Oireachtas Joint and Select Committees
Tuesday, 21 September 2021
Joint Committee On Health
Mental Health Services: HSE
Apologies have been received from Senator Hoey.
Today, we are meeting representatives from the HSE to provide the Joint Sub-Committee on Mental Health with an update on the proposed closure of the Owenacurra centre in Midleton, County Cork. I welcome the witnesses to the meeting: Mr. Michael Fitzgerald, chief officer of Cork Kerry community healthcare, HSE; Dr. Sinead O’Brien, executive clinical director, Cork mental health services and consultant psychiatrist with the HSE; and Mr. Derek Chambers, general manager of mental health operations in the HSE.
Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against either a person outside the Houses or an official either by name or in such a way as to make him or her identifiable. I remind them that they are only allowed to participate in this meeting if they are physically located in the Leinster House complex. In this regard, I ask all members prior to making their contributions to the meeting to confirm that they are on the grounds of the Leinster House campus.
I call on Mr. Michael Fitzgerald to make his opening remarks.
Mr. Michael Fitzgerald:
Good afternoon. I am the chief officer for Cork Kerry community healthcare. I thank members for the invitation to meet with the Joint Sub-Committee on Mental Health to discuss Owenacurra centre in Midleton, County Cork. I am joined by my colleagues: Mr. Derek Chambers, general manager of mental health operations in the HSE; and, here in the room with me, Dr. Sinead O’Brien, executive clinical director, Cork mental health services, and consultant psychiatrist.
The Owenacurra centre is a mental health services continuing care unit in Midleton, County Cork. It is registered with the Mental Health Commission to provide a service for 24 people for psychiatry of later life, continuing mental health care and mental health rehabilitation. There are currently 19 people resident in the centre. Mindful of the fact that the current building and layout do not allow for the needs of a modern residential and day service, our mental health services planned for a refurbishment of the centre. We are very aware of the excellent work carried out by the team at the Owenacurra centre and the special place it occupies in Midleton town centre. Our aim was to bring the building to a standard where it matched the care being provided there. We were also acutely aware that the current building simply did not allow for the kind of care and recovery which a modern service should provide. Unfortunately, as we moved to the advanced planning phase for the centre, serious concerns emerged that any level of refurbishment could not bring the building to the standards required. Advice from construction experts has led the HSE to take the difficult but necessary decision to close the centre. We have reviewed all options for the centre and every option involves a complete demolition of the existing building, rather than a phased refurbishment.
While we were aware of the pressing need to bring the building to the standard which residents deserve, it was only when the fabric of the building was assessed for this work that we established that they only way to refurbish the building was to knock it. This was not our original plan for the valuable service at the Owenacurra centre, and while it was a difficult decision, there was no other option open to us.
Although there were no conditions attached to the registration or escalation or enforcement actions since the previous inspection in 2020, the Mental Health Commission completed an inspection between 16 and 19 February of this year, raising serious concerns with regard to persistent non-compliance with regulation 22, which relates to premises. On foot of this, Cork Kerry community healthcare committed to providing plans for the Owenacurra centre to work to address the non-compliance. These concerns echoed the ongoing concerns of local management about the condition and unsuitability of the current building to serve the needs of the people using the service.
On 23 June of this year, the HSE informed the Mental Health Commission that we would close the centre on a phased basis by the end of October 2021. On 28 June, the acting head of service in mental health wrote to the staff, residents, families and carers at Owenacurra centre to apprise them of the issues arising about the condition of the building. Local Oireachtas Members and health forum members were also informed at that time.
The immediate priority is the welfare of the 19 residents of the centre. We are working with each resident and their families individually to agree an appropriate alternative placement based on their assessed needs. Residents will move on a phased basis after detailed consultation and discussion. They will transfer to the most appropriate setting that will meet their needs, and with their expressed preference to the forefront in any such decision. Assessments with residents have been completed and consultation with families is under way at present.
The site will be reviewed by Cork Kerry community healthcare organisation to confirm what healthcare services are required in the area so as to maximize the use of the site to the benefit of the local public. A mental health day service is also located within the building. Services in the day centre have been affected due to Covid. Work is under way to identify an alternative location for this service, as close as possible to the current location and to recommence this service as soon as possible.
An implementation team has been tasked to manage the closure of the Owenacurra centre within the timeframe indicated. An initial step in the process was for the mental health multidisciplinary team in the area to formally assess the needs of each of the residents. All of the assessments have been completed at this stage. A full Camberwell assessment of need has been completed with each resident and an action plan has been developed, following on from the assessment. The team has been asked to use the housing preference and assessment survey assessment tool, developed by Cowman, Gough and Cunningham, or a similar tool for all residents prior to a decision being made on their place of transfer.
The multidisciplinary team within the Owenacurra centre continues to have ongoing discussions with all residents to offer ongoing support and assurances. In order to keep residents and families informed throughout the process, a key contact lead is available to support and act as a facilitator between residents, their families and the project team. Social work input has been increased to support residents and families through this period. Social work also has support from the housing co-ordinator to assist with any third-party agency interactions which may be required to assist residents in moving to new homes. There is increased consultant input from the clinical director to assist with the transfer of residents of the Owenacurra centre. A member from the independent Irish Advocacy Network is part of the project steering group, in addition to a mental health service user family member and carer engagement representative, to ensure the residents and families continue to have independent supports available throughout the process.
The closure of any centre, particularly one that provides residential care to service users, can cause concern and uncertainty for residents and families. We understand that the Owenacurra centre has provided a very valuable service to residents, in a unique location, for many years. The HSE is committed to working closely with the residents to find appropriate alternatives as close to Midleton as possible over the coming period. We are committed to making sure that residents have the same level of links to their community and loved ones in their new homes.
I thank our witnesses for taking the time to do this because it is very important. I want to cover a couple of areas, starting with the building itself. Most of us have read the building report in detail and we can recognise the significant work that would have to be undertaken. I want to take a moment to understand the timeline of this process and how we got here. The first report in this inspection process was in 2016 when 14 areas of non-compliance were recorded. The premises was considered non-compliant with regulation 22, which is what we are discussing today. There was a moderate level of non-compliance. By the way, the rates of compliance and risk rating seem to change every year, which is not great in terms of trying to follow inspection reports. In 2016, the non-compliance was rated as moderate. We will not go through all the reports. The 2016 report referred to a lack of communal space, three-person rooms not being of a suitable size and the use of keys. The report stated it required improvement. It was also pointed out that there was no maintenance budget in the centre.
In 2017, the premises was considered compliant with regulation 22. The report states the quality rating was satisfactory, the building was in a good state of repair internally and externally and there was ample personal space. In 2018, the building was considered non-compliant again, with moderate non-compliance. That report stated the building was not in a good state of repair internally or externally. A change in external bad repair over a year is unusual, speaking from a professional point of view. Buildings degrade over a long period and, therefore, this is interesting. What seems to come up in a number of reports is that the toilets and bathrooms were not in good repair. In 2019, the building was back to being non-compliant with regulation 21 but the risk rating was considered low. There was a requirement for significant renovations. Some of these renovations have been done. The toilets and bathrooms were considered to be clean, hygienic and in good repair.
I have a number of questions about this timeline. In 2019, the report stated significant renovations were undertaken. Will Mr. Fitzgerald outline what the they were and the cost?
