Jerry Buttimer (Cork South Central, Fine Gael)
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I remind those present to ensure mobile phones are switched off or on silent or aeroplane mode. Our second session this afternoon is the meeting with the chairperson designate of Leopardstown Park Hospital, Mr. Eugene Magee. As part of its scrutiny role, the committee meets key appointments in the areas of health and children before they are appointed.

I welcome Mr. Eugene Magee to the meeting this afternoon to discuss his proposed reappointment as chairperson of the Leopardstown Park Hospital. This is an important appointment as Leopardstown Park Hospital celebrates its centenary in 2017. In common with a number of nursing home facilities, it faces a number of developmental changes. It is working to comply with HIQA standards, particularly for residents' privacy, and the hospital has made a submission to the HSE for funding to address these issues.

Before we begin, I wish to advise Mr. Magee that, by virtue of section 17(2)(l) of the Defamation Act 2009, he is protected by absolute privilege in respect of his evidence to this committee. If he is directed by the committee to cease giving evidence in respect of a particular matter and he continues to so do, he is entitled thereafter only to qualified privilege in respect of his evidence. He is directed that only evidence connected with the subject matter of these proceedings is to be given. He is asked to respect the parliamentary practice to the effect that, where possible, he should not criticise or make charges against any person or entity by name or in such a way as to make him or her identifiable. Members are reminded of the long-standing ruling of the Chair to the effect that they should not comment on, criticise or make charges against a person outside the House or an official by name or in such a way as to make him or her identifiable.

I call on Mr. Magee to make his opening remarks.

Mr. Eugene Magee:

I thank the Chairman. In March 2009, I was asked by the then Minister of State at the Department of Health if I would volunteer to accept the position of chairman of Leopardstown Park Hospital. The previous chairman, my predecessor, had to resign and there were approximately 20 months of his term to complete. With little knowledge of the institution, its history or its current status, I agreed to take on the job for the 20 months with the possibility of continuing for a further term if mutually desirable for the Department and myself. I was duly appointed chairman by the then Minister, Ms Mary Harney, who took an interest in the work of the hospital and with whom I had a number of meetings at which we discussed the issues facing the hospital and its patient body. At the end of the 20 months, the then Minister invited me to continue in post for a further five years, which terminated in September. By way of background, I was personally known to the former Minister of State, Mr. Barry Andrews, as a family friend and to the then Minister herself as a client in my office.

At this point, the Minister, Deputy Varadkar, wishes to appoint me for a second term which I am prepared to accept but under new protocol for such appointments, we are obliged to have today's meeting. I welcome that because it gives me an opportunity to enlighten this committee on elements of our work and the challenges around our hospital at this time of turbulence in the provision of Health Services.

During my six and half years as chairman we have had to live within a very tight budget. Every year since my appointment we have reported that we fulfilled our mandate within budget due to some continuing careful husbandry. We have had to provide complex services in all elements of older persons service provision, that is, inpatient, such as rehabilitation, respite and residential and day services, within the very strict moratorium on staff recruitment and we have had to deal with the arrival of HIQA and the standards rightly imposed on the quality of service. We are now grappling with a difficulty with a very significantly reduced budget and a notice to cease admission to some of our capacity due to the HIQA judgment that some of our beds do not meet the required standard.

In the same period, we have had a fundamental change in the composition of our board, three changes of chief executive officer, a new director of nursing and, by now, a total of seven resignations from the board and the appointment of four new members, all of whom have now been validly reappointed and await my reconfirmation after today's meeting.

The committee asked for what seems to me to be a curriculum vitae to establish my credentials to take on this position and, cryptically, I outlined my educational, corporate and management history. I will not go through that, if the Chairman does not mind. It indicates that I have had, I hesitate to say, a successful 50-year career in the travel sector, both nationally and internationally, and I have a degree in history, English and philosophy which I took in 1964 and a masters in law which I took in 2013, both at Maynooth - one under the old dispensation and the other under the new one of Maynooth University.

