to be provided will be as effective as the Minister and his advisers said they will be.
Mr. J. O'Keeffe: I am sorry that I have not been allowed to develop this matter because of the interruptions of Deputy Gene Fitzgerald but I should like to stress that, with Deputy Sheehan, I will continue to ensure that the best facilities possible are provided for our people. We will not permit the Opposition to wrong-foot us or stop us in our efforts by making a political football of this or any other issue.
Dr. O'Hanlon: Deputies Sheehan and O'Keeffe said that we did not know what we wanted in Bantry. They may not have been present last night when I asked the Minister to consider the points we raised, to write to the Southern Health Board requesting them to reopen the maternity unit at Bantry Hospital, advertise for a locum obstetrician and ask An Comhairle to recommend the appointment of a permanent obstetrician. I hope that is clear because when it comes to voting we would like local Deputies to support our motion. They appear to be anxious to have proper obstetric facilities in Bantry Hospital. Deputy Sheehan told us that an excellent service had been provided by Dr. McCoy over the years but he went on to tell us that Fianna Fáil should have made alternative arrangements for another service over the last 22 years. He told us that local women would prefer to go to Cork city to have their babies.
Dr. O'Hanlon: Deputy O'Keeffe asked if we agree with the service the Minister intends providing but the Minister intends to provide an anti-natal clinic one day a week in Bantry. If the Deputy considers that an obstetric service, we do not accept it as such. It is hard to understand how any Deputy would accept such a service. Deputy Haughey's record in office was good and anywhere there was a need for facilities they were provided. Like Deputy Sheehan, he was satisfied  that Dr. McCoy was providing an excellent service for the people of the area. The Minister of State and Deputy O'Keeffe, said it was unfortunate that the debate was taking place and referred to the issue as a political football. We are concerned about the health care of the people of west Cork and the health and welfare of the mothers and infants living in the Bantry Hospital catchment area. We did not make any effort to make a political football out of this issue. In fact, I am informed that the local Fine Gael executive in Bantry supported the reopening of the maternity unit and called for the appointment of an obstetrician.
Dr. O'Hanlon: I would not accuse that executive of making a political football out of the issue. The Minister of State referred to the element of risk if we continued an obstetric service in Bantry but there is an element of risk in every hospital. There is an element of risk in Cork and in Dublin. Last night we referred to the annual report of the Rotonda Hospital in which Professor Henry stated that peri-natal mortality had gone up as a result of overcrowding. That is an element of risk. Everything must be balanced and when one balances the risk of being delivered in a unit which is ideal against people having to travel up to 110 miles, I am sure everybody would come down in favour of having a maternity unit closer to the people.
The Minister of State asked what type of consultant would they get in Bantry. There are many hospitals in the country where consultants are doing excellent work singlehanded. Such consultants are appointed by the Local Appointments Commission. The evidence for the success of that is in Cavan and Clonmel. When an obstetrician was appointed in those towns the number of deliveries in the local hospital rose considerably. In the case of Cavan the number went up from 500 to more than 1,000 over a period of eight years. There is no reason to expect that the situation would be any  different at Bantry if a consultant were appointed.
The Minister of State said that Fianna Fáil commitments were going against the best medical advice available. He was referring to a document from Comhairle na nOspidéal. That document was a discussion document, not a policy document that must be followed by every Minister although it appears this Government and Minister are committed to following that document. I wonder what is their opinion of the document produced by An Comhairle three years ago on the paediatric services where it is stated that the ideal number is 5,000 deliveries per annum to have a viable maternity unit. Has the Minister any ideas on ensuring that there will only be units of 5,000 deliveries in the future?
Last week in reply to a question he told me there were 51 units with fewer than 1,500 deliveries. Is it his intention to close them? There are only 17 with more than 1,500 deliveries and there are only six of those not in the major borough areas. The Minister referred to the Trim and Dungarvan units which have been closed. What is significant there is that in each case the health board supported the closure. In the case of Bantry, the health board have backed the appointment of an obstetrician and the re-opening of an obstetric unit in the general hospital. At their meeting last Monday it was agreed that the basic requirement to establish a consultant obstetric service would be one consultant, one registrar and one senior house officer. The nurses, domestic staff and maintenance staff are there already. The aim would be to develop a service within three to five years, aiming at a maximum of 500 births per year. If at the end of that time the local community were not supporting the service it should be abandoned. The medical colleague who gave me that information remarked to me that he hoped a reasonable Minister for Health would give sympathetic consideration to such a proposal. The Minister did not refer to the economics of the case although the Minister of State did but, as can be seen from the report of the last health board meeting, apart from an obstetrician, a registrar and a house  officer the unit and the other staff are there.