The report states funding was sought and granted for a new wet room. Will Mr. Fitzgerald also supply us with the cost of this and whether it was used? We are trying to work out whether that wet room was built. The report states it would provide a total of three showers, including one assisted shower. This seems to be significant work. The 2020 report states all the lighting was upgraded to LED standard and all the fans in the bathroom were retrofitted. I presume this work was undertaken. Do we have a cost for this?
Mr. Michael Fitzgerald:
Yes, they were. I suppose in reality the building itself, and it is important that I outline this, was not necessarily coming up in lights, for want of a better phrase, in terms of having significant issues. As there is in any of these particular buildings, there is an ongoing minor capital spend and an ongoing maintenance programme to pick up on specifics.
At the same time, the condition of the fabric of the building and its layout are of concern and have always been of concern. It does not have large room sizes and it can be quite a cramped space, especially for people with a significant level of dependency.
Our estates department sought an external review from external professionals with regard to same. The Deputy earlier referenced those reports, that really centred on the prevalence of asbestos and fire-related issues. It then reached the conclusion, which we absolutely accept, with regard to doing works on the building even on a phased basis, given what would be required to bring it to modern design requirements that should be expected by those who would reside there, that the building itself is just not fit for this particular purpose.
Earlier, the Deputy pointed to various ongoing issues. There has been an ongoing issue with privacy and dignity. This is a design issue with the building. The building has been there since the early 1970s. We are speaking about a building that was of its time 50 years ago. Any renovation we try to do, whether a new build or refurbishment, is done to bring a building up to a standard at which we are protecting people's privacy and dignity, creating adequate space for circulation and privacy and creating a modern build. It was in this context that we looked at significant refurbishment of the building so we could deal with these issues and the expectations of the residents.
I do not mean to cut across Mr. Fitzgerald but I am very aware that other people will want to come in to ask questions. Do these other buildings have reports that state they are between a low and moderate non-compliance level under regulation 22?
Mr. Fitzgerald can absolutely see, from the point of view of residents and families, that if it is not flagged in the annual reports it leaves everybody in a residential unit in this country in a difficult position. I am aware of my time. In terms of the asbestos testing, in 2019 there was a significant report on asbestos. Mr. Fitzgerald mentioned a further inspection in February. Was that a more complete asbestos report?
If Mr. Fitzgerald has one I ask him to pass it on. Otherwise the asbestos report we are looking at is from two years ago and the question becomes why we are here, two years later, with a four month window to move people out of their homes.
The 2020 report states capital funding has been approved for a major refurbishment, the estates department has been engaging with the design team, the overall project has been costed and detailed drawings were included as supporting documentation. I cannot find this information. What was the total cost for the refurbishment project as proposed before this decision was taken?
I appreciate the opportunity to speak on this issue. My colleague, Deputy Stanton, who is from the Midleton area, is also on this call. He will also be speaking directly on this issue. I thank Mr. Fitzgerald, from Cork Kerry community healthcare for being with us. I understand that we have Jim Ryan, who oversees mental health services in the HSE, with us also. Is that correct?
There is concern for the 19 residents within Owenacurra who received the relevant information in the past two months. Deputy Hourigan went through the detail of the inspection reports. The communication in this respect could be improved. There should have been a better way to engage with the residents and their families. I understand from Mr. Fitzgerald's note that they were informed in June and that the timeline is the end of October. Has proper follow-on accommodation been sourced for those 19 residents? What were the initial thoughts of the teams in the HSE in that regard? Was it residential care? I am not aware of the level of need of these residents. Will the current accommodation that has been proposed meet the requirements of the families involved and their loved ones? Will Mr. Fitzgerald or Mr. Ryan, if he is available, comment on the communication involved? As Deputy Hourigan pointed out, the last few reports indicated risk ratings that were high to nearly critical. It appears that addressing that has been managed poorly on the communications side.
Mr. Michael Fitzgerald:
The Senator asked a number of questions. I am joined by Dr. Sinead O'Brien, who is the mental health clinical director in Cork and also a consultant psychiatrist, and by Mr. Derek Chambers, a general manager, in the context of having a national perspective on mental health.
The communication process has been ongoing with the families, particularly the residents. I will ask Dr. O'Brien to comment on this matter as well. Our first contact was the direct communication with the residents. Their will and preference are our priority. That would be married with their assessed clinical needs in order to ensure that any placement is appropriate and would have the best chance of being satisfactory for their well-being. That is absolute.
I take the Senator's point regarding the communication. It is always very difficult to communicate the ceasing of a service in a particular centre. We completely accept it is very upsetting for the residents and their families for a variety of reasons. We did not take this decision lightly. We took it on the understanding that the building is not fit for purpose. Even with significant investment, our estates people could not guarantee that we would have a fit-for-purpose building. That is an important factor. I will hand over to Dr. O’Brien who might want to comment on the assessment process.
Dr. Sinead O'Brien:
I thank Senator Dolan for her questions. The needs of these individuals is absolutely paramount. I stress it is each person’s individual needs. Every person has had a very thorough multidisciplinary assessment to identify the level of support each individual needs.
There has also been a discussion on individuals' desires in terms of where they want to go and what settings they want to reside in. Some individuals were on this journey just before the decision on the Owenacurra centre was announced. They came to Owenacurra for a period of time during which they would need an increased level of support. After getting such multidisciplinary support, it was always the plan they would move to other settings where they would not need the same level of support.
In terms of the 19 individuals, we are examining a wide variety of options to match their individual needs. Some individuals will require continuing care settings. Some people will need continuing care settings but their aim is to get to a point where they can live in lower support settings. In respect of others, we are liaising with communal voluntary housing bodies for communal accommodation to facilitate such accommodation with support. We have strong community services in the east Cork region and those services will support these individuals. Each person will have an individual care plan based on what will best meet his or her needs.
I wish to ask Dr. O'Brien about the issue of HSE recruitment, which arose when I spoke to the Minister of State, Deputy Butler, last week. In terms of resources to support, in this instance, the 19 residents in the Owenacurra centre, how is the recruitment process of psychiatrist or assistant psychiatrist positions in Dr. O'Brien's community healthcare organisation area going? Of the increased positions of more than 150 to be filled, only 40 people have currently been recruited. That has an impact. What is the position in Dr. O'Brien's region?
Dr. Sinead O'Brien:
In adult psychiatry we do not have any consultant psychiatrist vacancies. We have a number of posts currently filled on a temporary basis but the posts will be advertised shortly on a permanent basis. We have had approval to recruit a new post for a consultant rehabilitation psychiatrist. That post will be crucial in providing these individuals with the level of support they need right now and in enabling them to live the most independent life possible for them with the comfort of that support and a multidisciplinary team to support them. That post has been approved by the consultant appointment committee and we have also advertised it on a temporary basis pending it being filled on a permanent basis. I am reassured there is interest in this particular post.
I thank Dr. O'Brien for her response. I also thank Mr. Fitzgerald. It is crucial we monitor the progress of these residents, particularly in this period of transition, which will have an impact on their well-being if their mental health is not managed in a very strong way. It has already had a significant impact on their families and loved ones in giving rise to high levels of worry, concern and anxiety, which could have been avoided. We need to support our guests in developing and making sure the required supports and wraparound supports are in place for these people. We also need to ensure the accommodation to which they will be moved will be suitable for their needs. I am sure my colleagues will follow up with our guests on that. We would like to see follow-up reports on that.
