Martin Browne (Tipperary, Sinn Fein)
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Our next business is our engagement with Ms. Susan Mullins and Mr. Barry Torpey who are representing the Save St. Brigid’s Action Group. This concerns Petition No. 48 of 2021, Save St. Brigid’s Hospital, from Councillor David Dunne.

Before we start, I wish to explain some limitations to parliamentary privilege and the practice of the Houses as regards references to other persons witnesses may make in their evidence. The evidence of witnesses physically present or who give evidence from within the parliamentary precincts is protected, pursuant to both the Constitution and statute, by absolute privilege. Witnesses are again reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity, by name or in such a way as to make him, her or it identifiable, or otherwise engage in speech that might be regarded as damaging to the good name of the person or entity. Therefore, if witnesses' statements are potentially defamatory in relation to an identifiable person or entity, they will be directed to discontinue their remarks. It is imperative they comply with any such direction.

Before we hear from our witnesses, I propose we publish Ms Mullins's and Mr. Torpey's opening statement on the committee’s website. Is that agreed? Agreed. On behalf of the committee, I extend a warm welcome to Ms Mullins and Mr. Torpey, who will both read out the statement. I suggest they should make the statement for around ten minutes, if they wish. We will then have questions and comments from members. I ask members to confine themselves to about ten minutes at the start. This will allow members to contribute more than once. I invite our guests to begin.

Ms Susan Mullins:

I thank the committee so much for this opportunity and for welcoming our delegation to present an urgent appeal from the local community in Carrick-on-Suir and environs to reopen St. Brigid's Hospital. The hospital was for decades a source of much-needed respite, convalescence and hospice services under the excellent provision of care by kind, professionally qualified staff. We thank members for giving us their time to listen to our case and look forward to engaging with them in a positive step forward on this important issue that affects many families who live in the catchment area of Tipperary, Waterford and Kilkenny, and will into the future. We also extend our sincere thanks to the clerk to the committee for her patience, kindness and understanding at all times as we submitted our documents over recent years. We cannot stress enough that all our past meetings and peaceful protests held by local people have been non-political and always community-led.

I am a qualified solicitor and am self-employed in my family-run legal practice in Carrick-on-Suir and in Tramore, County Waterford. I live in Carrick, which is my native town. I am here in a personal capacity as a concerned member of the community in Carrick. I am not being paid for my attendance today, or for any work I carry out in the save St Brigid’s campaign. On a personal note, St Brigid’s Hospital has been an integral part of my life. My mum was a midwife there in the late 1960s and 1970s, and often after school I would be up there in the kitchens. St. Brigid's was a wonderful community hospital. My dad died there in the hospice rooms following palliative care. That was absolutely fabulous for me as I was pregnant and had an 18-month-old at home.

I was also trying to run a business. It was wonderful to be in our local town, where I could visit my dad in his final week. My paternal grandparents also died very peacefully in St. Brigid's, surrounded by very caring staff. Mr. Torpey will introduce himself and his expertise in a moment.

To give the committee a flavour of the history of St. Brigid's, it started 183 years ago, in 1840, when it opened as a fully functional small district 16-bed hospital catering and caring for local people from the cradle to the grave. The hospital facilitated local people who needed maternity care and were delivering children and catered for people suffering from all forms of illnesses. Minor operations were carried out in the hospital. In later years, it morphed to accommodate people for respite and convalescence, with separate male and female wings. In more recent years, the last 20 years, three state-of-the-art hospice rooms and en suite rooms with kitchenettes and sitting and sleeping areas for family were added. There were almost 30 people employed in the hospital.

The local people of Carrick and its environs part-funded the hospice rooms through years of massive fundraising efforts, some of which also went towards replacing all the windows and doors in the entire building and the installation of a lift. At funerals in Carrick and its surrounding areas, it is a regular sight to see signs seeking donations to St. Brigid’s rather than flowers for the deceased. It is impossible for me to emphasise adequately the connection the people of the area have with St. Brigid’s Hospital. Almost every family has had a loved one or neighbour stay at St. Brigid’s for one reason or another over the years. St. Brigid’s Hospital has been a haven for families in the area and the distress and anguish at its closure cannot be adequately articulated.

On the facilities, the hospital was a short-stay designated centre for older people with patients staying for up to two weeks - sometimes longer if deemed necessary by their GP but never longer than a maximum of four to six weeks - for convalescence after an illness and respite care, for younger people who were chronically ill and for end-of-life care for those over 18 years of age. Each palliative care unit was fitted with a private room for the patient, a bathroom and a kitchen and sitting room for family members who were staying at the hospital. Each of the three hospice rooms located on the ground floor led out to a beautiful walled garden and patio area, a haven of peace offering dignity and privacy to both patients receiving end-of-life care and their families at a time of extreme emotional distress. The hospice facilities gave family and friends genuine peace of mind and great comfort as they could call in and visit their loved ones at any time of the day or night and also stay overnight. It was also a source of relief for patients and families as a team of qualified nurses and care staff members were on duty 24-7 and nearby GPs could visit, assess and reassure their patients.

Following the loss of these services in April 2020, no alternative service was put in place. Instead, local people must now use the facilities of private nursing homes for respite care or travel to St. Teresa’s Hospital in Clogheen for end-of-life care. St. Teresa’s is a 40-minute drive from Carrick-on-Suir and no public transport is available. Carrick is a DEIS town. It is a disadvantaged town and an awful lot of people do not have cars or private transport.

The large number of people who have died from cancer in the Carrick area over the last few years and whose families have had no close access to hospice care has caused immense suffering and stress and this situation is continuing to impact severely on everyone in our community. Over the 20 years of palliative care service provision in St. Brigid’s Hospital, between 28 and 30 people died there every year. That is approximately one person every two weeks. It was very much end-of-life care in the hospice. Respite and convalescence care provision have also gone, putting severe pressure on carers who deserve and need a break from their 24-hour caring role. Our older people in respite care always enjoyed the high standard of care they received from the caring, diligent and friendly team in St. Brigid’s. They were also mostly among friends and local people they knew, which was greatly comforting for them in their later years. I will pass over to Mr. Torpey to deliver the second part of the opening statement.

Mr. Barry Torpey:

I thank Ms Mullins, the Senators and Deputies, the Chair and the clerk. I am a qualified civil engineer and technician with 28 years' experience in various civil engineering and construction sectors. I currently work in the health and safety sector. I am here in a private and personal capacity. My partner, Jean Welsh, was a staff nurse at St. Brigid's on the day services at the hospital ceased.

I will continue to read from our opening statement. We will move to the issues of the step-down unit designation and closure. The HSE designated St. Brigid’s as a step-down unit for recovering Covid-19 patients in April 2020 but it closed the following month with the cessation of all services. St. Brigid’s Hospital was a 16-bed hospital when closed and two beds were removed to adhere to infection control requirements during the Covid-19 pandemic. Despite many promises that inpatient services would return, the HSE stated that the building did not meet HIQA standards, as stated in its latest report of 2018. The HSE said it would be converting St. Brigid’s Hospital into a community health centre for chronic disease management, specialising in diabetes supports. Almost 30 staff were redeployed to other HSE facilities in Waterford and Tipperary during lockdown and all equipment was removed from the hospital.

