Mr. Joe Ryan:

Good afternoon to members. I thank them for the invitation to attend today's meeting. I am joined by my colleagues Mr. Fitzmaurice, chief officer, Community Healthcare West, Ms O’Donovan, chief officer, Cork Kerry Community Healthcare, and Ms McDaid, head of older persons services, South East Community Healthcare.

The HSE is committed to enabling older people to live independently within their own homes and communities for as long as possible. High-quality health and social services for older people provide continuity of care, integrated between care settings. There are a number of key constituents to comprehensive services, including GP care, public health nursing, home care supports, acute hospital care, rehabilitation and long-term care.

I will now give a brief update on Seven Springs day centre, Loughrea, Owenacurra in Cork and St. Brigid’s Hospital in Carrick-on-Suir. Over the summer months, the management of community healthcare west, CHW, took the opportunity to re-examine the issue of the day care at Seven Springs Day Centre, Loughrea. This was done in the context of a number of service developments both within and external to the HSE and the current Government policy context as it relates to older people. These include the full roll-out of the integrated care programme for older people model across the CHW area, the mainstreaming of the age-friendly healthy homes initiative within the local authority sector giving national coverage and the joint policy statement on housing options for our ageing population between the Departments of Health and Housing, Planning and Local Government.

As part of this work, CHW has commenced a review of the use of our short-stay beds as a means of enabling a step up of care from the community and a step down from the acute setting along a co-ordinated and integrated continuum of care. In order to maintain our older people ageing in place, this will necessitate the redesignation of some of our long-stay beds as short-stay beds and increasing the total number of beds available through investment in the urgent and emergency care plan. One of the sites we may be able to redesignate beds from long stay to short stay is St. Brendan’s community nursing unit. There are 100 beds in St. Brendan’s. At present, 12 are designated as short stay. We have made an application to HIQA to deregister an additional 12 beds to convert them to short stay. This will afford us a better balance in the overall service delivery model available in St. Brendan's in meeting the needs of the older population locally. Subject to approval from HIQA, this may result in a reduction in the overall area that is required under the regulations for communal space for the long-term residents of St. Brendan’s. If this were to happen, the management of CHW has committed to re-examining the day care in Seven Springs to see if it could be reopened to attendance by local older people in Loughrea and the surrounding areas. CHW is also developing a proposal to develop a multiagency ageing well hub on the campus of St. Brendan’s, with the aim of providing a one-stop shop for access to and information on services and supports with a specific focus on ageing well and ageing in place. As there are a number of issues that need decision and clarification, this is still very much a work in progress in CHW as we seek to come to a mutually agreeable solution with the concerned citizens of Loughrea group pertaining to Seven Springs.

On 5 September 2023, management from CHW met with members of the concerned citizens group together with a number of local representatives. At this meeting, CHW outlined a number of options with regard to the provision of the day care service in St. Brendan’s. The options included internal reconfigurations to the current Seven Springs day centre facility to allow for increased access to additional communal and recreational space for the residents of St. Brendan's. This is in addition to the redesignation of a number of beds in line with wider service developments and would potentially both decrease the overall area required for communal space in line with HIQA regulations and also increase the communal space options available to residents in St. Brendan's. The potential development of a multiagency ageing well hub would further increase the element of choice and communal spaces available to residents and day care attendees. The management of CHW gave a commitment to maintain regular communication with the concerned citizens group as the proposal was being worked on and key decisions were made.

The Owenacurra centre is a 24-bed approved centre located near the town centre of Midleton, County Cork. It is a single-storey building, built in the 1970s, and repurposed for mental healthcare in 1988, becoming an approved centre in 2016. The Owenacurra Centre was set up to deliver an inpatient care service for up to 24 people for long-stay psychiatry of later life mental health rehabilitation and continuing mental healthcare rehabilitation. The Owenacurra Centre is a registered Mental Health Commission facility. Currently, there are six people residing in the service. The current building and layout of the centre does not allow for the needs of a modern, fit-for-purpose residential and day service facility. The Mental Health Commission inspection reports on the unit note that while the therapeutic service and programmes meet the assessed needs of the residents, and while the service has endeavoured to provide privacy and dignity for residents, environmental factors and deficits of the structure of the building were highlighted.