I thank everybody involved for organising this meeting. I welcome Mr. Fitzgerald, Dr. O’Brien and Mr. Chambers. I will get straight to the point. The previous speakers covered much of the nitty gritty and the aesthetics of what we have been discussing, that is, the building. I listened to Mr. Fitzgerald's comments and the word "building" has been mentioned many times.
I am worried that this was flagged up in reports as far back as 2016. From listening to service users and families of the service users, they feel the patients have got a hard deal. One can put in all the fancy words about conditions, registration, escalation, enforcement of actions and bla bla bla but it comes down to the fact that the HSE has the responsibility to provide a service. If the HSE is not maintaining a building in good nick, it should not let that fall on the patients because they are suffering. The best example I can give is that if one brings one's car to get the national car test, NCT, and it fails the test, one will get a report. That car will not pass the test until those problems are fixed so I want to know why those problems were not acted on previously.
Dr. O'Brien mentioned assessments. When were these full assessments carried out? Is it true that some of the patients were so upset that they were uncontrollably crying? I also want to go back to what was mentioned about filling posts and temporary posts. I have seen posts being advertised for 13 years and lying idle. Those are not proper answers to our questions. One matter that really disgusts me, and I will be frank about it, is the matter of looking for appropriate accommodation for these people. They are not patients but are people and they have feelings. The appropriate place for this is Midleton in County Cork. One can go back over all the Sláintecare and A Vision for Change reports. They were about community integration and supports and we have that. We had a Covid case in that centre but there has never been a suicide. I have been in there and I have met the patients. I know the staff in there and the HSE has not been kind to them when it comes to communication. What is the alternative to losing those services? I was taken by page 4 of the Owenacurra briefing document on the future of the site. I have put in parliamentary questions over and over again and the generic answer has been:
As this Parliamentary Question relates to an operational issue, it is a matter for the HSE. However, members of the Oireachtas are advised that the HSE is currently unable to access the information to answer Parliamentary Questions...
This is going back to July. I resubmitted the question and now the generic reply states that it has been passed on through the Minister's office to the HSE for reply. That will take at least another two weeks. Communication has been poor for us and it has been atrocious for the families from what I have heard. On top of that, the document on the future of the site states: "The site will be reviewed with Cork Kerry Community Healthcare Organisation to confirm what healthcare services are required in the area". It then goes on to question whether the site is suitable for the delivery of any of these services. That is a very worrying line.
The HSE does not understand the importance of a community-led and integrated centre. There are many locals from Midleton, where I am from, in the centre but it also covers a massive hinterland. The HSE is going to move them to what it calls a suitable place. It cannot be suitable if the areas they have mentioned are not accessible by public transport. Some of them are out in the country and others are locked out for 12 hours per day. That is not the integration of people. We need to come up with a plan B because the HSE does not even have a plan A for the centre, the site, the day care services or for all of these patients.
We ask all of these questions but there is no answer to them because the HSE does not have the answers. I will tell the witnesses how serious it is. We were at a full public meeting last night and there was anger there. I am asking the HSE to reverse this and come up with an alternative project because this is not going away in east Cork. The people out there are angry and worried. The witnesses may not be aware of this but unfortunately we had a tag in our town going back to 2002 when it was known as the suicide capital of the world but the witnesses are telling me we do not need mental health services in this town or in east Cork. It is a farce that the HSE came up with this report and is using it as an excuse. It is also using the Mental Health Commission as an excuse and it is blaming it on it. The Mental Health Commission was designed to keep tabs on the HSE, keep it going and do things right.
There is a Midleton community book and the proceeds of that go to the Midleton Community Hospital. It is led and supported by the community. That is how important these things are to the town. I do not mean to be harsh, but I have to be honest with the witnesses.
References was made to when those full assessments were completed. It was also suggested to me via email by a number of worried constituents and family members, in the early stages around seven weeks ago, that some of the patients were coerced into signing stuff, including relocation forms. I do not know how true that is. Do the witnesses know anything about that?
In Midleton and east Cork, we need to respect and humanise this. The building is archaic and it may not be fit for purpose, but the services in that town, which serve all of east Cork, are fit for purpose. I noticed a poster put by a patient in my town last Saturday and it resonated with me. The poster stated, "Improve us not move us". I would appreciate it if the witnesses could answer my questions.
Mr. Michael Fitzgerald:
The Deputy is voicing a concern about services and the removal of services in the area, which is a reasonable thing to put to us. We are always anxious to develop, and always have developed, good, community-based services in mental health and in other services in that town and general area. It is our full intention to continue to do so. It is also important to say that we did not set out to close Owenacurra. The reality is that the building is not suitable for the purpose it serves now or would serve into the immediate future. That is a problem that is not easily fixed and that is an important issue. I know I have said it before but I have to keep coming back to this point. Some people are moving through those services and into more independent living where that is possible. It behoves us, therefore, to ensure that we are providing those services in an appropriate setting.
I ask Dr. O'Brien to comment on the assessment process because it is important to know that due care and attention are being given to that. We do not take that lightly and, as Dr. O'Brien already said, it is individual based.
Dr. Sinead O'Brien:
I agree with the Deputy about the care and treatment that are provided by the team in east Cork. In terms of the assessment process, the first thing I would like to say is that the assessments have been ongoing over the years. There is one consultant psychiatrist who is the responsible consultant psychiatrist for all of the individuals in the Owenacurra centre. There is full nursing care and then there is access to social work, occupational therapy and clinical psychology. We increased the occupational therapy resources early in 2021, which allowed a full-time occupational therapist to be on site and that allowed increased therapeutic work, both on an-----
I am sorry. I do not want to cut off Dr. O'Brien, but there are other speakers. On the specific question of the completion of assessments, it was stated some time ago that these assessments were all done. It was reported in a statement that these assessments took place over the last several weeks and that individual care plans had been put in place, etc. However, I am now being told that these assessments have been ongoing for years.
The assessment that we are talking about is the assessment of people to see if they are going to be put in an appropriate place, if they are happy to be moved out of their home and if they are going to be happy. The HSE has failed to invest in the building over the years and now the patients in the building are, basically, going to be evicted from their home because of the inadequacy of funding. The situation comes down to that. I am sorry for cutting across Dr. O’Brien.
My other point concerns Mr. Fitzgerald referring to building and independent living in that context. We have a housing crisis, but he might not have noticed. Where will the resources come from to supply independent living opportunities? I am sorry for cutting across Dr. O'Brien, but the main point here is that these services are working. There should be an onus on the HSE to provide these services. They are not a luxury for the people concerned, but a necessity. The HSE is failing them and all I am being given here are excuses.
I thank the Chair and Deputy Lahart for allowing me to contribute. It is much appreciated. I also thank the committee for inviting me as a Deputy for the constituency despite not being a member. It is also much appreciated.
Last night, I attended a meeting at the Midleton Park Hotel convened to discuss the situation at the Owenacurra centre. I acknowledge the phenomenal work undertaken in the background by our community in east Cork in response to the closure of this facility. The Owenacurra centre has done phenomenal work with the service users in the area and with our community in recent decades. We heard that last night from members of the families whose loved ones had been using the service in the years since the facility opened and also from some of the people who themselves had used the services. I commend the wonderful work that the HSE staff have done on the ground in the community and what people in Midleton have done to offer support to those who have used the Owenacurra centre since it opened. Some of the information which came to light at that meeting last night was concerning in the context of the decision to close this facility. I was even more concerned to hear what the head of the Mental Health Commission had to say yesterday on the "Drivetime" programme about the HSE’s decision in this regard, because I had assumed that the commission would have been working in tandem with the HSE to a degree. I will seek a comment from Mr. Fitzgerald on that aspect later.