On peaceful protests and the bed push, actions to support and highlight the need to reopen St. Brigid’s included weekly peaceful protest meetings and walks around the town, many of which were attended by older people from Carrick-on-Suir and its environs. A bed push from South Tipperary General Hospital in Clonmel to St. Brigid’s Hospital in Carrick-on-Suir took place on Saturday, 24 October 2020, when Catherine Foley from Carrick and a volunteer with Carrick-on-Suir River Rescue took on this remarkable 23.5 km challenge in a bid to raise awareness urgently of the need to reopen St. Brigid’s Hospital. Such is the passion and endurance of the local community to have their services returned. It is not just a fundamental need of the people; it is a just and fundamental right. A petition signed by almost 11,000 people from Carrick-on-Suir and the catchment area seeking to reopen St. Brigid’s Hospital was handed to the Minister of State at the Department for Health with special responsibility for mental health and older people, Deputy Butler, at Dáil Éireann on 22 September 2021 by representatives of the "Save Our Hospital" campaign.

We are in the middle of a perfect storm with the current trolley crisis in hospitals nationwide. There is evidence of delayed discharge in many of our local hospitals in Clonmel and Waterford and throughout the country. Nursing homes are closing and there are very few options for older patients who are recovering from illnesses or convalescing. It is very difficult to source carers under the home care packages and so older people are not being discharged from hospitals as it is not safe for them to leave. St. Brigid’s Hospital is an example of how the trolley crisis can be alleviated and it can assist in the discharge of older people from hospitals. We firmly believe that the reopening of St. Brigid’s Hospital would help relieve these ongoing issues as there were no long-stay beds in St. Brigid’s and there was a constant turnaround of people every two weeks in the beds available there over the years. These respite and convalescent services provided more beds not less beds. There is a staggering rise in the number of older people living at present and it is the global trend of this generation. The health issues arising from a larger older population is, and will continue to be, significant. This problem is not going away and is only going to get worse. The trolley crisis will continue and get worse every year with our growing older population.

In the HIQA reports, the inspector said “there were sufficient resources in place to ensure the delivery of safe and good quality care and support to the residents”. That is a HIQA inspector referring to St. Brigid's Hospital. The reports’ findings, while glowing in their praise for staff from the patients and visitors in respect of their care, say there is an issue in respect of the size of the building in light the number of patients being catered for and seek that a new hospital be built on a green-field site. We know of no funds allocated for such a hospital. There is a hospital in place that was fully operational prior to the Covid-19 pandemic and which could, with some minor internal adjustments, be up and running again in a very short period of time. We are of the view that the issues raised in the reports, in particular regarding patients’ ability to store their belongings, could be easily rectified with the addition of simple lockers or wardrobes.

We accept that a slightly slimmed down version would be necessary for the hospital to be reinstated. We are grateful for the committee’s assistance in hearing our petition and further, if the committee is minded to seek to raise the matter again in the Dáil, with the Minister for Health and the Government, particularly in light of the recent difficulties acute hospitals face and will face going forward. The decision to close our hospital was the wrong one. It is never too late to do the right thing and reverse this decision. I thank all the members for their time.

Martin Browne (Tipperary, Sinn Fein)
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I thank Ms Mullins and Mr. Torpey. Before I let others in, I thank Councillor David Dunne for submitting the petition on behalf of the people of Tipperary, Kilkenny and Waterford. I am from the constituency and I am aware of the concerns that have been raised about the hospital's future not long before it was changed from a step-down facility to a Covid facility. I am also aware of the huge public affection St. Brigid's has in that huge catchment area, especially for the families. I was at some of the protests. All the local representatives here, such as Councillor Kieran Bourke, Séamus Healy, Deputy Cahill, and Councillor Seanie Power from Waterford, will have heard about the concerns there. I thank the witnesses for bringing their concerns and the petition to the committee. I will bring in other members before I say any more. Senator Craughwell is anxious to come in first because he has to go to another meeting.

Gerard Craughwell (Independent)
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I thank the witnesses. I note that there are public representatives and members of the community here today. That is indicative of what we are talking about here. In fairness, Ms Mullins mentioned the word "community". It is a community resource and is one that is clearly loved by the people in the area. That is the emotional side of it. Then we have to look at what exactly is happening here. We need to bring this message across to organisations like the HSE. A decision has been taken behind closed doors without reference to local representatives and without reference to local Deputies and county councillors specifically because they are the people at the coalface. The first action taken is to strip everything out as quickly as possible to make it extremely difficult to reverse the decision. That appears to be what has happened in this particular case. Ms Mullins spoke about palliative care and I could see the emotion in her when she did because obviously she has been there with somebody. All of us in this room at some stage have faced into a situation where we had a loved one who was dying. To be able to go into a centre where people are allowed to have their dignity but also allowed to have their family in those final days and hours is so important. The decision that the witnesses are looking for - correct me if I am wrong - is to restore the respect to their community and the right of those citizens in that community to die with the comfort of having their families and loved ones with them.

Mr. Torpey spoke about respite or step-down. He quite rightly pointed out that there are trolleys in every hospital in the country. It is nothing new. I had my appendix taken out when I was ten years of age and I was sitting in a bed in the middle of a long ward in the regional hospital in Galway while there were beds in the corridors. We have had a trolley crisis and a bed crisis forever. What would happen if this hospital was open in the morning and somebody from Carrick had surgery in Ardkeen and needed the extra couple of weeks? Mr. Torpey said he accepted it would not take the full 16 anymore. How many people does he think could be accommodated there?

Mr. Barry Torpey:

The issue HIQA raised was the five beds. There are two five-bed wards and they would potentially have to come down to four-bed wards so there would be a patient lost from each of those wards. Two patients overall would be loss to that service. That is information we are surmising because that is not down on paper but it is implied by the HIQA report that there is a lack of space in that five-bed ward. The implication is that a four-bed ward would be the solution.

Gerard Craughwell (Independent)
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I do not want to put Mr. Torpey on the spot. He is a qualified engineer.

Mr. Barry Torpey:

No; a civil engineering technician.

Gerard Craughwell (Independent)
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It could be refurbished quite easily, I would think.

Mr. Barry Torpey:

Yes. It is about space and privacy issues. There are clearly simple things that could be done, like having the beds a little further apart or putting a wardrobe between the beds. It is simple stuff. It is not rocket science at all. It could be a new layout of a room or something like that. None of these issues appears to have been teased out or delved into at any level.

Gerard Craughwell (Independent)
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A long time ago I was advised by a trade union official that if you wanted to get a reaction to anything, it was a function of how much heat you could put under backsides at any given time. Getting 11,000 signatories in that catchment area is a lot of heat. Have the witnesses been in contact with all the Deputies and county councillors in their local area?

Mr. Barry Torpey:

Way back when there were signs of the services not being reopened, I went to all five of the Deputies in the constituency and communicated with all of them. I communicated directly with the Taoiseach and the Minister for Health at the time. A lot of other people took the same course of action. The HSE was written to directly as well.

Gerard Craughwell (Independent)
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I think most people in this room will agree with me when I say that from a political perspective there is every reason in the world to go down and save the hospital today. None of us in this room or in these Houses would want to see it closed. I propose that we invite the HSE and HIQA to come and explain precisely what needs to be done to maintain the hospital and keep it open. Clearly there has been fundraising there to maintain the building so there is very little excuse with respect to the building. If minor changes need to be made then they can be made. I would also like a study to be done on the cost to the individuals who have people in palliative care or people who are stranded in Ardkeen hospital or whatever other major hospital they are in, purely because there is not a step-down facility available within their community. Sometimes we look at the macro figure of the total cost of the hospital without looking at the knock-on cost to the community, with money spent on public transport for example. There is no public transport. I am fairly familiar with the area. My missus is from down that neck of the woods and I forgive her for that.

