The Adelaide Hospital Society’s Annual General Meeting

Good evening everyone. I am really honoured to be invited to address you this evening and indeed humbled, mindful of the long history of the Adelaide Hospital and the work of the Adelaide Hospital Society.

When I now walk past the old Adelaide Hospital in the morning and indeed the other small voluntary hospitals frequently, I cannot but reflect on what we literally have thrown away in the name of progress – and no amount of research could quantify the contribution of these hospitals to the life of their communities and the City of Dublin.

I first heard of the Adelaide as a very young child growing up in the shadow of Slievnamon on the estate of the late Olivia Hughes, one of the great Irish women of the last century. We picked wild flowers, especially primroses, wrapped them up surrounded by green leaves and sent then by rail to the Adelaide Hospital.

Of her many friends who visited our family I always remember Mrs. Beatrice Sommerville-Large, a great friend of the Adelaide Hospital, her daughter Faith is here tonight, she is a very special supporter and friend of ours in Trust, visiting regularly with her friend Vi. The late Dr. Becher Sommerville-Large encouraged and inspired me when nursing. I sometimes look at a reference he wrote for me to seek employment in Cunard Lines (I cannot swim and sometimes suffer sea sickness). At one stage I had considered going to the famous Moorfields Eye Hospital – but as I often quote the words of Bob Dylan “we are all prisoners in the mystery of the world”.

Let me talk to you about our work in Trust – daily on my way to work each morning I see people sleeping in sleeping bags all over the place, and then when I read some media reports on our health service and statements saying there is enough accommodation, I could be forgiven for thinking it is all a figment of my imagination.

Trust founded in 1975, grew out of work I carried out in night shelters and with people sleeping rough with a group of doctors, all working in a voluntary capacity. That work, and the generosity of the late Ann Rush, led to the foundation of TRUST – a private charitable trust and our aims are:

“to serve homeless people in need by promoting human services which would meet their immediate and long-term needs and by these means to encourage their development and give their lives a dignity which is their birthright.” (…from the Deeds of TRUST.)

The service we set up was first of its type, and has been used as a model for services here and overseas. We are sandwiched between St. Patrick’s Cathedral and Christchurch Cathedral in the Liberties area of Dublin. We work in the basement of the Iveagh Hostel for which we pay a nominal rent, a reminder daily that people have gone before us and I sometimes ask myself what would Dean Swift do today.

The philosophy of TRUST is based on two central principles:

The recognition of every individual’s right to be treated as an autonomous and unique human being.

The need to restore the dignity of individuals whom society has labelled deviant and undesirable.

Our work would not be possible without the enormous generosity and support of people from all walks of life, rich and poor. Incidentally I should mention the friendship, support and encouragement we get from the Protestant community all over Dublin and beyond, in fact without it I doubt if we could continue to work as we do. Please God that will continue for as long as it is required.

Everyday we meet over 50 men and women who sleep rough and meet with people as they present themselves to us – all outsiders in a city of plenty. Many come from outside the city, some from the remotest parts of rural Ireland, some returning to the land of their birth to be buried in the “old sod” and many from outside the jurisdiction, with increasing numbers from the EU Accession States and other countries. This is evident from the 2006 Census highlighting the demographic changes. Between 2002 and 2006, non Irish Nationals increased from 224,000 to 420,000 (+87%). EU Nationals make up the greatest numbers, particularly from Eastern Europe. Polish Nationals were the biggest group – 63,000 people and not all have become successful. However this week I note 35,000 Polish people have returned home but we have seen no decrease in numbers calling to Trust.

Some people we meet we have grown older with. We provide a health service, advice and dressings and much, much more, but most important is the human contact – sometimes Trust looks like a casualty department as many people we work with will not go to A&E, and if they do go they will not wait. As part of a holistic service we provide bath and shower facilities, a complete set of clothes and information on rights and entitlements. You may be interested to note that in April we had 677 consultations, 329 of those were non Irish Nationals, 22 new people called, 8 were non Irish Nationals, 407 people had showers and 375 people had clothes. I am sure you have seen our proposal for Public Showers and we were grateful to the Irish Times for the publicity given to it – it even led to voting on their website, 51% Yes 49% No. Our shower submission can be seen on our website

We seek to treat people as people recognising that they need help and have rights, especially their right to privacy and a right to be heard. Coming to TRUST we hope people can feel secure and are hopefully able to trust us. Hospitality is important – we provide tea and coffee as we would welcome visitors to our own home and provide a listening ear – now daily phone calls from prison from people we know with no one else to call. Many people we meet have no family contact, and often family members contact us about loved ones who have disappeared.

