Ms Susan Mullins:

I thank the committee very much for inviting the St. Brigid's campaign back here again. It is such a privilege to be here and to hear the other statements from Loughrea and Midleton. I feel profoundly privileged to have heard those and to hear the same strains through all of our stories.

We thank the Chairman and the committee for inviting our Save St Brigid’s delegation representing the local community in Carrick-on-Suir and its surrounding areas in counties Tipperary, Waterford and Kilkenny, back to the Joint Committee on Public Petitions and the Ombudsmen. We continue in our efforts to reopen St. Brigid’s and restore much needed step-down, respite, palliative care and short-term convalescence services to our community. I was here before in January.

I am a qualified solicitor who is self-employed in my own family-run practice in both Carrick-on-Suir and Tramore. I am a native of Carrick-on-Suir, where I also live. I am here in a personal capacity as a concerned member of the community and I am not being paid for my attendance here today nor for any time I have been before this committee, when the HSE were called before the committee or for any work carried out for St. Brigid’s.

As I said before, St. Brigid's has been an integral part of my life. My mother was a midwife in the hospital in the late 1960s and 1970s and I have many fond memories of calling into the hospital after school and waiting for mum to finish work in the kitchens. She would sometimes bring me round to the patients and I would get a few sweets and some chocolate, which was a big thing in the 1970s. My father and both my paternal grandparents died very peacefully in St. Brigid's and got the very best of care close to our home, which meant a huge amount.

To give some background, St. Brigid's opened 183 years ago 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 deliveries and catered for people suffering from all forms of illness. 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 the last 20 years or so, three state-of-the-art hospice rooms with en suites, kitchenettes and sitting and sleeping areas for families 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. It is impossible to adequately portray the connection the people of the area have for St. Brigid’s. Almost every family has had a loved one stay at St. Brigid’s for one reason or another over the years. St. Brigid’s has been a haven for families in the area who continue to suffer at its closure. Despite St. Brigid’s being designated a step-down unit for recovering Covid-19 patients by the HSE in April 2020, this never came to pass. Instead, it was closed the following month in its capacity for step-down, respite, palliative care and short-term convalescence and the staff were redistributed without notice. It is currently being used for administration and office work.

On the petition itself, the save St. Brigid’s campaign submitted a petition with in excess of 11,000 signatures seeking to reopen the hospital to the Minister of State at the Department of Health, Deputy Butler, on 22 September 2021. We were invited to attend this committee in January last and we were warmly welcomed by the members. Our petition was listened to and discussed at length and with great feeling and empathy by the majority of Deputies and Senators present, for which we were most appreciative. Following our petition, the committee invited the HSE to appear before it to explain its decision to close St. Brigid’s, which was thought of so highly in respect of the services provided to the community and the excellent care given by staff. Patients, their families and the community at large all had a positive experience of St. Brigid’s. The HSE appeared before the committee in February last and the main issue put forward regarding the closure in the officials' opening statement and throughout the proceedings was the hospital building was old, had substantial shortcomings and a new modern building on a greenfield site with increased patient capacity was required. We are unaware of any progress or plans in this regard to date. We would welcome with open arms the return of step-down, respite, convalescence and palliative care services in a new building with increased capacity on the same site or close by.

While the HSE states the site of St. Brigid’s is not suitable for a new building, a large building called the primary care centre was recently built to complement - per the HSE officials in their appearance before this committee - St. Brigid's on the same grounds and taking up a much larger footprint on the site with community services such as physiotherapy, public health nurse, addiction counselling, speech therapy and vaccinations. This is a modern, large state-of-the-art building providing complementary services to St. Brigid’s, yet the building it was set to complement has been closed down. I know from first-hand experience of bringing my 80-year-old mother to the primary care building twice a week to see the public health nurse that this modern building has a faulty outside lift at the front which is broken more than it works. This is because the building was raised 2 m in case of flooding, which it has never done in the 180 years St. Brigid’s has been there. The call bell for the lift is located at the top of the seven steps to make contact with the building assistance to enter. There is no ramp to enter the building at the main entrance. This is located to the rear of the building, which is a considerable walk for any person with mobility issues. A new lift is apparently being requisitioned, but measurements are yet to be finalised and there is no sign of when it will be ready. It cannot be guaranteed that any elderly person with compromised mobility will be able to enter the building and access services as the outside lift cannot be depended upon and he or she cannot contact the facilities staff for assistance as he or she would have to climb the steps to press the call button. The lift has not been working properly since at least last year. Furthermore, the public seating inside the building is too low for elderly people. Both the public health nurses and the physiotherapy departments have been seeking alternative seating for patients in the years since the centre opened, but they are still waiting.