Many questions will be asked about this situation as we debate the topic. An important question to ask first, however, is whether there is any possibility, despite reports about the building being in bad condition, of residential services being maintained in the building. I refer to those services being maintained not just for people in the Midleton area but for those people who come from all over my constituency and beyond to avail of the service at the Owenacurra centre. The loss of the residential aspect of the services being provided is extremely concerning. I find it hard to comprehend how moving the residential patients around the county, which is what has been described to me as a public representative, is going to be in the best interests of their health and care. I open with that question. I apologise in advance to Mr. Fitzgerald because I will be interrupting him, depending on the time we have left.
Mr. Michael Fitzgerald:
As I outlined, the reality of the situation is that we are not in a position to renovate that building, even on a phased basis. We certainly contemplated that possibility as we were considering a refurbishment of the building. It is important to state that there are issues in the building with the heating system, electrical wiring and internal elements such as ceilings, walls and floors. Those elements are the very fabric of the building. In addition, as I said, the building was of its time. I do not disagree with what the Deputy said about the benefits that people have derived from the services provided at the building over the years.
There is no question about that aspect. The problem, however, is that the building itself and its fabric is in a condition which means that it is not appropriate for us to go in and use it or refurbish it-----
I want to be clear about my question. Is it possible for the HSE to find an alternative location to provide residential services similar to those now being provided at the Owenacurra centre in the Midleton area? Yes or no?
I am asking a clear question. I will repeat it. Is it possible for the HSE to provide residential accommodation for people who are now full-time residents of the Owenacurra centre in the vicinity? It must be borne in mind that the centre is at the heart of Midleton. It is next to the Garda barracks and the local supermarket, Hurley's, in the centre of the town. Mr. Fitzgerald is familiar with the facility. Is there a possibility for the HSE to provide residential accommodation near Midleton for those affected by this decision? I refer to something similar to what happened with St. Raphael's, Youghal.
Mr. Michael Fitzgerald:
To be clear, our intention is to keep as many people and provide as many services and accommodation as close to Midleton as possible. However, we must also consider the needs and requirements of those people and their expressed wishes. They may not all wish to stay close to Midleton. However, that is certainly our intention where it is possible.
That is fine. I thank Mr. Fitzgerald for that answer. A suggestion made last night was quite a palatable one for the people involved. Everyone to whom I have spoken told me that they would like to see this service being retained in the Midleton area and that some alternative location for the provision of the residential services would be found there. That, in turn, would allow the HSE the time to go in and do whatever needs to be done in the Owenacurra Centre building. It might mean levelling and rebuilding it to provide a new service which would be fit for purpose. I am aware that there are significant concerns regarding the current building. Nobody disputes the issues which have been detailed in the reports released by the Mental Health Commission. I refer in particular to the deterioration in the building that occurred between the 2018 and 2020 reports. I have noted that aspect.
I am extremely concerned about what the HSE is trying to do. I state that as a Deputy from the east Cork area. I have also known people who have used this service and have seen at first hand the fantastic work done by people working alongside the service users. I know some of the staff as well. Mr. Fitzgerald mentioned what was in the best interests of the service users. I do not agree, however, with the move that has been made to relocate people to different centres. There is a great degree of confusion in this regard. I accept that there must be dialogue between service users and their families regarding whether they consent to allowing them to be aware of the information about where they might potentially be moved to. I am concerned though by the degree of confusion I heard expressed by family members last night at the meeting in the Midleton Park Hotel. Is it an option for the HSE to examine refurbishing the current unit, perhaps even knocking it down and rebuilding it? Is that a possibility?
Mr. Michael Fitzgerald:
The building is not fit for purpose in respect of the current services. The Deputy is aware of that point and I think he is agreeing with it. Regarding the future needs of the service, we are certainly going to look at this as a site and a location. As the Deputy said, it is a central location in Midleton and near the community hospital complex. We will certainly look at the site to evaluate if there are other needs or requirements that could be fulfilled by a development on that site. It would not, obviously, be in the same building but on the same site. We intend in that regard to have a widespread discussion with the community, the local authorities etc. to assess the feasibility of doing that. We are giving that commitment here. I cannot give the Deputy a commitment that we are going to rebuild the same service on the same site. Even if we were doing that, the site itself would have to be considered.
The modern build that one would be constructing for residential care would have a different footprint requirement and standards than what exists at the moment. That is an important fact to point out.
St. Raphael's centre provides a different service in that it is a service for patients with different needs. The work done by the HSE in taking people out of the central location and integrating them into Youghal town and the community has been quite successful. Why is that not a possibility in the Midleton area? In regard to communication with the people involved, that needs to be stepped up.
In regard to day care services, what progress has been made in securing a new location for them? I understand it is proposed to retain the day care services in the Midleton area, which I believe is crucial in terms of what is being provided at the Owenacurra centre. Has an alternative location been found?
Mr. Michael Fitzgerald:
I take on board the Deputy's remarks in regard to communication. We will certainly review our communications to make sure that everybody is at all times kept up to date. Central in that regard is the residents and maintaining a high level of communication with them.
With regard to the Deputy's latter point regarding the day services, we are pursuing a number of options and we are hopeful that we will be in a position shortly to say where the day services will be located, even on an interim basis because we are anxious to restart that service. It was ceased because of Covid. In the reopening of centres, it is important for us that that service be restored.
Dr. Sinead O'Brien:
There are no beds officially registered for respite. The registration is for the total number of beds. Any individual who availed of respite would have been classed as an admission and subsequently discharged. There is no clear distinction between respite beds and continuing care beds.
Would the families of residents who stayed at the centre for short periods have classed that stay as respite or inpatient? I suggest to the witnesses that we have to be very careful about language here because there is an expectation within the community that there is a respite provision. We can use all of the euphemistic language that we like. The HSE's understanding may be that they are technically not respite beds, but they are known and understood within the community to be respite beds. Notwithstanding that those beds may not have been occupied over the period of the pandemic, I suggest to the HSE that in closing this centre it is removing a massive respite service and that is going to have a knock-on effect for the people of Midleton, Youghal, Cobh and further afield.
What consideration is the HSE giving to St. Stephen's Hospital as an alternative setting for some of the residents of the Owenacurra centre?
I beg the Chair's protection. I do not wish to sound rude, but allow me to rephrase the question. Is the HSE, "Yes" or "No" considering St. Stephen's Hospital as an alternative accommodation for current residents of the Owenacurra centre?
Can I take it that the HSE is considering St. Stephen's Hospital and, possibly, St. Catherine's centre as well? If it is the case that the HSE is considering all of the needs of all of the patients, I put it to the HSE and to the clinical director that taking people out of the Owenacurra single room setting on the basis that room sizes are too small, as identified in the Mental Health Commission report, and putting them into a ward setting is a Dickensian and backward step and is not in the interests of the residents. I hope the HSE is not considering that as an option. I am no therapist or clinician, but I know from talking to the families that from a therapeutic point of view, that would be a very poor step. I ask Mr. Fitzgerald to respond. If he can tell me that the HSE is not considering St. Stephen's Hospital as an option, a lot of people will be very relieved.