The people we meet are perceived by the wider society as being different and difficult and indeed many are difficult. They suffer from the effects of isolation, neglect and health problems, exacerbated by what are often described as chaotic lifestyles. Accessing mainstream services – particularly basic accommodation is a major problem. We meet increasing numbers of people who were ‘re-settled’ in totally unsuitable accommodation, and then find themselves homeless again.

I meet people homeless in Dublin whose heartbeat I listened to while working as a midwife in the Rotunda and consider it a sad reflection on our society that we are now meeting 2nd and 3rd generation homeless.

The people we meet everyday present with a wide range of medical problems including bodies that are ravaged by disease and violence, some with pressure sores from sleeping out in all weathers, sometimes sleeping in urine soaked clothes for weeks; infected and untreated minor skin conditions and major skin problems e.g. leg ulcers and gangrene; as well as lice infected heads and scabies. In addition we often meet people who are suffering from malnutrition and all of the medical conditions common to the general public but exacerbated by their living conditions. We are now coming across conditions long disappeared since the advent of good food e.g. trench foot and impetigo (wild fire) – conditions clearly associated with extreme poverty and many of these people are our new neighbours from Eastern Europe, like our own Irish who immigrated in the past. [Racism is a new challenge].

Some people we meet cope with very serious addiction problems, including drugs, alcohol and gambling, suffering from despair, the pain of loneliness, and spirits broken. Pushed from service to service, often unable to get relief for minds at breaking point and the only solution offered is a brown envelope of medication and often unable to read the directions – seen just as statistics in our increasingly bureaucratic world.

Many people we meet struggle to create a sense of normality after years locked away in institutions and others who have been relocated from one institution to another. Some people who are locked in prisons they have created for themselves, often out of the frustration of not being understood or ignored. Many people we know have attempted suicide, and many have died on the streets. Now almost weekly we hear of someone known to us has died. Often families are ashamed to talk about it and others are grateful that someone cared for their loved ones and we can tell them something about the missing pieces of the jigsaw. When preparing this a long time friend of Trust who slept rough for years since coming to Dublin was being buried in Strabane. He came from a poor family, we made contact with them some years ago and remained in contact. A nursing colleague and friend of Trust in Queens University attended his funeral on Friday last and met his family. Rev. Ian Gallagher from Foxrock who will be known to many of you also came from the Northern part of our island, he often sat with him in Trust on Christmas Eve as they shared a cup of tea and a cigarette, one of the very few nice things that happened to him in his sad life.

Increasingly we get calls from members of the public seeking help in accessing services and dealing with bureaucracy, dealing with machines, seeking help when at their most vulnerable.

We meet some people who are so cut off from everything around them that they at times appear to be beyond reach. Others however challenge and inspire us everyday to look at the way we all live our lives and how we and other services attempt to provide a level of care.

Sometimes the only hearing the people we meet ever get is when they are being researched – an issue we have grave reservations about because of the quality and quantity of research taking place today as well as the time and money spent on “evaluating outcomes and cost effectiveness” while ultimately making no difference to the lives of those who have been examined in the course of these expensive research exercises.

Some people feel pressurised to take part in research into homelessness in case they lose their hostel bed or their entitlements. We in Trust only become involved in research, when we believe the research design is sound, ethical and likely to provide useful information and would be concerned about the sharing and storage of confidential information without due regard to the rights of our fellow human beings.

Of course research is essential to plan services. “If we are to push for fundamental change in the whole area of homelessness, then a certain amount of constructive research is necessary. We feel strongly however that it must be pursued with the greatest caution. It is clear to us that the ‘research industry’ uses that section of our society, which is the most vulnerable and the least able to battle for its rights as its’ source of material. We must never forget that we are working with human beings, who for the most part have been battered by our society and who for so long have been pushed about as just another number in a cold inhuman bureaucracy”.

This last quote is from Leahy and Magee – Report on Broad Medical Services for Single Homeless People in the City of Dublin – March 7th 1976 – 30 years later, in a new millennium -what has changed?

We have met with the Data Commissioner about our concerns regarding the recent Assessment Forms people are now required to fill in – 40 pages. We point out to people that we should not allow ourselves to be blinded by statistics and jargon – we should be prepared to question what is happening, rather than facilitating reports to further distance people from people, or just support entrenched ideas. Homelessness is not just about housing alone, it is much more about not fitting in, being different, being an outsider.

