Wednesday, 1 June 1988
Seanad Eireann Debate
An Cathaoirleach: Senator Ryan wants to raise a matter on the Adjournment of the House, that is, the need for the Minister for Health to respond urgently to the report of the Inspector of Mental Hospitals on the conditions in Our Lady's Hospital, Cork.
Mr. B. Ryan: This may well be entirely out of order, but may I first of all thank a particular representative of the press from my adopted city for her enormous patience in being here until this extraordinary hour of the morning? It is a reflection of the clear concern among people in my city about the issue I am raising tonight; and I can tell you that, if the issue were not as serious as it is, I would have informed the Cathaoirleach a long time ago that I was quite happy to dispose of the issue and go home.
The issue I have raised is the report of the Inspector of Mental Hospitals on the conditions in Our Lady's Hospital in Cork. I propose to devote a considerable period of my time to extracts from the  report of the Inspector of Mental Hospitals because, even though it is a very late hour and even though I, like everybody else, would like to go home, there are things in that report that need to be put on the record of this House and on the record of the Houses of the Oireachtas.
The first thing that needs to be said is that there are about 1,000 patients in Our Lady's Hospital in Cork and almost all of them, with the exception of about 30 or 40, are long-stay patients. The Inspector of Mental Hospitals visited that hospital in February of this year. I want to put on the record of this House brief extracts about a variety of wards. For instance, in St. Kevin's 5, a female ward with 28 patients, there was one toilet off the dormitory and five toilets off the dayroom which were dirty. St. Kevin's 6, a male ward with 18 patients. Some renovation work was going on in this ward. The dormitory was locked off during the day. Each patient had a wardrobe. There was no soap and no towels were available. The toilet area off the dormitory was dirty and there were no curtains on the windows. We are not talking about prisons or shelters for the homeless; we are talking about a hospital. St. Kevin's 8, female with 21 patients — a washing machine on the ward was bought from patients' money, a washing machine to wash the clothes of the patients was bought from patients' money. The toilet had no seat and there were no curtains.
The whole report could well be read onto the record, a Chathaoirligh, but I do not propose to do that. St. Patrick's 1, male, with 22 patients; all windows in the toilet were broken and had been covered by sheets of plywood; it was dirty. One dormitory had 13 beds and had no curtains. One patient had gone to bed. Another dormitory had eight beds with no curtains. There was no ward programme and the whole ward lacked any visual stimulation. St. Ita's 1, female with 20 patients; the enclosed courtyard attached to the ward was littered with old clothing, toilet rolls and plastic bottles which had accumulated over several months. We were informed that patients  do not get out of doors in winter time. The dormitory with seven beds had no curtains. Many patients were in bed for the night at the time of our visit — 5.15 p.m. Another dormitory housed ten patients and was also without curtains. Five beds were placed along one wall while on the opposite wall a structure had been erected in which five patients were separately incarcerated.
Each unit was roofed in the manner of a stall and each door was closed by three farmyard bolts. Mattresses were generally on the floor. These units did not have external windows or fresh air. There was a padded cell with a mattress on the floor of this ward. Toilets had no seats and there was no soap available to patients.
On this particular part the inspector had the following to say: “Regrettably the dining arrangements on the wards were equally bad. Hot food is taken to the wards in containers which are neither heated nor insulated. On the ward we saw patients' lunches being divided into portions and placed in a heated trolley which was not hot enough to keep them warm. Potatoes of poor quality had been placed on the table even though patients had not by then begun to take their places. Almost inevitably patients would be eating cold lunches. No effort is made to make eating an enjoyable experience.”
The first recommendation made on that part is to restore the beds that were taken down in St. Anne's Hospital as a consequence of the cutbacks. There is a lot more. On the North Cork area, Ita's 5, female, 18 beds, the reports says: Like many other wards the windows were dirty and many panes of glass were cracked or broken. The window nearest the entrance on the corridor had 23 broken or cracked panes of glass. Ita's, 6, female, 18 beds — two toilets off the dormitory had no seats. The windows were dirty. St. Patrick's, 5, 13 patients — the walls in the dayroom were peeled and blistered. There were no pictures on the walls. The toilet area was fairly poor. One of the two toilets had a seat. There were 12 broken panes of glass in the bathroom  window. There was no patients' centre for work. St. Patrick's, 11, 22 beds — the toilets were generally dirty but they had seats.
There is more. General comments on wards in this area: Milk comes to wards in, we were told, open buckets. This is because the milk is purchased in bulk thereby effecting a saving of about £3,000 than if it were to be bought in cartons. In some wards there is no adequate facility for storing food. In one ward we saw bread being stored in dustbins, most of it stale. Laundry facilities are not satisfactory in that units experience difficulty in getting their own clothes or bed linen back. We are told that most of the laundry staff were taking voluntary redundancy, that the machinery is antiquated and frequently breaks down and is in urgent need of overhauling. This would cost £200,000.