Mr. Michael Fitzgerald:
In fairness to the residents, and as we go through this process, we have to take account of people's needs and preferences. We also have to take account of the resources that are available to us and where appropriate services can be provided for people. It would be unfair at this point in time for me to be ruling in or ruling out particular centres. As I said, this is an ongoing process.
Has the Mental Health Commission been in touch with the HSE in respect of St. Stephen's Hospital? Is Mr. Fitzgerald aware of whether the Mental Health Commission has visited St. Stephen's Hospital? In terms of where I am coming from on this, Cois Alla in Kanturk covers a geographical area, Solas Nua covers Mallow, the Carrigabrick service covers Fermoy and the Carrigmore service covers Cork. What the HSE is doing in closing Owenacurra centre is to de facto take out a massive geographical area in terms of residential capability, including respite and short-term capability. That is the message that is being sent to the families. As a committee, we have to speak for the families. The witnesses may argue that we are being rhetorical in doing so, but we empathise and sympathise with the families on the basis that we share their concerns and fears that this process, which started in June and is to be a four-month process, is too short. Not enough time or consideration has been given to all of the factors involved such that every person can be happy that whatever transition he or she makes will be safe for him or her, but that if there are any question marks over the process, a break will be put on it.
The Minister should intervene directly on this issue. At this stage, we have all been in contact with him about this. There needs to be pause for thought and reflection about whether we are sending residents who have made huge progress from a therapeutic point of view backwards instead of forwards into life. We should not be providing services in a setting that is further away from where they live and where their families are. Do the witnesses understand those fears? They are legitimate fears on the part of people and we are trying to reflect them to the witnesses.
I refer again to the services in Kanturk, Mallow, Fermoy and Carrigmore. They are set within the towns and they are fit for purpose, although I accept there are issues with them from time to time in terms of meeting the full panoply of regulations. I am not convinced.
We have heard here from every single member across the political divide that there needs to be some pause for reflection on this. Quite frankly, the witnesses have not fully articulated the issue of the cost of replacement. They state that they have produced an internal report. However, it is unconscionable that the HSE should come to this committee without anticipating a question from one or all members as to how much would it cost to do the repairs and refurbishment, as well as on the cost of a replacement building on that site. The HSE has significant capital resources to do that. We do not want a situation following this decision whereby people in the east Cork region who need access to mental health services will be left bereft. I ask that the HSE pauses and reflects on this decision. They have given four months' notice. If you are kicking a dog out of the kennel, you would give him more notice than you have given some of these people to be out of their home. I am sorry if I sound exercised about this issue but I feel strongly about it. A pause needs to be put on this in the public interest and in order that we as public representatives have more time to interrogate line by line everything that you are doing here. Then we can fully and with good conscience represent constituents for whom we are deeply concerned on this matter. I apologise that I have used up most of my time, Chair. They have 30 seconds to reply.
Mr. Michael Fitzgerald:
I will respond to the variety of different issues that Deputy Sherlock raised. First, it is important to note that St. Stephen's Hospital is a registered centre with the Mental Health Commission and is always under the inspection process. I want to address Deputy Sherlock's main point regarding members' concerns and those expressed by the public. Our first thoughts are unquestionably with the residents. This is an assessment process. For the benefit of the residents, we cannot go into it here an individual basis but it is a thorough process, as was outlined by Dr. O'Brien. We undertake the process of the careful placement of people with great due care and attention and work closely with the people around that. Additional resources have gone in to make that project work well. We are mindful of that piece. Their care and well-being is utmost in our minds. I want to assure the Deputy of that.
I thank my colleague, Deputy Buckley, as well as the Chair, for keeping me up to speed on this emotive issue in my absence over the past couple of weeks. I have been reading and catching up on the opening statements. I have been reading the reports. I have even listened back to some of the recent podcasts and interviews with the residents in Midleton, as well as with residents of the Owenacurra centre and their family members. I do not think that I seen a community rally around mental health services in the way I have seen it done in Midleton. It is clear that people in the Owenacurra centre are part of the community of Midleton. They are not apart from the community of Midleton; they are actually a part of it. We often talk about integrated living and integrating different parts of the community. This is one of the best examples that I have seen. I heard one man talking on the radio about how he goes the local coffee shop to meet his friend. I have no idea if his friend is another resident in the Owenacurra centre, or if his friend is a resident in Midleton; it is none of my business. However, he goes into Midleton to meet his friend for a cup of coffee on a regular basis. That is his routine. Residents of the Owenacurra centre have their families, their neighbours and their routines, just like anybody else in society. We need to put the flesh on the bones of this. They are not statistics; they are real people and this closure will impact on them.
The closure of this facility will have a detrimental impact on the residents of the Owenacurra centre, its staff and the wider community in Midleton.
I will make a couple of charges that are not directed towards Mr. Fitzgerald but to the HSE in general. From reading the report, to me the HSE has been complicit in, and is responsible for, allowing the Owenacurra Centre to get into a rundown state and creating the situation in which we now find ourselves. Mr. Fitzgerald, in his opening statement, said the immediate priority of the HSE was "the welfare of the 19 residents of the centre". Where was this priority in the years that the lack of investment by the HSE allowed the building to get to the state it is in now? This is the situation we are in now. I will put this issue in context. These residents are real people. If they were living in a house and their landlord neglected to maintain their home, they would have recourse through a number of agencies, including the Residential Tenancies Board. In this case, the HSE is the neglectful landlord. Where is the residents' recourse? How do they go about getting recourse?
To address the other side of the issue, from all the evidence I have heard, the service provided in Owenacurra is very good. If it were not, people would not be fighting to stay in the centre and continue to use its services.
I will ask questions on the building and then ask about assessments. Mr. Fitzgerald has answered my question on the building already, but I will ask it again. Has the HSE explored every option available to allow the residents to remain in their current home? Mr. Fitzgerald mentioned the future use of the site. Was any consideration given to building a new centre on the current site and upgrading the current building to allow the residents to remain in situ and keep them in a safe space in the meantime? Was any consideration given to using the current site to build a new building, rather than moving the residents out?
Mr. Michael Fitzgerald:
As I said, we have looked at any options that would be there. Our thought process before we got into the advanced planning was to renovate the building. However, when we looked at how we might go about that, it led us to the more extensive reports. The best advice best professional advice we got was that we would not be able to invest in a building that can be guaranteed to bring us up to-----
Mr. Michael Fitzgerald:
The existing site is very narrow. The Deputy's colleagues in the area will know that the site is limited. There are many roadways around the building and the site is tight internally. The capacity to build on the site is very measured. That is the simplest way of saying it. The capacity to knock the building and rebuilding the same type of building on the site would be challenging, if it is even possible, to be honest.
I will echo Deputy Sherlock's comment on that. For the HSE to come to a meeting like this and not have the costs to hand is disappointing. I will move on.
A Camberwell assessment of need was mentioned in the report. Was this the first time this type of assessment was used? I ask because it is used as a comprehensive assessment of people with severe mental health problems. One of the indicators in the Camberwell assessment of need is to show deficiencies in the accommodation in which residents live, and whether these have a detrimental impact on their mental health and safety.
If it was used in the past, why was it not acted on in the current situation? If it was not used in the past, why? This is the standard bearer for assessments for people who have acute mental health needs.