“To be without a home is to be suspect. The homeless are easy targets. Their bodily integrity is constantly at risk. Their lives are an offence against the sacred canons of private property and consumerism. Their privacy is regularly intruded on as part of the price of being statistics in the poverty industry; their painful experiences are reduced to sociological research data. The true test of a civilised community is how people at the margins are treated. Not only must individual liberties be defended, but society should be educated and sensitised towards a broader vision of life and living.” – Dan Sullivan, then President of the Irish Council for Civil Liberties, describing what it means to be homeless in Ireland in a piece I asked him to write in 1995 for a book I co-authored.

The words of Emerson “The use of history is to give value to the present hour” used by the late Dr. David Mitchell to set the tone for his book “A Peculiar Place” on the history of the Adelaide Hospital now over 20 years ago comes to mind when preparing this paper as we often find ourselves describing Trust as “A Peculiar Place” and no doubt some people say that too about Trust. Two lovely chairs of the late Dr. Mitchell were given to us by his daughter Geraldine, one I sit on daily and one we gave Eddie, a dear friend of ours – perhaps the only comfortable seat he ever had in his humble room with his beloved dogs as he watched the old black and white films on a second hand television set until he died.

In some ways I draw comparison between Trust and the Adelaide as we face daily challenges. We are a small agency with charitable status and a Board of Trustees, not in receipt of grants from the Health Service Executive. The now highly bureaucratic HSE and indeed the same in the area of poverty has created a huge gap between planners, front line workers and ultimately the people needing services. No philosophical debate takes place at any level around care, quality of life and lack of choice, and more important the State’s responsibility to care for its most vulnerable people. This is an area extremely neglected now in Irish life, apart from the Adelaide Hospital Society.

The Adelaide too relied on donations, but I feel also on the enormous commitment, expertise and goodwill, together with a strong Christian commitment of all involved. A commitment that ensured a quality of care hard to find today. We value the enormous commitment, generosity of time and spirit of my colleagues at work, our Trustees and those who make our work possible.

I still visualise the cleanliness of the Adelaide, the freshness of the place when going up the stairs and the pride the nurses took in their special navy uniform with white spots. And how could I ever forget Margaret Horne in her tiny busy office, a reminder of the Adelaide Hospital’s staffs commitment to caring for people in the local community.

For over thirty years TRUST has been involved in advocacy work – trying to be a voice for the voiceless – as well as providing health and social services and have had a number of Education & Awareness projects, our Art & Essay competitions were supported by the Irish Times.

I should mention our latest book “Wasting Time with People?” just published. This book is dedicated to two very special friends of Trust, one of whom you would have known, the late Professor James McCormick. You would also know many of the contributors including Dr. Fergus O’Ferrall, Prof. Davis Coakley, Prof. Patrick Plunkett, Bishop Walton Empey and Rev. Olive Donohoe.

As part of our commitment to education and sharing our experience stressing at all times dignity of every individual should be at the very centre of everything we do, we take student Gardai on social placement and this has proved enormously useful. The last group of nursing students from the Adelaide on placement with us before you moved to Tallaght were surprised when I asked them to visit The District Court – all of human life is in there – everyone should spend a morning there, especially those involved in social work, medicine and nursing.

Human rights is about treating people with respect and dignity and sometimes we are afraid to use the language of human rights, a much more challenging concept, that we often think should be left to the lawyers. I should emphasise that when I speak about human rights, and human rights based approaches, I am talking about a philosophy of caring for people as people. The good thing about a rights based approach is that it constantly reminds us we are providing charity, or advocating charitable giving, we are demanding that we live up to the principles of justice and fair play outlined in our constitution which we all subscribe to.

Article 1 of the Universal Declaration of Human Rights states that “all human beings are born free and equal in dignity and rights”. However, by looking at the conditions and the way in which those who are marginalised in our society are treated from those who are homeless on the street to people unable to care for themselves and those living lives of isolation in urban and rural Ireland – we really have to debate with and challenge those responsible.

Some years ago I met in the RCSI Phil Barker, former Professor of Psychiatric Nursing, who runs workshops on the premise that “Knowledge can only be gained through experience”. I once wrote to him for permission to use a quote and he replied: “Alice, people don’t remember what you say or what you do. They will remember how you made them feel” – this excellent advice comes to mind daily and is a quote from a well known Afro American female poet.

Today through the development of human rights based approaches – which should be developed into a potential management philosophy in the health and social services, including all statutory and voluntary services – we have the potential to transform the way the most vulnerable are treated and in this I include all of us.

Some time ago a Welfare Officer, decided that a man who lives in a park and doesn’t use services should have his meagre €165.00 a week (try living on it) stopped because he refused to move into a hostel. His medical card had run out and his doctor hadn’t signed a disability form even though he was not disabled! The Welfare Officer told me it was a ministerial order and that was that! Is this about playing about with numbers, not her fault perhaps – people need to be trained and informed about the complexities of homelessness and indeed the human condition as well as people’s rights.

