Matt Shanahan (Waterford, Independent) | Oireachtas source

I thank the Chair and welcome the people who are supporters and those who are medically connected with St. Brigid's. I have come to show my support for a facility which I would not say I know very well, but about which I know quite a bit. As has been alluded to, it was doing an excellent job in Carrick-on-Suir and dealing with a wide hinterland. I am not sure that was well understood by the HSE. In fact, I know it was not. When the HIQA report came out and the decision was taken to close it, I received wide correspondence from County Tipperary, Clogheen, Clonmel and my own area of Waterford, including Rathgormuck, Portlaw, and Carrick-on-Suir itself, as well as, going further afield, Newcastle.

Some people were living there in semi-residential care status while others were transiting through for shorter respite periods. They were being managed exceptionally well. It provided a home from home for many people, particularly people coming to end of life. Hospitals are not the right place for people at end of life. If they can be managed at all in their community, in a home setting, that is where they should be. St. Brigid's was doing an excellent job with that. I thought the HIQA report was quite disingenuous about St. Brigid's. Money had been spent there in the previous two years to upgrade some of the rooms and settings there. If there were issues with fire safety and so on, all those things could be remediated. It is obvious that the Department, HSE, and maybe the regional community agency, were taking a different stance.

It is interesting to see where we have arrived in the last six months. We have seen what the surge has done and the overcrowding of our public hospitals. We see the lack of step-down care, the lack of residential care and the difficulties in trying to move people from the acute hospital setting into the community setting. St. Brigid's still has a pivotal role to play in that setting. I cannot understand why the HSE continues to refuse to look at putting resources back into that centre.

If modifications are required, they should be done. A GP facility was put in beside it and I know there have been issues in that the amount of community care it was thought was going to be triaged there has not been delivered. Two things need to happen. I do not know what the latest business case for St. Brigid's is, but I have spoken to some of the GPs who were providing services there before and I think a new business plan has to be put together, in the first instance in order that we can understand exactly what functions the unit and the hospital can carry out versus those they cannot. I would encourage those working on the business case to do that. In the second instance, I have spoken to the palliative care teams in Waterford and the senior palliative care consultants there. As the witnesses will be aware, they are responsible for administering palliative care in that area and they do it very well. They have arrangements with other private residential care centres to provide palliative beds, but there is a vital need for certainly three to four palliative beds. They can be managed without consultants having to be on call. There are care plans in place which are easily and well worked by nurses and nursing staff, and it has worked that way for years.

I think there is a very strong case here, but unfortunately, those of us who work inside the system are constantly frustrated by the lack of logic that we come up against all the time, particularly in health planning, and in many other areas of our national economy as well. Looking at the decisions that are being made, there is no doubt that there is a culture that when the State produces reports, the report is produced when it already has the objective in mind. The report gives us the end result; it is not really an independent report. It is just a way of saying that a safety audit, surveillance and a cost-benefit analysis has been done, and it sets out the reason for the decision taken. It makes absolutely no sense in terms of where we are trying to go now with Sláintecare and trying to deliver increased community care in the community. The first thing that needs to happen is that we need to have a real look at the remit of St. Brigid's. If it is possible, I think there are people within the system who would be willing to take the time to look at it and make proposals that will involve the acute hospice, the need for step-down and residential care, and show what can be done and done very efficiently on a cost basis. It is not efficient to have people in other settings, particularly in the acute hospital, who can be managed at St. Brigid's.

There is also the social component. A woman contacted me last year crying. She was travelling 14 or 15 miles to see her mother in palliative care and she was living just over the road in Carrick-on-Suir. She knew her mother was failing for a while, but she always thought that when she did need care there would be a home from home available nearby and that she could be in and out of there. That put huge stress on the family. It made for a very difficult end for a very dignified lady. That is not the healthcare that we want to be providing. We have an ageing population and an ageing demographic who are being put upon in our rural and regional areas because they are not close to the services, which are all being urbanised. For that reason, I would support a new business case setting out proposals to the Minister. Let us put together a framework that makes sense. Let us try to involve the senior consultant teams in the area in terms of the palliative question. They never said that they would not support the palliative beds in St. Brigid's. That was never said by them. HIQA decided that it could not be done. The consultant teams were very happy with the service and the care that their patients were receiving up there. I have said my bit. I commend everybody here today on coming in. I think it is very important. We have to keep driving the campaign on, and I will certainly support it where I can.