Martin Browne (Tipperary, Sinn Fein)
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The Senator should be kind now-----

Gerard Craughwell (Independent)
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As a good Galwegian, I would not have much time for Tipperary or Kilkenny. I really think we need to have HIQA and the HSE in here. We need to find out what the decision was that ultimately led to the closure. It strikes me from what the witnesses are saying that Covid came along and it provided the ideal vehicle to ship everybody out. As soon as the Covid thing passed then it was closed down. There is not a whole lot more this committee can do than bring in those responsible and get them to answer for the decisions that have been made.

I wish the witnesses well in every way. I am sorry that this has happened to their community. Places like Carrick and down around that neck of the woods are very closely knit and people are very supportive of one another. It is a wonderful part of the country and the people there deserve more than what they are getting. At least they deserve some straight answers. If there is a cost factor involved then let us hear what it is and see how we might meet that. I propose that both HIQA and the HSE be brought in to answer the questions that are there.

Martin Browne (Tipperary, Sinn Fein)
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I agree that we need to bring them in and see the reports on which the HSE has made a decision. The committee and the community itself have long tried to get a reason why the hospital was closed and have failed to get it. The Senator asked about fundraising. I know from being in the constituency, and Deputy Cahill would agree with me, the amount of fundraising that has taken place down through the years in the north Tipperary, south Kilkenny and Waterford area to put different doors and every kind of a thing you would wish for into that hospital. That has all been collected locally.

For that reason alone the witnesses deserve the answers to the questions they are asking.

Gerard Craughwell (Independent)
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When Ms Mullins mentioned going up to the kitchens to her mum as a schoolgirl, it really brought home the whole community thing. It was a part of the community. I know it is facing us all. We will all have to die at some stage. I will have to die at some stage. I am in the departure lounge but I hope the flight is delayed. When I die, I would like to be in a place like that, where the community - the people I grew up with, the people I loved and the people I lived and worked with - is there. We here will do all we can for the witnesses.

Ms Susan Mullins:

I thank the Senator.

Gerard Craughwell (Independent)
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The real problem they have, however, is the HSE and HIQA. That is what we have to work with. I am sorry I have to go to another meeting. I very much appreciate the witnesses being here.

Ms Susan Mullins:

I appreciate that. I thank the Senator.

Jackie Cahill (Tipperary, Fianna Fail)
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I am not a member of the committee so I thank you, Chairman, for facilitating me this week. Tipperary is my constituency too, so this is of very significant importance to me. I compliment the people of Carrick and the surrounding areas - not only the public representatives, Councillor Bourke and Councillor Dunne, but all the community - for the good fight they have put up to try to save their community hospital. They have fought this since April 2020, when, as was said, the decision was taken, under the cover and veil of Covid, to close St. Brigid's, despite Councillor Bourke and me getting verbal assurances from the Minister for Health that it would be open post Covid. Unfortunately, that commitment was not delivered on. It was a source of serious disappointment to me and Councillor Bourke that the commitment we got from the Minister for Health was not delivered on. That needs to be said and put on the record.

Ms Mullins and Mr. Torpey made opening statements that were very descriptive of the role St. Brigid's plays in the community of Carrick. No one is saying we want this to be an acute hospital. We fully realise its limitations and the role it played in Carrick-on-Suir. I refer to a comment that was made by Deputy Micheál Martin when he was Taoiseach about another facility in south Tipperary, that we must always deal with the low-hanging fruit first to try to deliver health services. If ever there was low-hanging fruit, to have respite beds and palliative care in St. Brigid's is it.

We have here a copy of the report done in 2018. While it listed some of the limitations of St. Brigid's, at all stages it is unanimous that the care and the healthcare in St. Brigid's were of the highest standard. While the hospital needed modifications to be brought up to modern HIQA standards, and no one is denying that, and while, as Mr. Torpey said, there would probably have been reduced occupancy, we would still have a core community hospital in Carrick.

Unfortunately, palliative care, as Senator Craughwell said, touches us all. When palliative care beds are taken out of a community, the heart is torn out of that community. Clogheen is a significant drive from Carrick. It is to be hoped St. Anthony's in Clonmel will now provide palliative care beds in the new facility being built there. However, palliative care beds are needed in a community. When people are in their last week or days, they want their family around them. When the bed is in your own town, you can run in three, four, five or six times a day and spend five or ten minutes there, whether you are going to work, on your lunch break or whatever. The value of that to a community cannot be overestimated.

Senator Craughwell spoke about bringing in HIQA and the HSE to go through this report. Why was more cognisance not taken of the report when the decision was taken by the HSE to close St. Brigid's? As has been said, there were no serious flaws found with St. Brigid's, only that it needed modernisation and a reduction in the number of beds in some of the rooms. There was a proposal about a greenfield site being needed into the future and the investment in that for the town of Carrick. All of that was ignored and the decision just made for closure.

We have the fundamentals of serious questioning of the HSE as to how the basis for its decision was arrived at when it had a report on its desk that was fulsome in its praise of St. Brigid's, focused on the role it had in the community and what it was delivering for the community of Carrick. In a time when we have a serious shortage of beds, we have a facility that could provide respite beds that would take the pressure off Tipperary University Hospital, University Hospital Waterford or University Hospital Limerick. It does not matter which acute hospital it takes pressure off, because respite beds would take pressure off the trolley crisis we have.

I compliment you, Chairman, on giving the community the opportunity to bring this to the Oireachtas. As a Deputy for Tipperary, I will do all I can to support the witnesses to see if we can get common sense to prevail as regards St. Brigid's.

Pat Buckley (Cork East, Sinn Fein)
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I welcome all the witnesses and the people in the Gallery. I am known for being blunt. The big problem we have here - let us cut straight to the chase - is that there is absolutely no oversight in the HSE. We in this committee have met a number of times to discuss other centres, and the exact same excuse comes up, that is, buildings are not fit for purpose, and instead of investing in them, the HSE just closes them. In my town, Midleton, we have a 22-bed respite and mental health centre and we have battled for the past year, or maybe 18 months to two years at this stage, with the exact same excuse: the building is not fit for purpose.

The following is the advice I will give the witnesses. They should look at the reports from any of the organisations that went in, whether HIQA or otherwise, and try to access that information in the reports. I have reports that date back to 2016 right up to 2021 on the centre in Midleton. The HSE did not spend a brown penny, and it is the patients and the families who are suffering. Ours went from a 22-bed centre - 20 long-term respite and two short-term respite - to a centre where we now have six residents, which is what we call them. We do not call them patients because it is their home for more than 30-odd years. They are the ones who are suffering. The witnesses will find that the HSE will blame Tusla for the recommendations, but I urge them to find out what, if any, recommendations were made prior to the announcement of the closure and to see if the HSE actually took the recommendations on board. That is the first thing I would say to them.

There is respite and then there are associated services. They could be chiropody, dental, mental health - anything. The witnesses will lose all those as well in the community. While I had the honour of sitting on the Sláintecare committee, I am listening to the witnesses today and I have listened to this before with other centres. There is a trend now coming between Carrick-on-Suir, east Cork and, a couple of weeks ago, west Cork, in Bantry, where there was something similar with mental health beds. It is the same thing: when these services are lost, they are gone. The knock-on effect of that is that when something is lost in the community, there are no step-down beds. If there are no step-down beds, it puts pressure on the main hospitals, thus leading to overcrowding. Then there is a big explosion instead of an implosion.

Coming back to privacy, dignity and associated services, I read one of the articles on this in which an elderly gentleman said it was a home away from home. The Sláintecare report refers to having community-led, fully integrated services within each community. What I have seen in maybe the past two years is that the HSE is coming up with the excuses and - the witnesses should watch this - will blame Tusla for this.