As to its history, Leopardstown Park Hospital was founded and opened for patients, as the Chairman rightly pointed out, in October 1917 on foot of the bequest of the house and lands at Leopardstown, by Ms Gertrude Frances Dunning to "cause and permit the buildings, together with the lands and premises to be equipped and furnished as a hospital sanatorium or home for the care and treatment of persons described as "Officers or men of His Majesty's Navy and Army" who had been disabled or invalided while serving or thereafter be retired".

Records show that several hundred men were hospitalised in Leopardstown Park Hospital after the war, with many of those who returned mortally wounded spending their final days there. From 1917 through to 1974, throughout the War of Independence, the formation of the State and the Second World War, the hospital continued in this way. At all times, the deed of trust under which the hospital was owned and the trustees still operate stated that, in the event of closure, the reversion of the house and lands would be to Ms Dunning and her heirs. In 1974, the trustees sought and were granted an amendment of the trust to allow for the treatment of widows and dependants of veterans.

The 1979 negotiations between our Government and Her Majesty's Government led to the transfer of the hospital to our Department of Health and to the Leopardstown Park Hospital Board under the Leopardstown Park Hospital Board (Establishment) Order 1979, a copy of which we included in the material that we provided to the committee. At that time, the board was set up to run and manage the hospital. The order states:

The functions of the Board are, on being permitted by the Trustees to use the hospital in accordance with the terms of such permission,(a) to conduct and manage the hospital;

(b) to provide such services and facilities at the hospital as may, from time to time, be approved by the Minister...

It also states: "The Board shall consist of nine members appointed by the Minister, two of whom shall be appointed on the nomination of the Secretary of State" for Social Services.

That was the situation when I was first appointed. In the past two years, it has changed by agreement between our Government and the UK Government, with the two nominated members being withdrawn and the UK Government giving up any reversionary interest in the trust should we cease to operate as a hospital. That reversionary interest was transferred from the heirs and family of the late Ms Dunning. Changes to our procedures following this negotiation - the reduction in the board number from nine to seven members and all other terms - were never communicated to me as chairman of the board. This leaves some anomalies that are probably of no great concern to the committee or its Chairman.

Our issues today are entirely in the realm of funding and the suitability of our facility in the judgment of the Health Information and Quality Authority, HIQA. Immediately, four "nightingale" wards, with a capacity of 67 beds, have been deemed unsuitable for the long-term care of the elderly and we have had to cease admissions of this category since September. We have a plan to which HIQA may give approval to refurbish these wards and allow 60 beds to be accessed on an interim basis while we move to replace the full 171 beds in the medium term. The estimated cost of this refurbishment is approximately €2.5 million. We are hopeful that this will be incorporated within the HSE capital plan that is soon to be published. If this funding is confirmed, we will submit the funded plan to HIQA for approval and seek the removal of the condition restricting long-term care admissions.

It is clear that the refurbishment will only provide an interim, limited solution to HIQA's concerns regarding the environment. There is a requirement to provide a new, modern and fully compliant facility for all of our beds in the medium term. Our registration with HIQA will once again be up for review in 2017 and we expect that there will be a requirement to have a funded plan for the full replacement of the existing facilities at that time. It is clear from this that, unless we can provide the above new facility, Leopardstown Park Hospital as we know it today will cease to function in the medium term. This would be a catastrophic loss to the local community, with the removal of 171 hospital beds for this growing segment of people who cannot care for themselves or be cared for in the community. The best estimate for the cost of such a new facility is €20 million, bearing in mind that we have the valuable site provided under our licence from the trustees. We are in negotiation with the HSE to ensure that our full replacement proposal is also part of the next capital plan and we have secured €2 million as a contribution to the cost of the new facility.

Maybe that is enough but, in light of our current circumstances, our future looks bleak. With the goodwill of the trust, which is important, and the availability of public funding, our good work at Leopardstown Park Hospital will be allowed to continue for another 100 years. We will continue to serve veterans of Her Majesty's forces - approximately 30 currently - as principal primary beneficiaries and we can continue providing a necessary element of health care to the ageing population of Dublin and south Leinster.