This report goes on and on and on: “St. Kevin's, 9, male, 28 patients — there is no activity in the day room. The patients sat around in armchairs waiting for bed time, which was somewhere between 5.30 p.m. and 6.30 p.m. The washhand basin area was used to store all sorts of rubbish. One window had four broken panes of glass. Again, in that area it is recommended that the 15 beds taken from the acute unit by the cutbacks be restored. “It goes on and on and on. West Cork is covered with less detail: Patrick's, 8, 29 male patients — there are no curtains on the dormitory or on the corridor. General comment on the ward in this area: there is evidence of lack of activity and occupation for patients although some patients do leave the ward to go to occupational therapy. Again, in that area there is a recommendation for restoration of the cutbacks.
Having catalogued this “chapter of horrors” as The Cork Examiner described it, the inspector went on to make some general comments about Our Lady's. I want to put these on the record of the House. “The exterior of Our Lady's Hospital can only be described as filthy. Rubbish, litter, discarded toilet rolls are to be seen in profusion around the bases of the building, behind the grey  building, behind St. Kevin's and in internal courtyards. Connecting corridors and walkways, particularly within the old building and leading therefrom to, for example, the industrial therapy centre, are dirty beyond description. Saucers of milk”— and I am talking now about a psychiatric hospital —“and other food are left out for cats. However, those cats must fulfil some function as many of the wards are mice-infested. One of our party saw some mice during the inspection and there may even be rats around”. This is a hospital we are talking about. “We did see one carcase. Internally, some but not all wards are dirty with windows grimed with opaque matter and walls peeling. These latter states of affairs were particularly evident in the main mentally handicapped ward in the grey building, St. Patrick's 1. Generally wards, particularly male wards, lacked curtains. There was a general feeling of crowdedness and a great single open space in some of the dormitories and in none of them was there any satisfactory attempt at dividing sleeping areas into warm, homely comfortable subdivisions. Lavatories, too, were generally unsatisfactory with lavatory seats missing and in some cases floors dirty and wet.”
The report goes on: “Earlier redundancies among nursing staffs were to have coincided with significant ward closures. The redundancies happened but the ward closures did not. The result is that the remaining staff are spread thinly over too many wards. It is not possible to establish cogent reasons why the ward closures did not go ahead as planned”.
Then we come to general comments on Cork psychiatric services. This is the comment of the Inspector of Mental Hospitals: “Our impression of the approach to the delivery of mental health care in Cork city and county is that it is seriously deficient from a planning point of view. No clear objectives appear to have been identified, no priorities delineated and their solutions adopted. There appears to be a lack of clear lines of command and proper structured consultation. In addition, there seems to be industrial unrest which has never been  adequately dealt with. This has hindered progress in providing adequate services and bringing about change. This is most notably evident in the illegal opposition to the transfer of patients from Our Lady's to Sarsfield Court. This was a disgraceful episode which reflects no credit on anybody and exemplifies management's inability or unwillingness to direct the service in the interests of the patients.” I want to emphasise that. The Inspector of Mental Hospitals clearly identified the responsibility in this matter as a responsibility of management. It reflects managements inability or unwillingness to direct the service in the interests of patients.
The report continues: “Equally disturbing is the manner in which management has taken, apparently without consultation, decisions to curtail the vital community and acute aspects of the service.” I did not say that the management had cut back on the services, the Inspector of Mental Hospitals Services did. “The withdrawal of community nurses, the suppression of beds in the Regional Hospital unit in St. Anne's while leaving intact the entire ladies' complex is incomprehensible and can only lead to the transfer of more patients to Our Lady's. Our Lady's costs approximately £10 million to £11 million annually to run. The service provided by the hospital is extremely poor and for the most part appears to provide the worst form of custodial care. The majority of patients are unoccupied and no attempt is made to provide appropriate rehabilitative inputs for them on their wards. It is our view that the board should establish and operate proper management techniques in relation to the whole Cork service. This should involve as primary objectives the prevention of further admissions to Our Lady's, which cannot provide up-to-date psychiatric care of a standard commensurate with proper human dignity, and an intensive rehabilitation programme for existing in-patients.”
That is the view of the Inspector of Mental Hospitals together with those who assisted him on that inspection. I have frequently talked in this House  about the conditions of the homeless and of travellers and of prisoners. I know that you, a Chathaoirligh, have a considerable concern about the welfare of the mentally handicapped. The institution whose appalling record I have just read on to the record of this House does house, if that is the right word — I would say probably “contain” is a better description — many mentally handicapped people. I have talked about this matter in this House. I have never — and at 3 o'clock in the morning it is not possible to start acting about things — in my life been so outraged about something. To be truthful I have, perhaps, been more outraged about one thing and that was the condition of some children I saw once. With that exception I have never been so outraged as I have been by this report. I have known, and most of Cork has known or suspected that that hospital was a disgrace. That was the position until we got this independent, authoritive written document — and incidentally, I did not say it at the beginning, the fact that I have it in my possession renders me in breach of the Official Secrets Act because it is not a public document but I have it and I am very glad to have it. It is among the most appalling, distressing, disturbing, offensive documents that I have ever had the misfortune to read.