It will say it is not its fault but Tusla's fault because it submitted the report and said it was not fit for purpose. Be very careful in that regard because it said exactly the same thing about the centre in my home town, the Owenacurra Centre. Yet, when I look at this, there were reports in 2016, 2017, 2018, 2019 and two reports in 2020, with a mismatch of half a fire report and half of another one on it. It was all over the place, yet the HSE spent nothing. I commend the 10,000 people who signed the petition. This is people power here. The beauty of this committee is that it is apolitical because this is the last chance saloon for people to air genuine concerns. It makes me very angry that the most vulnerable people in our community will bear the brunt of the incompetence of whoever is running the place. What makes this worse is that when people put their hands into their own pockets to keep the hospital going, that too is dismissed. It beggars belief.

This centre covers a very large area, extending into counties Tipperary, Waterford and Kilkenny. That is a massive area. The population is ageing, yet we are being regressive with services. The pendulum is swinging in one direction as demographics show an ageing population whereas services are reducing. I guarantee that in 12 months’ time the HSE will address the Minister and say we have a problem here. The biggest problem here is the lack of HSE oversight. I will look for a report or recommendation to see if the HSE actually invested money in the services.

This action group certainly has my full support in this. I agree that the HSE and Tusla must appear before the committee to answer questions for all those in the Public Gallery and those who signed the petition. It is downright disgusting and degrading to see what happens when community-led services are privatised. They are no longer people-led or people-centred but driven by profit and euro. I commend the action group.

There is no such thing as a stupid question in this committee. The issue is the stupid response people will get.

I will leave our guests with this example. I asked a question of the HSE one time that featured the words “blue” and “pen”. I received two separate responses and “blue” or “pen” were not mentioned in them. That is what the action group will deal with. It will meet resistance. I cannot understand why there is resistance within the HSE. I am talking about management, not front-line workers. It is top-heavy management. We raised this issue last night in the Dáil when we discussed the trolley crisis. St. Brigid's in Carrick-on-Suir, the Owenacurra Centre, Bantry Hospital and elsewhere are perfect examples of the HSE closing community-led services, leading to overcrowding in our hospitals and adding fuel to the fire.

It beggars belief that the action group must come before this committee. I am delighted the Chair and all the members have facilitated this meeting because it is probably one of the most powerful, open and level committees. It is also, however, the last chance people have to air their views because where can they turn to after this?

Ms Susan Mullins:

I thank the Deputy.

Martin Browne (Tipperary, Sinn Fein)
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During a meeting on the St. Brigid’s facility at the Hotel Minella, we were told another 350 community beds are to be lost. In recent weeks, we have seen services backed up in acute hospitals. If we remove another 350 community beds, what will we finish up with?

Paul Gavan (Sinn Fein)
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I thank our guests for coming in and thank members for allowing me to pop in to find out some more information about this issue. Before I put some questions to Ms Mullins and Mr. Torpey, I will make a general comment. When a community loses a hospital like this without any consultation whatsoever and then goes to the trouble of achieving the impressive feat of collecting 11,000 signatures, it does politics enormous damage if there is not some kind of accountability. It is clear the action group has the support of its local representatives, which is very important and credit is due to all of them. As well as communities, politics loses when there is no accountability about why such an important facility is lost to a local community.

I want to learn a little more about what has happened here. The first question that strikes me is what people are to do now. Unfortunately, I imagine most of us in this room have lost loved ones. I certainly know the importance of having a good respite facility and the privacy and space that people need. We have heard that some of these people now have to go to private, for-profit nursing homes. With the best will in the world, that is an entirely different type of experience. Will the witnesses tell us a little more about the impact of this on the local community? What was communicated to the local community? When was it first told about the future of St. Brigid’s? What information did the group look for? I gather there was quite a problem getting information from the HSE. I understand the group had to contact the Information Commissioner at one point. I would like to hear a little more on those points, if possible.

Mr. Barry Torpey:

Yes.

Ms Susan Mullins:

I thank the Senator for giving us the opportunity to expand a little. We are so grateful to hear the feedback. It means an awful lot to us because no matter where people live in Carrick or what they do, St. Brigid’s and health transcends all of that. The loss of St. Brigid’s has massively distressed our community. I do not want to sound like I am exaggerating or being over the top but the immediate response of anybody you mention this to, be they old or young, is to say how terrible and awful it is. It is like a post-traumatic event. It is as if the rug was pulled from under us.

This was done under the guise of Covid-19, which was fair enough given the way things were with Covid, but there was no consultation process. The staff were traumatised. There were almost 30 staff members and they did not know where they were going to be sent. St. Brigid’s was originally supposed to be a step-down facility for people recovering from Covid-19, so it was perfectly fit for purpose in March 2020 for people recovering from Covid-19. Then, suddenly, it was not fit for purpose. These words are not in any HIQA report. We have not been able to find those words. The HIQA reports are glowing about the staff of St. Brigid’s, the patients’ experience and the families of the patients. Only very minor issues were raised and all of them could be overcome.

In a time of sustainability, when we hear about our planet and everything else, we are hearing talk of razing this facility to the ground because it is an old building. Everybody in the community of Carrick-on-Suir has put their hands in their pocket and done everything for St. Brigid’s. It is so loved and is like our little treasure in our town. Deputy Buckley spoke about Midleton. I imagine there are many places all over Ireland in this situation. With our ageing population, this is a perfect storm. Is the HSE living in cloud cuckoo land? Does it not look at statistics? Is it not asking what is going on?

I am talking from both an emotional and a practical point of view about the loss to our town. Mr. Torpey and I and the rest of the team were just talking about the loved and well-known characters and figures in Carrick who got cancer. One gentleman, in particular, who was loved in Carrick, had to go to Clogheen when he had cancer. That is quite a distance away and his wife has no private transport or car. It is just horrific trying to get him back so that he could die at home. This is only one family but it gives a glimpse into the pain.

Carrick is not a rich town.

It is a beautiful town and I love it. I am very proud of it. I love my home town but it is tough. It is not easy; we are the unloved child between Clonmel and Waterford, including politically. I always say that. Mr. Torpey has gone on a mission to discover who made these decisions and why were they made. We have done a great deal of research on HIQA reports and old reports. Mr. Torpey tried to get information and he will tell the committee all about that. His tenacity is incredible. He was using freedom of information requests and found these throwaway sound bites like "not fit for purpose" with no measurements or anything but Mr. Torpey will tell members about that. He is the technical person.

The town of Carrick and surrounding areas are in mourning. We are all grief-stricken. That is genuine. I am not a political person and I am not looking for anything. That is a glimpse or a screenshot of Carrick. There is a low, depressed air all around St. Brigid's hospital. St. Brigid's was so loved by our community. It was paid for by the local community, which is not wealthy. I will get emotional if I keep talking about it. It is very personal to everybody, as well as being extremely practical especially with the ageing population. It is more practical than ever. It has been there for 180 years, or whatever, and it is not going anywhere. We are talking about sustainability. We have it; it is there and we should use it.

Paul Gavan (Sinn Fein)
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I thank Ms Mullins. What she has said is powerful. It is important to emphasise that this was a public hospital. This belonged to the local community yet it has been closed without any reference or consultation whatever with the people in the community. They have all stood up together and have collected 11,000 signatures, yet to date they have been ignored. That is why I commend the committee again on bringing the group in. Will Mr. Torpey tell us about the struggle in getting information and anything else he thinks would be valuable?