Fianna Fáil are flexible in their approach to any of these documents. People must be taken into account. We cannot adopt a doctrinaire philosophy that is not suited to the people. We must cater for the needs of those whom we represent. With regard to schools, farms and other sectors, we are back to the policy of “small is beautiful”. I have no doubt that will be the case with regard to health care in the future.
I accept the ideal is to have a baby born in a hospital where there are 1,500 or more deliveries per annum, but when one balances the risk of travelling 60 or 100 miles a maternity service closer at hand is the ideal. I do not think anybody would say the mother's life is at risk by having the service in Bantry Hospital. While there may be a risk to the infant because a paediatrician is not available, why cannot we adopt a radical solution as they have in other countries and develop a paediatric flying squad service? In that case a paediatrician would go from Cork to Bantry in the event of an emergency. We are talking about a small percentage of cases. We do not know where an emergency will occur, but if one can identify such cases at ante-natal examination they can be sent to a more specialised unit. In the case of an emergency at or after birth, why not have a paediatric flying squad? That would be much safer and more in the interest of mother and infant than having the mother travel 100 or 60 miles to Cork.
This is the kernel of the problem. Fianna Fáil believe it is not possible to cope with the emergencies that may arise as a result of having the hospital so far away. The only way of ensuring that the emergencies will be dealt with is to have a maternity service in the general hospital at Bantry.
Last night I asked the Minister what is the position of the health board having  regard to their statutory and legal obligation for the births taking place in Bantry at the moment. Neither the Minister, the Minister of State nor Deputy Sheehan replied to that question. There have been 19 deliveries there since the unit was closed last February and three have been emergencies. Last night the Minister told us he attended a Medical Union conference in Kilkenny last Friday. He said:
I spoke to many members of the Union from Munster, both consultants and general practitioners. Not one of them criticised my decision. They were representative of all political parties. They all said it was a terrible shame that for narrow political purposes politicians in Leinster House were creating this storm.
Dr. O'Hanlon: He agrees that the unit should be re-opened. What does the Minister think of the Southern Health Board? Does he believe that for narrow political purposes they have asked Comhairle and the Minister to appoint an obstetrician in Bantry?
Dr. O'Hanlon: The Southern Health Board have made it clear that they want the unit re-opened. In a letter to the chairman and each member of the Southern Health Board dated 29 April 1983 from the CEO their views made very clear. The letter spoke about the catchment  area and the human and medical factors. The letter stated:
If it is accepted that patient interest and patient care surpasses all forms of statutory prohibition, then the law and regulations should be tempered to recognise and cater for a humanitarian solution.
That is what we are asking the Minister to do. I appeal to him to reconsider his decision. What would any Member of  this House think if they lived in southwest Cork or out on one of the peninsulas? Would they like the nearest maternity unit to be in Cork city? I appeal to the Minister to reverse his decision about Bantry, Monaghan, Dundalk and in any other area where he may contemplate cutting maternity services.
Birmingham, George Martin.
Conlon, John F.
Cooney, Patrick Mark.
Cosgrave, Liam T.
Cosgrave, Michael Joe.
Durkan, Bernard J.
Enright, Thomas W.
Farrelly, John V.
Flanagan, Oliver J.
Harte, Patrick D.
Sheehan, Patrick Joseph.
Brady, Gerard. Byrne, Hugh.
Coughlan, Cathal Seán.
Gallagher, Pat Cope.
Haughey, Charles J.
Burke, Raphael P. McCreevy, Charlie.
Morley, P. J.
Nolan, M. J.
Noonan, Michael J.
O'Malley, Desmond J.
Wilson, John P.
Question declared carried.
Motion, as amended, agreed to.
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