I would not like this occasion to pass without reference to our long tradition of care of the highest quality from our medical staff, nursing staff, health care assistants, physiotherapists interestingly, occupational therapists, dietician, speech therapist, social worker, pharmacists, pastoral care, catering, maintenance and other clerical and support staff who are critical to the running of the hospital, not forgetting the high-quality and dedicated management team that provides me with great support. They all enjoy the highest possible reputation and the warm respect and regard of the population at large and among our peers.

Jerry Buttimer (Cork South Central, Fine Gael)
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Are the army veterans Irish?

Mr. Eugene Magee:

The hospital responded for the returning veterans of Her Majesty's forces. That is still the case. Strangely enough, we are both cross-Border and national, but there is still a pipeline of personnel retiring from Her Majesty's forces to whom we offer care. The category of "principal primary beneficiary" gives them a nod over other people in the event of there being two people for one place under the evaluation of the local health authority.

Billy Kelleher (Cork North Central, Fianna Fail)
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I thank Mr. Magee for outlining the rich heritage of Leopardstown Park Hospital and I wish him well. He stated that the principal primary beneficiaries were members of Her Majesty's forces. Are they Irish citizens?

Mr. Eugene Magee:

Yes. They have now become fashionably "not forgotten", having fought in the First and Second World Wars. We still have veterans from the Second World War. They are an interesting bunch of people. They account for approximately 30 of the total 171.

Billy Kelleher (Cork North Central, Fianna Fail)
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The main challenge facing the hospital is licensing and compliance with HIQA's standards under the new regulations. The hospital has a short-term capital cost as well as a longer term one. Does the short-term cost relate to renovating and refurbishing the building and the long-term cost relate to a new build?

Mr. Eugene Magee:

Yes.

Billy Kelleher (Cork North Central, Fianna Fail)
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As in, demolish and build, or will the hospital be able to build on another site?

Mr. Eugene Magee:

We have a 24-acre site. We envisage that the bulk of the existing hospital will be demolished and replaced over a phased period by a newer one. Were we to get the nod for that, spending €2.5 million over a five-year period would be bad value, but the latter will be necessary if we are to maintain the patient quota for reasons of privacy, space, etc. When I was appointed, the nightingale wards had 25 beds, but they have been reduced to 17 in an effort to make them a more satisfactory environment for the patients. Despite that, they still do not meet HIQA's requirements.

Billy Kelleher (Cork North Central, Fianna Fail)
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As matters stand, the hospital is not allowed to accept admissions for long-term care for the elderly.

Mr. Eugene Magee:

Not into those beds.

Billy Kelleher (Cork North Central, Fianna Fail)
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If the €2.5 million for the hospital's refurbishment was approved, for how many patients could it care?

Mr. Eugene Magee:

If we did that immediately, we would reduce the 171 total by seven.

Billy Kelleher (Cork North Central, Fianna Fail)
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What of the long-term capital requirement?

Mr. Eugene Magee:

We envisage returning to being a 200-bed unit.

Billy Kelleher (Cork North Central, Fianna Fail)
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There would be a further reduction in the number of people during the building process.

Mr. Eugene Magee:

We hope that the logistics can be worked so that we can maintain our quota while building and moving. We have a bit of space. In the provision of the modified nightingale wards, for instance, we envisaged including a drop-in 50-bed unit on the site. We understand that a portakabin-type thing is available.

Billy Kelleher (Cork North Central, Fianna Fail)
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The hospital has submitted an application for funding its short-term capital requirements, but has it incurred costs in its long-term planning yet, for example, on architectural drawings and quantity surveying?

Mr. Eugene Magee:

No. Prior to my appointment, a plan, some architectural drawings and the like were produced, but that work will form part of what has to be funded almost immediately. Currently, we can produce €2 million towards it.

Billy Kelleher (Cork North Central, Fianna Fail)
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In the event of there being further military actions that result in veterans needing rehabilitation, has the requirement to take people from Her Majesty's forces as principal primary beneficiaries ceased?