Mr. Barry Torpey:

If the Chair will allow me, I will read some submitted information. It is a copy of the briefing statement from the HSE on 8 December 2020. I will take one paragraph that will sum it up. It said that the south-east community healthcare area "has advised staff previously attached to St. Brigid's that its role as a short-stay inpatient care facility is being discontinued" and that it took this decision "in light of current infection, prevention and control best practice and in the context of the layout of St. Brigid's premises – which features narrow hallways, inadequate space and facilities available in two wards of five beds each". That was the smoking gun to close the hospital. That is all that was given.

Paul Gavan (Sinn Fein)
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That is all that the group got.

Mr. Barry Torpey:

That is it; that is the smoking gun. There was a follow-up radio interview by the chief officer of the community healthcare area with Councillor Dunne the following day. There was a little more expansion on that. As it simply did not measure up, I wrote to the HSE directly and I asked 14 specific questions. If someone says to me that there is a narrow hallway, I want to know what it measures. Is it supposed to be 6 ft., 5 ft. or 4 ft.? So I asked what it was supposed to be; was there a particular area of the hallway that was narrow? Was it just where there was a door? Was it the whole hallway? None of this information-----

Paul Gavan (Sinn Fein)
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Sorry, was that given as one of the key reasons as to why this hospital should close?

Mr. Barry Torpey:

Yes. The phrase was, "which features narrow hallways". There were four sentences there.

Paul Gavan (Sinn Fein)
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In that case, it must have qualified what size it should have been.

Mr. Barry Torpey:

You might believe that would all be in the background there, lined up and ready in the report but that is not the case. I wrote with 14 specific detailed questions. Of those, 12 were unanswered and two were partially answered. That was after a freedom of information request which was not complied with by the HSE. I had to go to the Information Commissioner who annulled its decision and forced the HSE to give information that was not answering the questions. That was an 11-month journey with the HSE.

Paul Gavan (Sinn Fein)
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It was 11 months.

Mr. Barry Torpey:

Eleven months.

Paul Gavan (Sinn Fein)
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Oh my God. One final thought. I cannot help but remember the closure of Barringtons many years ago in Limerick. I am sure Deputy O'Donoghue will remember that too. There was a huge campaign at the time. For a couple of decades the same building has been used very successfully for a private hospital. I apologise as I have to go to another meeting but I commend all the people on coming along today and particularly Ms Mullins and Mr. Torpey for making such an articulate case. They certainly have my full support.

Martin Browne (Tipperary, Sinn Fein)
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Deputies O'Donoghue and Devlin are next. I will make my apologies as I must speak in the Dáil in a few minutes' time. Deputy Devlin will take the Chair while I am there.

Richard O'Donoghue (Limerick County, Independent)
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I thank Ms Mullins and Mr. Torpey for attending. Barringtons Hospital in Limerick was just mentioned. One thing that we all have in common here, no matter what county we are from – I am from County Limerick and the others represent the other three counties – is the HSE and HIQA and the ludicrous reports they come out with that make such a difference to us when we are trying to keep hospitals open. They come out with a report that says something is not fit for purpose. Here they talked about narrow hallways. I am delighted we have a legal opinion and a common-sense opinion, which is not that common, and we have building experience, again with common sense which is not that common. I am from a building background myself. I am a building contractor. The report says that the building is not fit for purpose; narrow hallways, yet University Hospital Limerick, UHL, has trolleys on both sides and you cannot get in sideways, which is not fit for purpose. Should we close down UHL in that case? This is what we are coming up against. Some of the statements they come out with are absolutely ludicrous.

When we talk about Barringtons, it has been decommissioned as a private hospital because a new hospital is being put up. I was at a meeting with the Minister of Health last week. The Taoiseach was there and the CEO of UHL. Now they are considering the option of Barringtons going back to being a public hospital. Imagine that. After it going from public to private, now they are looking at it to go back into public ownership for more bed care for a public hospital. Then they come up with a report to say that they want to close St. Brigid’s in Carrick-on-Suir. Yet they wanted to use it for Covid even though they said the hallways are too narrow and there is no space for whatever bits and pieces like lockers. That is off the wall to me.

I am sorry that I was not here for the opening statements but I was listening on the monitor because I could not get down to the meeting. From what I heard in the introduction, this is more than a hospital. This is personal; it is family, it is local, it offered support and it worked. We have reports showing that the care you got in St. Brigid’s was at the highest standards yet there were narrow corridors and smaller rooms. There are 11,000 signatures collected. People went in there for end of life and the people who visited them there have no complaints but we closed it. We have hospitals open now and there are nothing but complaints yet we are keeping them open and keeping management in place.

The HIQA report and the HSE’s position do not add up to me. If you have a nursing home, there is no notice of a HIQA inspection, they just come in and inspect but if you are a public hospital, they give you two days' notice. It is amazing that when we have a trolley crisis and when HIQA says there will be a report, there is no trolley crisis. It disappears. Just like that, like Paul Daniels. It is magic; they just disappear. I am a member of this committee, which is why I came down to the meeting. I am not from the county but we all have the same problems here.

I am thinking about when we come to end of life. Both of my parents, God rest them, have passed away. We were lucky that we were able to give them palliative care at home. I am from a large family of 11 and we were very lucky that we could do that. To talk about it in political terms, I went into see the former Minister, Michael J. Noonan of Fianna Fáil, when he was in Milford hospice. I remember the dignity he had in Milford hospice. It rings in my head. He had his phone up in front of him along with his notepad and he was happy in the environment he was in and politically, he was still doing his job. Two weeks later, that man passed away, surrounded by his family and friends.

He was still doing the job that he said he was elected to do in a care facility that looked after him completely, as well as his family, friends and anyone who wanted to visit. I cannot understand why the HSE and HIQA were trying to fix something that was not broken because they cannot fix the stuff that is broken. If the media, the Government and all the people who are listening today take anything from this, it should be that the local community and the people and staff in Carrick-on-Suir had no complaints. The facility was doing what it did at 100%. If there were to be minor alterations, being from a construction background myself, they were only minor alterations. If it came to it, I bet the community would have done it. It fundraised for doors and other things in the hospital but it was not given an opportunity to do it this time.

People who would have be in this care facility are now being sent to other places where there is not even transport on the bus network because of where they are situated. St. Brigid's Hospital was doing a significant job. It helped the environment because people were able to walk there or to travel there. It was important in the local community and it has now been stopped.

The HSE and HIQA should retract this and say that they have got this wrong. It seems that when they do something, they take a stance where they cannot say they are wrong because they are liable. If one looks at the number of cases that the HSE and HIQA are fighting and the legal expenses of those, they could open three or four more hospitals instead. They deal with legal cases every day. They should say sorry, that they got it wrong, put their hands up, say they will fix it instead of looking at liability, and that they will put back something that was not broken but that needed small changes. Billions have been spent on the national children's hospital and it is still not finished but we are talking about minor things to be done to keep this unit open at a minimum expense for a community of people who, at the time of the end of their lives, want to be around their families. That facility has been closed down and taken away. I cannot believe it and I have been elected for almost three years now.

I did not realise I could speak on the first day in the Dáil because I was new to it. I had a small piece of paper with me. I looked around and wondered if I could speak because I was new to it. I was a councillor for six years beforehand. I put up my hand. The Ceann Comhairle, Deputy Seán Ó Fearghaíl, was there. He wrote down my name. I had to write down a few notes on what I wanted to talk about in case I got a brain-freeze. The first thing that came out of my mouth was about the structure of University Hospital Limerick. Two and a half years later, it has got worse. The HSE has not fixed it. The management has been in place for ten years or more and it has got worse. The legal bill for the hospital has gone through the roof from fighting cases rather than fixing and putting supports in place for nursing staff, the doctors and the structure. St. Brigid's Hospital had structure, community, spirit and everything, but the HSE and HIQA closed it.