Dr. Sinead O'Brien:
The Camberwell assessment of need is one of the rehabilitation assessment tools that can be used. There were ongoing multidisciplinary assessments taking place with the individuals in the Owenacurra Centre. The Deputy is right that the Camberwell tool indicates whether a need is met or unmet. While the individuals are residing in the Owenacurra Centre a certain proportion of people's needs are met. For a number of individuals it was always in the plan that they were planning to move to more independent accommodation, some stepping to high-support hostels and others going into community living. In terms of whether a need is met, it is very much individual determination whether that person has all his or her needs met at that point in time, but we also need to enable individuals to live the best life they can and some people are clearly requesting that they live in a more independent setting in the future.
Okay, I get that, and that autonomy is very welcome. However, I have a question. During the recent undertaking of the Camberwell assessments of needs, did that indicate that the needs of some of the residents currently living in Owenacurra were met?
The HSE's assessment tool is saying that their needs are met in Owenacurra, yet it appears that the HSE is going to move people out of Owenacurra. That does not make sense. That is all l have, Chair, and I thank you for allowing me to contribute.
Thank you, Chair, for the invitation to attend and I thank the members of the HSE for attending as well. Like my colleagues, Deputies Buckley and O'Connor, I also attended the meeting in Midleton last night. In my almost 25 years in the Oireachtas I have never been to so sad a meeting; there were so many upset people. They were not all directly associated with families who had residents in the centre. They were people from the community who attended to give their support. There was some anger as well, but a great deal of sadness, upset and concern. I raised this in the Dáil last Thursday as a Topical Issue. What I wanted to know, first, is the future of the service. There are three parts to the service. Deputy Sherlock referred to the respite part, which is not technically known as respite but I understand that every two weeks two residents use the centre for respite purposes. There is also a residential centre and the day care. Could Mr. Fitzgerald provide certainty with regard to the three services and that they will be retained in the town? As my colleagues said, they serve not just the town of Midleton but also Cobh, Youghal and as far as Glenville. It is a massive area of east Cork which is, in fact, the size of some counties.
The second issue is that this was notified to us last June. I have been told by some of the families that realistic engagement with families did not happen until last week, and one member said that it is not going well. Of the 19 residents there, with how many has agreement been reached at this stage that they would move to another location, whereby the families, residents and the HSE are happy? Where are we now in respect of the 19?
Mr. Michael Fitzgerald:
I will refer the second part of the Deputy's question to Dr. O'Brien shortly. On the first part of the question, which is whether I can guarantee or tell the Deputy that respite residential and day care will continue in the town, I cannot say that. I can say that day services will certainly continue insofar as we are, as I said earlier, actively seeking accommodation for day services. Once we have day services we will open them in the context of Covid reopening, which is taking place at this point in time.
A residential setting must be built in the context of regulation, ensuring that regulatory requirements would be met with any accommodation that would be provided. What we will be doing, however, is ensuring that the needs of the residents who are there currently are met and that where it is their preference and where it is possible, we will keep them as close to or within the town as possible.
I will ask Dr. O'Brien to respond to the Deputy's other question.
Dr. Sinead O'Brien:
In terms of the residents, we have one high-support hostel placement becoming available next week, with a further high-support hostel placement becoming available the week after next. We have also secured a place in communal voluntary sector shared accommodation, and that was the will of that particular individual. There are a number of individuals for whom, before this decision was made regarding the premises, it was identified that their physical healthcare needs were such that they would require a nursing home placement. That is being pursued for a number of individuals. For the remaining individuals, we are pursuing a number of different options. We have yet to confirm the exact destination for those individuals. We are expecting individuals to start moving from next week.
I thank the witnesses for that. By my reckoning, there are six or seven individuals, as Dr. O'Brien calls them, who now have some form of agreement with the HSE regarding a future placement. If that is the case, there are a number of people who have not reached agreement. If agreement cannot be reached - Mr. Fitzgerald keeps referring to the will and preference of the residents - and if their will and preference is to remain in the centre and not move to where the HSE offers them, what happens then?
Dr. Sinead O'Brien:
To be clear, there have been discussions with every individual about a number of options. In terms of the options placed, individuals have expressed an agreement to consider those options, so we are waiting to confirm when places become available. It is challenging to find accommodation for 19 individuals and we are pursuing that. I wish to confirm that.
With regard to the centre, it has been stated that the concern here is regarding the suitability of the premises. We did not intend to close the premises. In fact, we intended to renovate it. The issue here relates to the suitability of Owenacurra from a premises perspective. The care has been commended repeatedly here today.
Leaving aside the concern and upset of the residents, their families and, indeed, the east Cork community at this stage, there is still no certainty or roadmap with respect to where quite a number of these residents may end up. Is it the case that many of the residents may end up in places outside the community, far removed from the places they know, what is familiar, the shops and the friends they know? Is that a possibility?
Dr. Sinead O'Brien:
We are looking at all options that are open. We have been liaising with the housing co-ordinator in terms of supported accommodation also. There are some individuals who will require further rehabilitation and then will likely be able to move out into the community. We have been informed that there are options in the Midleton area.
Mr. Michael Fitzgerald:
This question has been raised a couple of times. When this decision was made in June, we needed to give a timeframe for a couple of reasons. First, Owenacurra is a registered centre with the regulator. We have to be mindful of that so we can continue to be registered. Second, we were very mindful of what would unfold in terms of the standard of accommodation we have. Currently, we do not have a building that is fit for purpose. We also wanted to have some lead-in time to ensure assessments that had been undertaken, and any placements in place, would be secure.
The Deputy asked if 31 October is set in stone. We are still working towards 31 October though, of course, if it is the position that there are not suitable or available placements for a number of residents, or a placement is yet to come up that would be suitable for a person that goes beyond 31 October, we will certainly look at that, unquestionably.
Mr. Michael Fitzgerald:
With respect, they are two different things. It is not a pausing. We have to continue the process in order to undertake this. I am saying there are practicalities around placements, etc., that mean we have to ensure we are matching people to their placements and their needs are well met. If that in any way compromises 31 October, or 31 October compromises that, then we will certainly look for an extension to that piece. It would be incorrect for me to say that a pause can happen, that we can look at it and that there will be alternatives. There is a reality to the building we have at this point in time and a reality to the structure that is there. There is also a responsibility, and Deputies have pointed it out to us, for the HSE to make that right for people. It is certainly not a-----
I get all that. I understand the building is in poor condition, it cannot be renovated because people cannot live there while it is being renovated and all of that has to be done. However, does Mr. Fitzgerald understand - he has heard from colleagues here and there were seven or eight county councillors at the meeting last night, about 150 people in all - that many people are very upset, concerned and worried about this. Is there any way that the HSE could "hasten slowly" with its decisions in this matter?
I am very concerned that Dr. O'Brien suggested placements have not yet been found for many of the residents that they and their families would agree and be happy with. It seems to me that will not be possible. We do not want people to be evicted from the centre at any stage and forced to go somewhere they do not want to go. Midleton is their home, it is where their friends are and it is what they know. If the HSE move them somewhere alien, where they do not know anybody and, as Deputy Sherlock said, maybe even in an institutionalised setting, God forbid, it will look terrible for all of us. I ask Mr. Fitzgerald to consider hastening slowly on this.
Will he give us an update on the community hospital project next door to the centre? When will that start and what is the anticipated completion date for that project? I have a reason for asking that question.