When Cork Kerry community healthcare moved to the advanced planning phase for works to the centre, serious concerns emerged that any level of refurbishment could not bring the building to the standards required. The possibility to refurbish the existing Owenacurra centre, with residents remaining on site during the works, was considered, but the position of the HSE is that this is not possible, would not be safe and would not be in the best interest of residents. The fact that the current building is a prefabricated building from the 1970s, which would have had a life expectancy of 40 years, is a key factor. Despite considerations as to how such a refurbishment could be achieved in a safe and cost-effective manner, no such refurbishment could be delivered to the quality of accommodation which residents deserve and in line with modern requirements and standards.

In June 2021, further to advice from construction experts, the HSE took the difficult but necessary decision to plan for a closure of the centre. The HSE plans to provide a new ten-bed purpose built rehabilitative residential unit in Midleton town. This service will have 24-hour staffing and will have a focus on supporting people to return to their homes and communities. This unit will be put in place to meet the local needs of the community and this will complement the work of the local community multidisciplinary mental health team. The CEO of the HSE recently visited Owenacurra and met with some of the staff and residents. He will be issuing further correspondence to public representatives on the topic of Owenacurra shortly.

St. Brigid’s Hospital in Carrick-on-Suir was a short-stay unit with 16 beds including three palliative, two respite and 11 convalescent short-stay beds. There were no long-stay residential beds at the hospital. The HSE operated activity at the hospital and the design and layout of the hospital was largely reflective of the time period in which it was built. Over time, it became a district hospital providing general medical, dental and maternity care. The service thereafter changed to provide short-stay services as per the bed configuration stated.

In February 2023, South East Community Healthcare area provided detail which informed the Joint Committee on Public Petitions of a HIQA report 2018 which identified continued regulatory non-compliance which identified substantial shortcomings in the premises of St Brigid’s service to deliver safe and fit-for-purpose services and of the Covid-19 response by South East Community Healthcare to designate St. Brigid's as a Covid-19 step-down facility to support flow from the acute hospitals in the region. While the predicted demand for the Covid-19 step-down facility did not emerge, it was necessary to use the staffing resource from St. Brigid’s to meet demands in community healthcare services due to the impact of Covid-19. With improved understanding around the requirements for infection prevention and control regarding Covid-19, coupled with the challenges of the structural environment of St. Brigid’s, it was determined that it was not viable safely to resume St. Brigid’s Hospital as an older persons short-stay unit.

The location of St Brigid’s is noted and acknowledged for its enduring history and connection to the local community, and in order to preserve the community ethos at the existing St. Brigid’s Hospital site, it was determined that St. Brigid’s would be used as a hub for integrated community services. St. Brigid's is ideally located for access to the community and supports as it is adjacent to the primary care centre and thus allows for optimum team co-location. A number of adaptions were made to the building in order to enable St. Brigid’s to be converted into a community health centre.

The service for older people at the South East Community Healthcare organisation continues to be committed to reviewing services delivered, including in south Tipperary, in line with population health planning and Sláintecare principles. There is an ongoing building programme for our older persons’s services, with current builds in Clonmel, south Tipperary, where there will 50 beds and Thomastown, County Kilkenny, where there will be 95 beds, and, under the national enhanced community care programme, there has been a fundamental shift in the planning and delivery of healthcare services, moving away from hospital-based activity to community-based services for people in their own homes.

The HSE met with support groups and public representatives in Clonmel on 18 September 2023. A further meeting is scheduled for 23 October 2023. South East Community Healthcare welcomes this opportunity to work with the interested support groups. The focus of the meeting on 23 October will be to establish terms of reference and membership.

We will be happy to answer any questions from members of the committee.