The people in Our Lady's Hospital are guilty of nothing. They are vulnerable, innocent and, in the old Irish phrase, in the area of the country that the Minister comes from and that I have close connections with, they would be described as “harmless”. They do not deserve what is being done to them. They are victims of misfortune; they are victims of illness and indeed, tragically, of abandonment. They deserve our best. They have got our worst. Instead we lock them up in a vermin-infested — not my conclusion, but the inspector's conclusion — unsanitary — not my conclusion but the inspector's conclusion — dirty, dark confinement. It is a disgrace. When you consider that we make them all, old age pensioners, pay for it. We take most of  their income, the best part of £40 a week from them. They pay for that confinement, that locking up in dirty unsanitary conditions. We have to and must make very fundamental choices. It is a disgrace that people have been paid large salaries, salaries twice and three times the average industrial wage to manage such an institution of confinement. Those people have failed to discharge their duties. They should resign or be sacked. Messrs. Denis Dudley, Donal O'Sullivan and Pettit should either resign or be sacked. They are unfit for their job. They are a disgrace to their profession and they should be dispensed with.
An Leas-Chathaoirleach: I am not making an excuse for the hour of the morning. But it is abusing the privilege of the House to name people when they cannot protect themselves. There is a long standing rule of the House that this is never done.
Minister for Agriculture and Food (Mr. O'Kennedy): I regret that my colleague, the Minister for Health, who has a very deep concern about issues of this nature is not here at this hour of the morning to respond to the matter on the Adjournment due to the manner in which the business of the House has been conducted during the course of a long night and early morning. I hope that the Members of the House and all the staff involved will appreciate that it is no indication of lack of interest on his part that he is not here.
For my own part, I have been here for almost 12 hours now and, before addressing the House on behalf of my colleague, the Minister for Health, may I express my appreciation to you, a Chathaoirligh, your staff and the press for their attendance during what has been a protracted debate to no particular purpose. The business which brought me here is a very serious business, and I regret to have to say at this point that it was used and abused by some Members of the House for a purpose that was not meant to be in the interest of the legislation we were discussing. I would have wished to have had the opportunity of replying, but circumstances, which I accept as the procedure of the House, did not enable me to do that.
I have the privilege to reply now at this hour on behalf of my colleague. I want to indicate to the House that this is the reply of my colleague, who has given a lot of thought and attention to this issue raised by Senator Ryan. I quote precisely from what my colleague, the Minister for Health, Deputy Dr. O'Hanlon would have said: “As the Senator is no doubt  aware, the management and operation of Our Lady's Hospital, Cork, is the concern of the Southern Health Board. Under the provisions of the Mental Treatment Act, 1945, the Inspector of Mental Hospitals is obliged to make a formal inspection of each district mental hospital every year and to submit a report to me on his inspection. Earlier this year the inspector visited Our Lady's Hospital and subsequently submitted a report to me. That report was critical of both the hospital and the psychiatric services in the area. I sent copies of the report to the chief executive officer of the board for his views. I understand copies of the relevant sections of the report were sent to the clinical directors concerned and that copies of the report were sent to the members of the psychiatric services committee of the board.
I have been considering the inspector's comments and his recommendations as to how the shortcoming he reported could be overcome. I have had detailed discussions with senior officers of my Department, including the Inspector of Mental Hospitals, prior to having discussions with the chairman and the chief executive officer of the health board, which will take place very shortly. These discussions will have two objectives. First will be the steps which need to be taken as a matter of urgency to improve the very unsatisfactory conditions described by the inspector. I would include in that the creation of structures which will ensure not only that improvements are made but also that they are maintained. It is disappointing to find the report critical of the physical conditions in an institution on which my Department spent almost £1 million in recent years under the minor capital scheme, in addition to the board's own maintenance.
The second objective will be to bring about organisational changes in the psychiatric service in Cork city and county. The ultimate solution to the problems which exist in Our Lady's Hospital will only be found in the development of a psychiatric service based in the community. In line with national policy, I feel it is essential to  decentralise the current psychiatric services in Cork and develop a network of community based facilities. This is in keeping with the policy outlined in Planning for the Future.
Our Lady's Hospital services four catchment areas, each of which should have its own admission and acute care unit, day hospitals, out-patient clinics, day centres, hostels and other smallscale facilities. In this way admissions to Our Lady's Hospital would cease. Instead patients could be treated at or near their homes. Only a small proportion require in-patient care and usually for a short time only. A psychiatric service based on this model would be of great benefit to patients and would prevent the build up of long stay patients such as we have at present in our psychiatric hospitals. Part of the reorganisation of the service will be the rehabilitation of existing long stay patients. A significant proportion of the  900 patients now in Our Lady's Hospital could and should be enabled to leave the hospital and live in ordinary houses in the community.
In my discussions with the chairman and chief executive officer I expect it will become clear what steps are necessary now to bring about the desired changes. I will be anxious to help in bringing them about.”
An Cathaoirleach: Before we adjourn I would like to put on the record that I deeply regret that Senator Ryan did not withdraw his charge against the three named individuals. In fairness, Senator Ryan abused the privilege of this House and I would like to put it on record that I would not like him to do that again. As it is now 3.15 a.m. the House stands adjourned until 10.30 this morning.
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