A Christmas morning a few years ago I happened to catch Eurovision Mass from Circus Pinter Top in Paris. Apart from the charm and artistry of Parisians I was struck by a few quotes from the Pastor: “Encounters with people move us” he further said “It is the blind application of the law which makes us inhuman”.

The collapse of the Public Private Partnerships, which were supposed to lead to the provision of social and affordable housing in Dublin, and regenerate some of the most deprived areas in the city, illustrates in a compelling and powerful way where we have been going wrong in recent years as a society. We cannot expect the private sector, which is solely concerned with making profits, to protect peoples rights to basic services. The shattering blow this has dealt to the people waiting for the redevelopment of their areas, and families on waiting lists for housing, can only be imagined.

I would appeal to everyone in the voluntary sector to become much more forceful, in speaking out as advocates, in defending those in society who have no voice, instead of becoming involved in providing services that should be provided by the State. We risk becoming complicit, in letting the State avoid having to provide decent quality public services, unless we speak with one voice in demanding justice for the most deprived.

We have argued against this trend because we have seen the serious consequences for the people we work with. Many well meaning people in the voluntary sector let the government off the hook, when they accept apparently large amounts of money to take over the role of the State in providing services. This represents a form of privatisation that has enabled the State to obtain services on the cheap, with the shortfall in service quality falling on the most vulnerable. In other words, goodwill and generosity has been exploited, often with low wages and poor conditions, and worse still, has then impeded the ability of once authentic voices to speak out, because they are in receipt of State funds.

PPPs and the privatisation of services are not about caring for people, they represent opportunities for the private sector to maximise profits in areas where the State should be in the driving seat protecting peoples’ rights. If we are serious about caring for people as people, everyone in the voluntary sector must reject the encroachment of privatisation in all its form in the health and social services, and increasingly in the provision of accommodation for people who are homeless.

Now more than ever before we should have confidence to debate at all levels the concerns of our time. It is indeed something the Adelaide Hospital Society continue to do – your fearless highlighting of issues is required more than ever I think in the history of the State when “Peculiar Places” instead of being valued and included in the vision of where are, are dismissed. At a time when the biggest challenge for public service providers is to ensure that services are responsible for inclusion of all, regardless of race, class, creed, gender and age.

Caring for people does require us to speak out if we feel people are being denied their rights. If anyone is not being treated with dignity or worse still being excluded from society or our world we do have a big responsibility.

We must be prepared to discuss and highlight these issues and support those who speak out. I am mindful of the words of Mary Robinson, our esteemed former President of our country, when she said in 2001 “Each time you speak out with a critical voice you pay a price”.

All of you no doubt have read “A Peculiar Place” over and over again. However it is worth noting the words of John Healy written in the Irish Times May 1987 – looking back to 1970 wrote ” Fianna Fail created the health boards; they were going to effect great savings; they were going to give Ireland a very modern and efficient heath service… Mr. Erskine Childers was a very earnest Minister for Health, and when his Fianna Fail backbenchers warned him that he was creating bureaucratic monsters, he argued long and passionately against them. He would not hear any criticism that the boards would become petty kingdoms which could not be touched by a national government and that such a bureaucratic stratum would be laid down that there could be no way in which the health service would become “patient-centred”.

Also in 1972 Comhairle na nOspideal (The Hospital’s Council) was established, it had advisory functions and published reports – its worth noting that in its “4th report, 1982 – 1985, expressed the view that the assumption in the document that community care was a cheaper alternative to hospital in-patient care was not proven and that there were indications that it was incorrect”.

In 1987 “any computer screen in the Department of Finance must have shown that education and health were the two big spenders, which had to be cut back – the cuts began” – sounds familiar today.

So where now does the Adelaide fit in? I think more important today than ever before, the Adelaide Hospital continues to be a powerful, sometimes lone voice in raising important issues.

I agree with Dr. Fergus O’Ferrall when addressing the Old Dublin Society earlier this year said “There are great dangers that the precious intangibles which produce quality personal patient care which so typified the Adelaide at its best will be eroded by centralised control and micro-management by bureaucrats who have the power but little responsibility for patients at the point of care. The Adelaide Hospital Society continues to seek to preserve such intangible values and to ‘inoculate’ them into our health system”.

If care and compassion never make the agenda, those delivering our services and our country will be the poorer – the onus is on all of us to ensure this is not allowed to happen.