Mr. Eugene Magee:

No, we still have that requirement and commitment to the trustees. It is an important issue for them, as that is their background. Does the Deputy get me?

Billy Kelleher (Cork North Central, Fianna Fail)
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Yes.

There is a principal primary beneficiary clause in place. In circumstances where the State were to provide funding for a new capital build and in the event of a large-scale military operation, what guarantees would the State have in respect of the many Irish people who might join Her Majesty's forces and who might need to spend time in recuperation afterward?

Mr. Eugene Magee:

We still envisage having the principal primary beneficiary category and it would still be subject - as is currently the case - to the judgement of the local health authority with regard to their suitability for Leopardstown Park and fair deal. A quid pro quoin this regard would be that the site comes free of charge.

Billy Kelleher (Cork North Central, Fianna Fail)
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I accept that. I am trying to work out what would be the position in circumstances where they might be an ever-increasing number of veterans with severe injuries requiring rehabilitation. What percentage of the beds could-----

Mr. Eugene Magee:

Yes.

Billy Kelleher (Cork North Central, Fianna Fail)
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The State could end up providing huge amounts of funding for a hospital and in the event of their being-----

Mr. Eugene Magee:

That is absolutely true, I suppose, particularly if there were a huge influx of recruits into the British Army. In the first instance, we would not get them back until they reach 65 years of age.

Billy Kelleher (Cork North Central, Fianna Fail)
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Okay.

Mr. Eugene Magee:

Clearly, that would modify the flow.

Billy Kelleher (Cork North Central, Fianna Fail)
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I wish Mr. Magee well and thank him for his service to date. It is a very challenging time not only for yourselves but in the context of care for the elderly across the State.

Mr. Eugene Magee:

It is.

Billy Kelleher (Cork North Central, Fianna Fail)
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It will require huge capital investment. I am aware that some money was made available this year but it is something that will stay with us as a society for a long time to come.

Mr. Eugene Magee:

Absolutely, we are not the only ones. We are coming from a very awkward situation.

Billy Kelleher (Cork North Central, Fianna Fail)
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In the context of the hospital's dealings with HIQA, what is the position with regard to drawing up plans in the short term? I do not expect a response but I would appreciate it if Mr. Magee could say what he feels it is possible to say. In terms of planning, I understand the pressure under which the hospital is operating and the fact that it will be necessary to turn away people because-----

Mr. Eugene Magee:

We will be getting to that stage very shortly. At present, we can take them in at other locations. We deal with HIQA in two ways. First, it has an official who deals with the hospital but I never see that person. On one occasion I wrote to then chief executive of HIQA and she put one of her senior executives in touch with us. That individual was quite helpful and forthcoming. I do not think we necessarily find that on a day-to-day basis in the sense that it would be difficult to get HIQA to say that if we spend the €2.5 million on refurbishment, it will still license us in five years' time. I do not think one will get an easy answer to that question.

Sandra McLellan (Cork East, Sinn Fein)
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I thank Mr. Magee for his presentation and for the CV he presented, which made for interesting reading. I note that in recent years he pursued a master's degree in law. I do not know where he gets the time but fair play to him. I look forward to working with him in the future. My question centres around the 67 beds that have been deemed unsuitable from September 2015. Does that mean that 67 beds are empty? Does it mean they will be phased out?

Mr. Eugene Magee:

It is obviously phased for the departure of our existing patients. We can use a way of admitting patients to the remainder of the beds in the hospital and move people around a wee bit. Currently, we are not reducing the number because revenue is very important to us. If we lose five patients we lose five annual revenues which would be reflected in our bottom line very seriously.

Sandra McLellan (Cork East, Sinn Fein)
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I am reading between the lines. Mr. Magee has made a few comments, one of which is that the HIQA deems them to be unsuitable. Does Mr. Magee agree with that?

Mr. Eugene Magee:

That is its prerogative. That is its terms of reference.

