running a hospital part 2

The introduction of the Poor Laws in Ireland in 1838 was a controversial measure opposed by politicians and members of the medical profession alike. The main concern of the medical profession was the consequence for the various medical charities operating at the time and their fear of being subjected to a regime similar to the English Poor Law which had diminished the role and income of the profession. The intention of the Poor Law was to raise a rate to fund the operation of workhouses. This led to a decline in subscriptions to medical charities as subscribers considered the tax to be a form of double taxation. The background to the introduction of the Poor Laws was the Poor Inquiry of 1833/1836 headed by the Archbishop Whately of Dublin. His radical report recommending legal provision for those suffering from mental and physical disability was rejected by the government. Instead George Nicholls an English Poor Law Commissioner made a lightning tour of the country and produced a report recommending a system of relief based on the workhouse and administered by the English Poor Law Commissioners. In practice Nicholls ran the system on behalf of the English Commissioners.  The 1838 Act also provided for an inquiry into the existing medical charities and the power to recommend extra medical facilities in each poor law union. Additionally the Poor Law Commission had the power to inspect any medical institution in receipt of government funding and to recommend and enforce changes in its management structure. In 1840 the Commission began a formal inquiry into the management and structures of Irish medical charities. Its report recommended bringing these charities under the supervision of the Poor Law commissioners. In 1842 a bill based on these proposals was presented to the English Parliament. It was strongly opposed by the Irish medical profession and eventually was withdrawn under the weight of these objections a year later. .  


In In addition to government grants and subscriptions a third source of funding was provided by legacies and bequests. In 1851  a very substantial bequest came their way from the estate of a William Bushe. The list of properties included number of houses in Baggot Street and James Street. The rents from the properties were left to Mr. Bushe’s wife for her life and then to be divided between The Meath Hospital, Simpson’s Hospital and Cork Street Fever Hospital.  Simpson’s Hospital specializing in the treatment of blind and gouty men was locating near Jervis Street. The board of the fever hospital attempted to purchase the interests of the two other hospitals to no avail. In the event the Fever Hospital was awarded the Baggot Street and James Street  properties following the drawing of lots. There were fifteen properties, all held under long leases.

In 1842 the government began a serious review of the funding of Dublin medical charities. A committee established to review expenditure noted that the 1800 Act of Union had only guaranteed such funding for twenty years. The committee recommended the continuation of the existing grants subject to continuing review. The arrival of famine in Ireland diverted government attention from the issue but in 1848 as the effects of the famine eased the issue was revisited. An across the board cut of ten per cent was imposed in that year. In 1850 however the government announced its intention of completely withdrawing the grant from all the Dublin medical charities. They proposed to achieve this by reducing their grant by ten per cent per year until it reached zero. Prior to this proposal the government had provided grants which appear not to have been predicated on the actual number of patients. Instead lump sum payments of £3000, £3800 were the norm in the 1840’s.  As might be imagined the 1850 proposal provoked a great deal of outrage at Cork Street hospital board meetings. Papers were prepared showing the consequences of such a move over the ensuing years. The equivalent of cash flow projections show the difficulties this would cause. These assumed a total grant between the years 1850 and 1854 of £13,280. In fact the grant received was £15,200.    These projections also assumed the grant would cease entirely in 1858. Plans for its orderly shutdown were drawn up. Dublin hospitals under the auspices of the Lord Mayor formed a group to oppose this proposal and representatives of the group traveled to London to lobby parliament. The government decision to withdraw the grants was either an attempt to force the hospital’s to rely on charitable donations entirely or to force the hospitals to come under the wing of the Poor Law Commissioners.  Cork Street hospital began a process of stringent cuts in expenditure. This involved laying off senior medical staff and a type of redundancy payment was agreed with the government to achieve this. In 1850 the hospital employed sixteen senior medical staff three of whom were in temporary employment. The equivalent of one year’s salary was paid to three of the departing senior medical staff, the house keeper and the porter.  The hospital now only employed two permanent physicians and two temporary physicians who were paid on a case by case basis. The remaining staff had their salaries reduced and the practice of paying a year end gratuity to nurses and servants was also discontinued.  The records provide no indication of the consequences for the broader nursing staff. In the same year though three ‘aged’ nurses were dismissed as they were unfit for duty. Mary Dunne had been appointed in 1817, Judy Delaney in 1826 and Mary Rooney in 1835. They were paid one year’s salary. In an era where no social welfare existed, other than the workhouse, how did these people survive? The system of collecting patients in the hospital’s horse and carriage was discontinued and the capacity of the hospital was reduced to 120 beds from a potential 1847 total of 426.  The Commissioners for Auditing the Public Accounts, Somerset House, London requested the hospital’s accounts for the period 1848 to 1850 and appear to have examined them in great detail. A long list of queries was submitted to the hospital the consequences of which took up considerable time at board meetings. One such query in 1852 revealed that the board had purchased £500 of government bonds from their grant in 1851. Though a number of letters were exchanged explaining this investment it appears that the board were attempting to provide for the future. Increasingly the hospital looked to its own resources to stay open. Discussions aimed at increasing the voluntary contribution took place frequently at board meetings. The hospital was not without options. The value of various investments and legacies was put at £11067 in December 1853. However in 1850 the hospital had only fifty subscribers who had donated £110.  In 1854 a Select Committee of the House of Commons once again reviewed hospital expenditure in Dublin. They based their inquiries on the 1851 census which had been published that year. The Irish Quarterly Review claimed that there was a significant error in the census figures.  The census returns stated that there were only 1053 in- patients in Dublin hospitals on census night. In addition the census stated that 576 people were sick in their own homes.  The number of excess hospital beds available in Dublin was put at 514 on census night. Surgeon William Wilde gave evidence before the committee and in the opinion of the Review he only added to the confusion surrounding the census returns. The Review strongly criticized Surgeon Wilde’s lack of knowledge of Dublin hospitals. The census put the total population of Dublin at approximately 278,000. In 1854 the total parliamentary grant to all Dublin medical charities was put at £13,000. This compares with an income of £111,648, from public funds, to London hospitals in the same year. In fact, the Select Committee recommended an increase in the hospital grant to £16,000 per year and the abandonment of the previous policy of gradually reducing the grant. The grant to Cork Street hospital was increased from £1900 to £2280. This marked the end of a difficult period for the hospital during which its expenditure was under constant review by the government. It seems difficult to believe that at the end of the Irish famine, the British Government embarked on a policy of reducing Dublin hospitals grants. A government which had found itself ill prepared for the appalling effects of the famine seemed determined to ensure that it was equally ill prepared for any future emergency.

P1, P2.