The HSE, HIQA and the Minister should look at the reports of what was there before this which show the care that was given there. They should man up, say that they got it wrong and they should not have listened to the report. Deputy Jackie Cahill was here and said he got a commitment from the Minister of Health at the time but that he did not follow through. It has to be hard for Deputies to get a commitment from someone in their own party who then does not follow through. That is no reflection on Deputy Jackie Cahill but it is a reflection on the Minister, who got something wrong, as did the HSE and HIQA.

Let us do something right today. We can see the support from everyone around the room here, even people from different counties. We want the facility in Carrick-on-Suir open. I want it open. I want the same things for Limerick as I do for Carrick-on-Suir, Kilkenny, Waterford and Tipperary. They had it and it was taken away by the HSE and HIQA. It is time for them to reverse the decision and do what is right. Common sense is not that common when it comes to politics but it needs to change. I thank the Chair for this meeting and for the opportunity to speak.

I say to everyone who has come here that this is about people power. The HSE and HIQA will look at it and try to stop what we are trying to get to the communities. We can probably be more open when we are not in a party. People in a party often cannot say what they want to say, whereas people can say it when they are outside a party. It is not that they are trying to take down the party but that we are trying to help the parties to do the right thing. Today, I want the parties to do the right thing and to reverse the decision about Carrick-on-Suir. Put the facility back in place. This was not broken and they took it away. It could have done with investment. I ask everyone to go back to their Cabinet Ministers and their parties to tell them we should do the right thing for places like Carrick-on-Suir. In future, let us investigate all the reports to see if they are correct and proper, what will happen, what supports are in place and what extra pressure we are putting on other sectors within the HSE by closing such facilities, as it has just done.

As I said, Barringtons hospital has gone from being a public hospital, which I was in when I was 13, to being a private hospital, which I was also in, and now it is turning public again because a new private hospital is being built in Limerick. The Minister has said he wants it to go back to being a public hospital again.

A mistake was made and should be rectified.

Martin Browne (Tipperary, Sinn Fein)
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I will make apologies because I have to go to the Chamber to speak. I will be back soon. Deputy Devlin will take over. I assure Deputy Donoghue that none of us believes that he ever had a brain-freeze.

Cormac Devlin (Dún Laoghaire, Fianna Fail)
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Good afternoon members and welcome to our witnesses. The next speaker is Deputy Matt Shanahan.

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

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

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

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

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

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

Emer Higgins (Dublin Mid West, Fine Gael)
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I thank Ms Mullins and Mr. Torpey for being here with us today and for sharing their experience. I welcome all our visitors. It is really important for us, as a committee, to understand the impact on local communities, staff and patients when decisions like these are taken. I thank the witnesses for coming in here to articulate that. They have articulated it very well. It is also important that we hear the rationale from the HSE and HIQA as to why decisions are being made. It is very clear that the decision was not made on the basis of care. All of the testimony that we have heard and even the reports we have seen show that the care being given was second to none, but it seems the decision was made on the basis of the building. That is why it is so great that there are health and safety and engineering experts on the campaign team. I have no doubt that they have the skills to be able to suggest to the HSE ways to go about getting around issues and rectifying things. I must say that I am really glad that the building is still in use as a healthcare facility. That is really important for two reasons: first, because of the care and services being given to the local community and, second, because it is still a live building. It is still a building we can invest in and make long-term strategies for. This is the public petitions committee. It is not necessarily the committee to look at those kinds of long-term strategies, but I think we have the opportunity to collaborate with the Joint Committee on Health, which does a lot of work in this area in terms of healthcare strategy and HSE operations. I am not sure if the group has corresponded with or attended meetings of the Joint Committee on Health, but I think it is something to look at because that is where these decisions and the policies around them emanate from. I thank the group not only for successfully petitioning this committee, but also for gathering 11,000 signatures for its own petition. That shows the strength of the campaign it has put together. I thank the witnesses for that.

Cormac Devlin (Dún Laoghaire, Fianna Fail)
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I had intended to speak from the floor, but the Chairman has sent his apologies because he is going to speak in the Dáil shortly. I, too, thank the witnesses for coming in and for sharing their experiences. Obviously, a number of people are part of the campaign. Deputy Higgins just mentioned the sizeable petition and the number of signatories. I can empathise with the witnesses' situation. They spoke passionately of their fond memories as children of St. Brigid's and their personal experiences and loss. So many families not just in County Tipperary but also in the wider area will have experienced similar loss. Palliative care is important. We cannot underestimate the value of that type of care. I represent Dún Laoghaire and in my own area a step-down facility closed not too long ago. We are in the process of determining whether that facility may be repurposed for the benefit of primary care or indeed other healthcare services. From my understanding, and the witnesses can correct me if I am wrong, but St. Brigid's is currently being used as a community healthcare centre. There was also talk of a diabetes clinic being opened. I should declare that I am the Chair of the Oireachtas cross-party diabetes committee. I know, from our experience, that there is a need for better facilities for those with diabetes. That being said, the group's campaign is nonetheless important because of the amount of people who obviously feel great attachment to St. Brigid's.

I know that a lot of questions have been asked of the witnesses. There will be a broad recap of the questions posed. Deputy Higgins mentioned the Joint Committee on Health. I think the group has engaged with the committee. Perhaps the witnesses can clarify that for us. This is my first engagement with the Save St. Brigid's Action Group. How many people are in the group? Is one of the witnesses the chairperson or secretary of the group? Who has that enviable job? The witnesses have mentioned that St. Brigid's closed in April 2020. In terms of the group's meetings to date and practical steps taken, in that period the group has met with the HSE directly and it handed a petition to the Minister of State, Deputy Butler, outside Leinster House. I am sure there have been other meetings. I ask the witnesses to elaborate on that. As I have said in our private meetings, I personally feel that the Joint Committee on Health is probably a better fit for where the group is at in terms of the campaign. That being said, this committee also hears issues of public concern, and there is clearly concern around the closure of St. Brigid's.

Moving back to the role of Acting Chairperson, in terms of the questions that have been asked by various colleagues, including Deputy Cahill and others, I ask the witnesses to respond at their leisure. I do not know who wants to go first.

Mr. Barry Torpey:

Just to clarify, the Vice Chairman referred to meetings. Was he asking whether we had meetings with the HSE?

Cormac Devlin (Dún Laoghaire, Fianna Fail)
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I was just wondering whether our guests have had meetings with the HSE.

Mr. Barry Torpey:

It has not facilitated any meetings with us.

Emer Higgins (Dublin Mid West, Fine Gael)
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Was that just earlier during Covid in person, or have there been no meetings at all?

Mr. Barry Torpey:

There have been no meetings in any format.

Ms Susan Mullins:

Moreover, the body has been very reluctant to engage in correspondence. Mr. Torpey had to go down the freedom of information route to get any information.

In regard to the committee of Save St. Brigid's Action Group, Mr. Torpey and I have been mostly in the background of the campaign, and he has done a great deal of paperwork. We submitted some documents where members will see correspondence, on which he has followed up. He has a background in health and safety and is a civil engineering technician. He was very on the ball in that respect. While I am very supportive of the action group’s campaign and it is close to my heart, I have not been involved in the committee. I am not sure of its exact structure or who, if anyone, is the chairperson. Councillor Dunne, who is attending this meeting, and other members of the action group will be able to answer all those questions.