I asked that question because I understand from other information that the HSE may go to tender on it in October and it may take a year and a half, or thereabouts, to build it. I congratulate the officials on the work they have done there; it is badly needed. If the HSE could hold off on closing Owenacurra until that was ready, a fine building would be available in the old Midleton hospital that could be used in the interim for residents in Owenacurra. I am putting that suggestion on the table.
Another suggestion that came up last night, was if the HSE would consider building a purpose-built centre in Midleton. The HSE has other grounds there, not at Owenacurra. The overwhelming request and pleading from the meeting last night was for the HSE to please not evict these residents against their will and preference, to use Mr. Fitzgerald's own words, and against the wishes of the community and all the elected representatives who turned up. There was cross-party agreement at the meeting, as there is here today. I ask Mr. Fitzgerald to do anything he can to hold off on that. As he said, October is not set in stone but is, rather, an arbitrary date that was picked out of the air. We were told of this in July and I am told that families only had real engagement on this matter in the past week . Families are very upset about it because they want proper engagement. There is a long way to go on this and I ask Mr. Fitzgerald to hasten slowly on it; as he said himself, it is not set in stone. I ask him to give time to work it out to make sure this vital service for the region, not just the town, of residential care, respite care and day care is maintained. I thank Mr. Fitzgerald for his commitment on day care. I understand he has not given any commitment on the other two matters but I again want to reflect, with my colleagues, the feeling in the area on this issue. He might come back on that.
I have a number of questions I did not quite get to but they speak to Deputy Stanton's previous points about the timeline. I am trying to understand how this timeline came to be and how we got here. To be clear, the decision was made in June and the residents and families were told in July, but the newest building report or estates review was done in February. Is that correct?
Mr. Michael Fitzgerald:
I am not sure what I said about that particular piece, but we got the culmination of various reports the estates section had undertaken on 18 June, which was inclusive of the fire report, the earlier report on asbestos the Deputy referenced and the estates section's own condition survey.
The timeline is important. The last significant report on asbestos reviewed approximately one sixth of the building's floor area in the plan attached to the report, which would be standard. It found that asbestos is present and that it is in relatively good condition, as anyone who works in the area would know. If it is disturbed, it would be of particular concern. That dates to October 2019, which means that if it was of particular urgency, it would require that residents move immediately. Not taking action in almost two years is something that we need to follow up with the HSE, if there are other reports. Have other facilities received similar asbestos reports?
Earlier in the meeting, Deputy Sherlock spoke about St. Stephen's Hospital. I agreed with much of what Deputy Sherlock said. He spoke very well. Like all of the residential facilities in the country, that was also reviewed. The most recent review was in 2020. Like Owenacurra, under Regulation 22, the premises of St. Stephen's were noted as non-compliant. That risk rating was high, unlike Owenacurra, which is considered low. Mr. Fitzgerald is not ruling out that residents could be moved to St. Stephen's Hospital. Is that correct?
I am sorry to cut across Mr. Fitzgerald. I have a quick question. I know other people want to get in. I requested building reports on the long stay and acute wards in St. Stephen's Hospital in August and I have not received them. Can Mr. Fitzgerald give an undertaking to send those reports to me?
Dr. O'Brien talked about the idea that it was not planned for many of the individuals who live in Owenacurra to live there in the long term. For many, a high-dependence hostel or some kind of community setting would be appropriate. Many of the people in Owenacurra would have lived there for a decade or more? Is there a clinical concern regarding moving people who have lived in a residential setting for more than a decade into a community setting or high-dependence hostel?
Ms Sinead O'Brien:
Every individual will be assessed individually to determine what level of care he or she requires. Some individuals will require ongoing, continuing care. For that to happen with the least amount of stress, it is important that staff who are well-known to the individual would follow those individuals to assist them with that transition period.
Before I call Deputy Buckley and then Deputy Stanton, I will read out a note sent to us by one of our members, Senator Martin Conway, who is unfortunately not on the grounds of Leinster House today. He has asked me to say that he would like the HSE to answer Deputy Stanton's final set of questions and that he would like to register his disappointment about the lack of answers to many of the questions today.
I will try to be brief. The witnesses have listened to all of us. Some committees are different to others and this committee does not play party politics when it comes to local issues. I said it at the public meeting last night. I asked for everybody's support with this because it is not about scoring political points but about protecting the services in east Cork. I ask the witnesses to take on board some of the statements in that hall last night. One individual has gone through a hard time. It was brave of him to come up and ask. He told his story, his family's stories and how helpful the services in that centre have been. He said that if the building is not fit for purpose, it should be knocked down, but it should be replaced with a new state-of-the-art centre with improved services, which is fit for purpose for the next 60 to 80 years. I ask that that be taken on board. I have a simple question for the witnesses. Have any of them visited the Owenacurra centre in the last 12 months?
I have to put the crux of the issue on the record. It is all about communication.
Some of the speakers today have mentioned that communication is very poor. If we as elected representatives receive separate disclosures on this, will the witnesses give a commitment that somebody in the system who makes such a statement will be protected and the issues will be resolved? It is an issue when things get heated like this and people are excluded. I do not want to get into exclusion because I am aware some staff have been excluded from some meetings and some staff who are not part of the HSE remit but are in the centre have been excluded. Can I get a commitment on that?
If we receive a protected disclosure concerning mistreatment, mismanagement, misinformation or lack of co-operation in the service and give it to the HSE, can I get a commitment from the HSE that it will be acted on, the issues in it resolved and the so-called whistleblower protected?
Mr. Michael Fitzgerald:
We operate the protected disclosure legislation and have a process within the HSE for it. I assure the Deputy than all issues raised through protected disclosure, certainly within my responsibility, get examined and considered and there is protection there if the whistleblower wishes to retain anonymity. I can absolutely give that guarantee.
I think we ran out of time in the last lot, so that might be the reason. I join Deputy Buckley in acknowledging Mr. Fitzgerald, Mr. Chambers and Dr. O'Brien for being here. I also acknowledge that this is extremely difficult for them in their role and for everyone. It is not an easy one. There is no easy answer here. I thank them for the work they are doing and for listening to us and to the people through us today.
Am I right in saying it was the practice in the past that when people got quite ill they passed away in the centre and the hospice people came to the centre and helped with that? Was it a practice that people died in the centre because it was seen as their home?
Dr. Sinead O'Brien:
There have been a number of individuals who passed away in the Owenacurra centre. There were other individuals whose needs could not be met within the centre and they needed to be transferred to an appropriate medical facility. All options were considered. The ethos of the staff in the Owenacurra centre would always be to do everything they can to accommodate an individual's needs. It has happened but there were occasions when people needed to be transferred because their needs could not be met within the centre.
I thank Dr. O'Brien for that. We all know dying is part of life. I had good friends who passed away in the centre. They were looked after extremely well up to the end by the staff. Can Mr. Fitzgerald tell me how many staff are attached to the centre and what the plans are for their futures? Has he engaged with them on that?
Mr. Michael Fitzgerald:
We have adequate services that people can support and I am confident we will be able to place any staff appropriately. It is important to say what we are trying to do in mental health services in general.
We are trying to develop and build community- and home-based teams and to provide interventions for people so that, in the long run, there might be a lesser need for the type of residential setting we are talking about in the future. For people who have long-term mental health requirements, we are trying to find the place where the supports they need and would get from the services from a multidisciplinary perspective would be available to them.