Sandra McLellan (Cork East, Sinn Fein)
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I am just reading between the lines.

Jerry Buttimer (Cork South Central, Fine Gael)
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The Deputy is leading the witness.

Sandra McLellan (Cork East, Sinn Fein)
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I suppose.

Mr. Eugene Magee:

I thank the Chairman.

Jerry Buttimer (Cork South Central, Fine Gael)
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I always wanted to say that.

Sandra McLellan (Cork East, Sinn Fein)
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Am I not allowed do that?

Mr. Eugene Magee:

I do not think any chairman in my position would quibble with HIQA's aspiration to improve the standards for older people.

Jerry Buttimer (Cork South Central, Fine Gael)
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To be fair, Mr. Magee is attending in his role as chairperson, not to be asked whether his adjudication of HIQA-----

Sandra McLellan (Cork East, Sinn Fein)
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Fair enough. I just thought I would ask. Mr. Magee stated, "in light of our current circumstances, our future looks bleak." This comment stands out. Is Magee concerned that funding will not be provided?

Mr. Eugene Magee:

I think I would have to be in the current circumstances. It was a bit emotive, perhaps, to use the word "bleak". If current circumstances continued to obtain, we would be closing down 67 beds over a period. That might take four or five years and, effectively, we would cease to operate.

Sandra McLellan (Cork East, Sinn Fein)
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Okay.

Colm Burke (Fine Gael)
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I thank the witness for the work he has done in the past six and a half years. It has not been an period for anybody in the health care sector. As a person who has been involved in the elderly care area for the past ten years, I am very much aware of the particular difficulties the witness would have experienced. How many beds are currently occupied under the fail deal scheme?

Mr. Eugene Magee:

All of our beds are occupied under the fail deal scheme.

Colm Burke (Fine Gael)
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So that is over 170 beds that are occupied under fair deal.

Mr. Eugene Magee:

There are 171 beds in total.

Colm Burke (Fine Gael)
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I thank the witness for that clarification. In the context of a future development cost of €20 million, is it envisaged that capacity would increase? Given that the number of people over the age of 65 will increase by 20,000 every year, for argument's sake, by the time those who enter government in 2016 serve out their term of office, there will be an additional 100,000 people over the age of 65. I am not saying that everyone over the age of 65 will be seeking a nursing home bed. There has also been a huge increase in the number of people over 85 years. Does the witness envisage the hospital increasing capacity, particularly in view of the fact that he referred to a new unit? Has consideration been given to entering into a public private partnership for funding the development - as is the case with schools and local authority projects - over a 25-year period? Has the issue of a joint approach between the trustees, the HSE and a private partnership been considered as an option in view of the fact that the service being offered is essential? I agree that it is vitally important that it be maintained and upgraded.

Mr. Eugene Magee:

I thank the Senator. I am informed that the best or the most cost-effective management of hospital beds is in units of 25. We would certainly aspire to a 200-bed unit if we get around to the new build programme. That would be our hope. We have an issue with public private partnerships. One must bear in mind that we are operating under licence from the trustees, whom I often describe as a benign landlord, who have a serious view about how they award the licence. It is interesting to note that the licence is on a year's notice. We can get a notice to say we should be out in a year if they decide they have another way to spend their money or to liquidate the trust but, thankfully, that does not arise. We get huge support from them. We raised the issue at one point because the former Minister, Mary Harney, who appointed me suggested we look at public private partnership. We did not take it any further than bouncing it and it did not meet with a huge response from the trustees and I do not think they would find it comfortable.

Jerry Buttimer (Cork South Central, Fine Gael)
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I thank Mr. Magee for his participation. I am glad he graduated from Maynooth. I am sure Professor Corish and former President O'Donnell may have been his lecturers in ethics and philosophy, so he has come with good credentials. I thank him for his forthright presentation and responses.

I propose that we forward a transcript of our deliberations this afternoon to the Minister for Health. Is that agreed? Agreed.

Colm Burke (Fine Gael)
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I wish Mr. Magee every success in the next five years.