Cormac Devlin (Dún Laoghaire, Fianna Fail)
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Our guests might also take the other questions that were asked. I acknowledge some of the contributions were statements rather than questions, but they might wish to respond to some of them.

Ms Susan Mullins:

I think most of the contributions from members have been overwhelmingly positive and supportive and I have been quite blown away. It is lovely to hear that but it is also sad to hear about other towns that are in a similar position to us. I cannot recall any specific questions apart from those relating to liaising with the HSE and the health committee. That has been done but we need to ramp it up. This committee was our final port of call, from what I could see. We are at the end of the road here and there has been a bit of stonewalling. It felt like a fait accompli, so it has been fantastic to be able to raise the issue with this committee and to hear from people outside and others who have a similar story. It does not just affect us but goes across the board.

Mr. Barry Torpey:

I might make a clarification about the term "not fit for purpose". My understanding is that HIQA did not use that term anywhere, and I have not seen it in any of the reports. Rather, the HSE used that term. HIQA did not use the term "not fit for purpose" in any of its reports. I have gone through the 2018 report and the phrase is not there. That was brought forward by the HSE as one of its reasons. If the committee takes anything away from today's meeting, it might reflect on the key issue raised by the HSE relating to narrow hallways. What does it mean for a hallway to be "narrow"? The first metric should be the dimensions. After 11 months of us seeking information, nobody in the HSE had measured the hallway. There is no figure on paper to say what it is or what it should be. What more can we say? Nobody even measured the hallway. That is what we face when we look for information, and that took 11 months of going through the Information Commissioner. It turned out nobody had measured the hallway, and the HSE cannot tell us what it is or what it should be.

Pat Buckley (Cork East, Sinn Fein)
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When St. Brigid's was being closed, was there any consultation with family members or anything like that? Our guests are shaking their heads. Did they get anything in writing that outlined the rationale for the closure of the building?

Ms Susan Mullins:

There was just the media briefing.

Mr. Barry Torpey:

It was just the one paragraph provided in the media statement.

Pat Buckley (Cork East, Sinn Fein)
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This is a very serious situation and it is not the only such case in the country. I had to write this down because I could not believe it. You cannot be fat to go into St. Brigid's. It is as simple as that. That is the issue here. If that is the issue of non-compliance, that is ludicrous.

Mr. Barry Torpey:

We do not know that because we do not what the issue is.

Pat Buckley (Cork East, Sinn Fein)
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Exactly. That is why I said it. To correct the record, I meant to refer to HIQA rather than Tusla earlier in the meeting. I reiterate that representatives of the HSE and HIQA should come before the committee and be accountable. It is always down to no accountability, no responsibility and passing the buck. As our guests noted, HIQA never mentioned those recommendations; it was the HSE. I am going back on older records of other cases. This is why I asked whether there had been any consultation with the families of residents of the centre. It has not done that, so it has not followed the procedure. It has not given any proper rationale for why the centre was being closed, so it has not followed procedure in that regard.

In the information our guests received from the HSE or HIQA, was there a signature? Was anybody's name written on the bottom of the letters?

Mr. Barry Torpey:

In the information I sought through freedom of information, some of the reports contain signatures and some do not. I do not know whether I can even call what was received from the technical services section in Cork a report because it has not been titled or dated and it does not include a signature. I am not sure what it is.

Pat Buckley (Cork East, Sinn Fein)
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There is nobody who can be asked whether it was Mr. X or Mrs. X who issued that response. They cannot follow it up because they do not know who is accountable for issuing that statement, so they do not know who is responsible for dealing with the information and whether that is misinformation or disinformation. As I said earlier, I have heard about cases like this previously. I had a stern conversation with representatives of the HSE during a meeting of this committee relating to the closure of mental health services. What they said, and it reflects what I am seeing again with our guests, was that five or six reports from the Mental Health Commission made recommendations to upgrade the buildings to make them fit for purpose. The HSE maintained that the Mental Health Commission had indicated the building was not fit for purpose. The commission then stated that it had not said that and that it had made recommendations for the HSE, which is the proprietor of the building, to make those repairs and it never did so, and it was the people and the community who suffered.

What makes our guests' case worse is that they have put a lot of public money into it and crap is their thanks. The way they have been treated by the HSE on this matter is contemptible, disgusting, degrading and inhumane, whereby with the stroke of a pen it can make everything disappear, without any accountability or responsibility for what is going to come down the road in a couple of years. Our guests will have nobody to revert to because they do not have a name on the letter. The HSE is still not accountable to anybody. This is an apolitical issue and I can understand how difficult it is even for Government Deputies, because even senior Ministers, of any Government over the years, have found it difficult to deal with top management within the HSE. Some people will have heard me in committee meetings and assumed I am very anti-HSE. I am not, but what maddens me is when there is no accountability or responsibility and when no rationale is given for closing a centre, yet it is still being closed.

I am asking our guests to email me and I will give them questions to ask the HSE to build their case. As I said, it is very difficult to get anything from the HSE. One of its representatives stated, “The current building simply did not allow for the kind of care and recovery that a modern service should provide. As a result of the Covid-19 pandemic...” There was no Covid-19 pandemic in east Cork in 2016, 2017, 2018 or 2019. That is what I mean by using excuses. Our guests are being fobbed off. I do not know what the HSE's plan is for the building but I guarantee it will not tell them. I would love to have representatives of the HSE and HIQA appear before the committee, and some of our guests could attend, even if they were only to sit in the Gallery to listen.

This has been happening all over the country. It is starting to get repetitive and yet nobody has been accountable for it. What has been happening will affect everybody, no matter where they are living.

Ms Susan Mullins:

The Deputy will see in the report that patients with diabetes and respiratory issues were supposed to go to St. Brigid's. That was the plan. It has never happened. There are some offices that are in the building that staff from Clonmel - I think they are doing works in the hospital in Clonmel and staff had to be moved - are caretaking. There are approximately five people in there but there are no community services as such. Those staff are clerical officers.

As the Deputy was saying earlier, the decision was made. St. Brigid's is an old building. HIQA loves everything to be just so with the i's dotted and t's crossed. St. Brigid's is not just so. It is an old building but it worked for our community, for 11,000 people and all the people who have died and were involved in it. St. Brigid's works. We completely accept a few small issues need to be dealt with. We totally accept it may have to be slimmed down a bit and that the Minister was handed this matter. The decision was made by somebody at a desktop who just decided the building was old and would be shut down. The perfect opportunity was seen to do it nice and quietly, under the guise of Covid, without any fallout.

That is what is very difficult for people who raised considerable sums of money. Carrick-on-Suir is not a wealthy town. The fundraising drive was incredible. They were able to fit out all the windows and doors and three palliative rooms, along with a lift. We are de factoshareholders and stakeholders in that hospital.

We have been studiously ignored. Mr. Torpey has written many times about the disrespect in the letters back from the HSE. It just does not care and that attitude goes across the way. It will go full circle. I have no doubt the building will be closed. When we come to next year, with our aging population and the same situation with trolleys, the HSE will look to reopen it under a different guise.

The people of our area are so prepared to fundraise for our beloved St. Brigid's. I think approximately €90,000 in funds was raised by the community. It is held in an account and is still there. We could make small changes to lockers and wardrobes. We could take the shoulders off the narrow corridor for which we do not have the measurement. These are things that can all be done. We are speaking to the converted here. Everybody is very supportive. As many Deputies and Senators have said, it is HSE, HIQA and policy. Policy is made and then a report is done afterwards to make it fit the policy.