I acknowledge to all members that this is not an easy place to be in. It was not of our choosing. Ideally, if we had a purpose-built building people could move into, it would be great. We do not have such a centre at this time so we are in a difficult position. It is not something we set out in the morning to do. That is important to say. I acknowledge to the public representatives hearing of the concerns and issues raised that we are hearing that clearly and we know committee members are getting that from the public. We will redouble our communication process with committee members and members of the public.
That would be important. I received a communication and there was very little sense in it. I know it was the summertime and so forth. The witnesses have five weeks from next Saturday. What happens if they cannot get agreement from quite a large number of residents and their families to the relocation proposals? What will they do then?
Mr. Michael Fitzgerald:
As we have said a good few times, the needs of the people are utmost and the first thing. The discussion we have is ongoing and, as Dr. O'Brien said, the placements that will be available, etc., will be important as part of that discussion and dialogue with the residents, so-----
Mr. Michael Fitzgerald:
In fairness to the staff and project people involved in this, who are highly skilled, know the residents well and are sensitive to their requirements, I do not think we will get into a high-noon situation and words like "evictions", etc., which can be inflammatory, need to be used. We are not in that business. We are trying to place people in better accommodation than what they have at this point, to get away from this building, which is not fit for purpose, and to have that uppermost in our minds. We are not-----
I understand it is difficult and I do not want to be inflammatory but I attended the meeting last night, as did my colleagues, and many people were very upset and see this as their home. Of the 19 residents, how long has the longest serving been in the centre?
We are talking about somebody for whom this has been their home for 25 years and we are saying they must go somewhere else. This person has mental health challenges. Let us consider if any of us were asked to move miles away from what is familiar, from our friends, from the locality and from being able to walk out the front door and down the street to meet people we know and go into shops we know. This location is ideal for people living there. How would Dr. O'Brien feel if it happened to her? How does she think as a professional about people being moved from what has been familiar for 25 years and taken out of there, maybe against their will? They do not want to go. This is what they like and love. When was the last time a resident took up accommodation in Owenacurra? I ask about the most recent resident to take up accommodation there.
A few issues are emerging and this is something I want everyone to take away. What emerged from the meeting last night was this is seen as people's home and what is familiar to them.
We know that sometimes when people move out of their homes and into nursing homes, they can regress very quickly because what is familiar is gone. This is something we really need to take into account. I understand, as we all do, that the building is not fit for purpose. I am not sure whether it would be considered a dangerous structure. Is it the case that it has been condemned by the fire service?
Mr. Michael Fitzgerald:
It has not been condemned by the fire service but it certainly has significant defects. It is not a good place. I just want to be clear: if it was of that nature and if our risk was at that level, we would have had to evacuate the building. It is not in that shape, however. The context of the decision is whether one would have a building that is fit for purpose after renovation.
The feedback last night for Mr. Fitzgerald and his team was that all staff - nursing, catering, medical counselling and so on - are excellent and have been providing a fantastic service. My colleagues and I would agree with that. The feedback we are getting is that the staff are very caring and professional. This is a fantastic service.
We know the building is not fit for purpose. As already stated, it appears that 31 October is an arbitrary date that was picked. Mr. Fitzgerald said it is not actually set in stone. As a result, there is a possibility of pausing this, going slowly and reassuring people and their families that their will and preferences will be taken into account and that we will all work together to come up with another solution. I put one on the table already with respect to the building across the road, which could, perhaps, be used on a temporary basis instead of the centre when the new hospital is built. The latter might be a year and a half away. I am not sure if Mr. Fitzgerald can or is prepared to wait that long.
I ask that Mr. Fitzgerald please take into account what we are saying. In my 25 years in politics, I have never been at a sadder meeting. I have been meetings where people were angry and where I have been taken apart and at meetings where I have received abuse. However, I have never been at a sadder meeting. Mr. Fitzgerald might take that away, and, with his excellent team on the ground, see what he can do to slow matters down in order to listen to the families and people involved and read the files in order to see what is going on.
I thank all our members. I have one or two questions before we conclude. It is very upsetting to hear what is happening to the families and residents of the Owenacurra centre. I listened to some of the residents speaking on the radio yesterday. I was extremely moved by how they spoke about the fear and anxiety, and how they feel about being moved out of their home. This is a place that changed their lives dramatically. These are people who had been struggling with mental health issues for many years and who had nowhere to go. They had a home at Owenacurra but not only that, the staff were just so brilliant. I feel upset for them.
At one of our meetings approximately a month ago, we heard from the families about the devastation, anxiety and worry this has brought for them. There must be some way that this decision can be reversed. Listen to what the residents and families are saying to really hear the anxiety of being moved and placed somewhere else. They will not in their communities anymore. The fact is that they can walk down to their local library. Everybody knows and welcomes them in the shops. The community in the Midleton area is wonderful. The people involved here risk being moved to somewhere close by but they will not be able to walk to Midleton if the relevant facility is five miles away.
Where will future service users who suffer with enduring mental illness be referred for respite for long-term placements if the centre is closed? Can this decision be reversed? What will it take to reverse it? I would love to hear the answer to that question. I thank the witnesses very much.
Mr. Michael Fitzgerald:
To answer the second question, unfortunately, it is very difficult to get away from the facts regarding the standard of the building. I know I am repeating what I said already, but, in reality, we are not being left with much to play with. It is a poor building and is substandard. The layout is also not great but I will leave that aside because people made that point earlier. It is not a building you can renovate without demolishing. That is coming from professionals who have looked at it and considered all the various different options that surround it. That is the position we are in.
I am sorry; I lost track of the Chairman's first question.
Dr. Sinead O'Brien:
I thank the Chairman. Within the Cork region, we have different levels of support depending on the assessed needs of individuals. We have other continuing care units and high-support hostels. It is really important to emphasise, however, that we have put significant investment into the community in Cork. We have four home-based treatment teams, one of which is specifically for the east Cork region and the communities of Midleton, Youghal, Cove and Carrigtwohill.
We also have a seven-day service in the community. This means that individuals can be seen every day if that is the level of support required. The introduction of that service has proven to be invaluable to individuals and their families when they have periods in which they require increased support. These teams have multidisciplinary support, so, again, they serve to enable individuals to address matters that are causing them either difficulty or distress. The input of social work, occupational therapy and psychology is invaluable, and the community supports are very strong. This year, we have a psychiatry of later life community service that now covers all of Cork. Up until that, we would not have had a service for all of east Cork but now we do. It can provide support to individuals in their homes, residential settings for older persons and in nursing homes.
I will finish on this. What the residents and families need now more than anything is certainty. Another drawn out period of uncertainty will only worsen anxiety among those who are most affected by these decisions. For any of us, uncertainty about our accommodation is deeply unsettling. It would be really unfair and unethical to subject a group of people with significant mental health difficulties to a further ordeal of uncertainty over the coming months. We need a funding commitment for the retention of these services on the site of the Owenacurra centre as a matter of urgency, either for a major renovation or a rebuild of the premises. That is what we will be focusing on here in Leinster House. We will do everything in our power to achieve that.
I appreciate that the witnesses have been put in a difficult position today. I thank them so much for attending. We will probably send them some questions. Deputy Hourigan asked some questions in respect of which they might also send us some written replies. I thank the witnesses most sincerely for appearing before the committee today and for their contributions. Go raibh míle maith agaibh.