Pat Buckley (Cork East, Sinn Fein)
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May I have 12 of those 14 unanswered questions?

Mr. Barry Torpey:

They have been submitted.

Pat Buckley (Cork East, Sinn Fein)
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That is great. I think it was back in June last year when €220 million of additional money was put in to the HSE on the Revised Book of Estimates to pay out in compensation. The witnesses can see how bad the system is. One can keep making mistakes and we will keep paying for them. My final point is very simple. It was said that if you rip the heart out of the community, the community dies. That is what the HSE is doing.

Matt Shanahan (Waterford, Independent)
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Everybody is very supportive. It is important one tries to take account of where health planning is going. Otherwise the group will keep getting shot down. If it is not the facilities, the HSE will come back to it about something else. Getting St. Brigid's back into use and, I hope, getting palliative care back into St. Brigid's properly is the high-end of achievement that should be looked for. I do not doubt there will be very little opposition from medical palliative people. There will be opposition from other-systems people. It can be done. If the proposal is well-grounded and well-researched and brought back in here, I think everybody here will be prepared to front up.

If the group is not getting access to questions, we as Deputies can put in parliamentary questions, which Departments are obliged to be answer. One does not always get the full comprehensive answer but Departments are obliged to answer. I ask the witnesses to keep on sending them to me or anybody else here. We will keep putting them forward and trying to seek answers. This issue has to be kept alive or the HSE will hope it will fall away over time.

Martin Browne (Tipperary, Sinn Fein)
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I apologise for stepping away and I thank Deputy Devlin for stepping in. I will not ask questions because most of them have probably been answered at this stage. I will give a quick brief of what has happened. In the HIQA report into St. Brigid's, did it give any recommendation to close St. Brigid's? No. We wish to let the public know before we finish this session. On what advice was the HSE informed that the closure was warranted in the first place? Were its reasons in the form of relevant documentation made available to the group, the committee or anybody else?

Ms Susan Mullins:

We have the undated, unsigned report that Mr. Torpey got through the freedom of information route.

Martin Browne (Tipperary, Sinn Fein)
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It is not an official report, is it?

Ms Susan Mullins:

No.

Mr. Barry Torpey:

We do not know.

Martin Browne (Tipperary, Sinn Fein)
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The HSE had thought about alternatives for St. Brigid's such as a diabetes clinic and all that. Has that been provided for Carrick-on-Suir and St. Brigid's?

Mr. Barry Torpey:

Not to my knowledge.

Martin Browne (Tipperary, Sinn Fein)
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St. Brigid's and Carrick-on-Suir have lost out there as well. Are the families who would have used the services provided at St. Brigid's any longer able to care for their sick mother, father, brother or sister? Do they have to travel 40 km to Clogheen? I am from the constituency. I know how far away is Clogheen. I know there is no bus service or public transport. It must be absolutely horrific for families who had people in St. Brigid's to find themselves looking for some place or for someone to carry them 40 km. No provision has been made for that, has it?

Mr. Barry Torpey:

Not to my knowledge. Clogheen is the only location.

Martin Browne (Tipperary, Sinn Fein)
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We will ask the witnesses for a closing statement, but before we finish, will they give the public a brief or maybe even a personal view of their experience of St. Brigid's? We have had other people before the committee with regard to thatched cottages, Owenacurra and other matters. Witnesses' personal experience of these services have really struck a chord with the public. I ask the witnesses for three or four lines each about why this decision needs to be overturned and what experience they have had of St. Brigid's.

Mr. Barry Torpey:

Locally, if anybody had to go in there for palliative, respite or convalescent care, the person would know he or she would be looked after. The patient had the knowledge he or she was going in to a safe place, would be looked after and that family would be able to come in to see him or her. The family equally, felt that when the person went to St. Brigid's he or she would be well looked after and would have no worries. If the person went in for respite, everybody would be rejuvenated when he or she came out. If it was palliative care, the family would know what facilities St. Brigid's had to see the person out of this life. It gave the patient confidence.

Martin Browne (Tipperary, Sinn Fein)
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Thank you.

Ms Susan Mullins:

I will reiterate that. I had touched on my own personal experience earlier as a child. I have had my paternal grandparents and my dad die there. It is exactly as Mr. Torpey said in that people knew they would be in a safe place and would not be out on a trolley. They knew they would be well looked after by people they know in their local community and that their families were close by and could come to see them. People are working and it can be very difficult for them to try to make these journeys.

St. Brigid's is universally loved in the area. It is very rare to get a place about which everybody says positive things, but that is St. Brigid's. Everybody has positive memories and experiences of being there. I have never come across anybody who has had a bad experience. Many friends of mine have mothers and fathers who have been in palliative care and died there. All of them have had very positive experiences.

Martin Browne (Tipperary, Sinn Fein)
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During this meeting and beforehand, we have heard about transferring care into the community. At the same time, we are seeing decisions such as the decision to close St. Brigid's. As I said, at the meeting at the Hotel Minella we heard about the closure of another 350 beds. It seems crazy and it is baffling at the same time.

I do not believe Senator Craughwell, Deputy Buckley or any of the members will object if the committee requests that the HSE and HIQA appear before us in order that members can put this case to them. If need be, we will also ask the Minister to attend. I hope the witnesses will be happy with that proposal as a means of moving forward. We will ask HIQA and the HSE to explain what information they have given to the action group or, more to the point, what information they have not given to the group or to public representatives when we have sought information.

I thank the members from other parties and none. In three years, this is the largest attendance by so many parties and Independents. This will indicate to the witnesses how important the parties and Independents believe this matter to be. I hope this support will continue and the committee will try to help the case for opening St. Brigid's and getting answers for the action group. I have no doubt it will. I see in the Public Gallery that a wide range of political parties of different persuasions are represented. More than 11,000 signatures is a fair achievement to be able to kick off with, especially with the parties supporting that. Do the witnesses wish to make any closing statements before they leave?

Ms Susan Mullins:

That is more than we hoped for. It is music to our ears that the chairperson has said the HSE and HIQA will be asked to come to explain their reasons. They are not written down in any reports that we can see. It is just an opinion that was made. Asking parliamentary questions is also fantastic to keep the issue and hopes alive. It is about keeping the hope alive. We did not lose it during Covid and there is still hope. We will continue to fight for that in a peaceful way but very strongly. We all feel very strongly about this.

It was lovely to have such a warm welcome and hear so much support across the political divide. The action group and everybody supporting it are completely apolitical. Health transcends all of that. It was lovely for us and the members of the action group, including Mr. Torpey and me, to have such a warm welcome from the Deputies and Senators, and the Chairperson who has been so helpful and so nice. Thank you.

Martin Browne (Tipperary, Sinn Fein)
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When this committee was being set up and we were drawing up its terms of reference we asked all the party members to leave their political jerseys outside the door. That has been one of the big advantages of this committee. All parties and Independents have come together to help in cases such as St. Brigid's and the Owenacurra centre, as well as others who have come before us. I thank members. They have not brought political interference, or whatever we want to call it, to bear but left it outside the door.

Ms Susan Mullins:

We really appreciate that.

Mr. Barry Torpey:

I have a final word to the Chair. If the committee has HIQA and the HSE coming before it, perhaps the Chair will try to get the definition of what is "not fit for purpose". Who makes the decision that something is not fit for purpose?

Martin Browne (Tipperary, Sinn Fein)
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Everyone who has spoken wants that answer, as does the group. We will seek that definition. I thank the witnesses again. It has been very beneficial for the committee. I assure the witnesses that we will have the HSE and HIQA before the committee and see where we go from there. We will suspend for five minutes.