Since we last appeared before this committee on 19 January, things have become a lot worse in the provision of healthcare, particularly in respect of care and step-down facilities available for older people. There were attempts to justify the closure of St. Brigid’s by the HSE with reference to capacity being met in the private nursing home sector and the provision of a number of beds through this prism. A further justification was the service could be managed through the community services home care package. While the HSE states most people who are dying wish to remain at home, there are many who have no spouse or children living with them to make that possible. Accordingly, they have need of palliative care in their local community where their friends and family can spend precious time with them. Some of the latter may not have access to private transport. There is no public transport to St. Theresa’s Hospital in Clogheen from Carrick-on-Suir, which is a 40-minute drive away in a car.

I have attached a couple of articles regarding nursing homes and step-down to my submission. On a national level, we unfortunately see the nursing home sector is desperately struggling for capacity with a raft of closures commonplace. Rising utility costs and higher regulatory expectations have forced large numbers of smaller nursing homes to close in 2022 and more closures are coming down the line this year. HIQA said the closure of smaller nursing homes "requires urgent attention in order to avoid further closures impacting on the lives of residents and their families and friends". It went on to say this also affects the availability of step-down care from acute hospitals and long-term care for an ageing population. Nursing homes provide much-needed step-down care and respite. All of this was provided in our local district hospital. We never had such worries in relation to our publicly-funded St. Brigid’s Hospital until its unilateral closure by stealth during the advent of the Covid-19 pandemic. The contraction in bed capacity in smaller nursing homes last year totalled 466 beds according to a HIQA report from October 2022. HIQA went on to say that 247 beds have been lost with the closure of nine nursing homes between January and October 2022. A further 219 beds have been lost at seven other nursing homes that have informed the regulator they are closing their doors. That is from last October to the first quarter of this year. In total, 16 smaller nursing homes announced their closure last year.

We need more capacity and not less. That is why our call to reopen St. Brigid's Hospital is now more urgent than ever. Even though it was not a long-stay facility it was treated as such by the HIQA inspectors. It provided much-needed respite for families caring for their loved ones at home. It also provided much-needed step-down beds, which have nosedived in availability nationwide. We are in a crisis for facilities for our older and most vulnerable population and yet the HSE continues to close small district hospitals that could and have alleviated this issue over the years without putting anything alternative in place before it closes them.

I have also attached an article on the home help crisis. The most recent information available from the HSE shows that at the end of March 2023, more than 6,400 people were on the waiting list for new or additional home support care. These are often extremely vulnerable people whose need for home care has been proven and accepted by the HSE. In May, 240 people were being kept in hospital while waiting for residential care to be put in place. The census last year found there were 776,000 people aged 65 years or older, which is a staggering increase of more than one fifth on the position in 2016. The number of elderly people aged 80 years or older will quadruple to more than 500,000 in the next three decades.

Some medically well patients who no longer need to be in overcrowded hospitals have been languishing in wards for more than six months because of a lack of suitable step-down care while others wait on trolleys with no privacy while waiting for a bed to become available. For example, in late November last year, 47 patients who had been deemed ready for discharge at least six months earlier were still stuck in hospital.

The health service blockages in some social care supports and rehabilitation services for patients with the most complex needs are adding to the hospital gridlock. This led to another 530 patients on trolleys struggling for access to a bed late last year, which could be projected forward to the first quarter this year. Only weeks before that, hospitals had suffered recent record overcrowding. HSE figures showed there were 599 patients who were fit to leave but could not be discharged because there was nowhere for them to go. Of these, 552 were in hospital for less than six months and the rest were there for longer. Meanwhile, our hospital remains closed.

We still do not have replacements for the three palliative care beds that were lost when the HSE decided to close our hospital. Since that time, figures provided to us by the local undertakers tell us that each year between 40 and 50 of the people who died could have availed of our wonderful palliative care hospice rooms. Dying with dignity is a core part of a whole campaign. While the HSE states that most people's dying wish is to remain at home, there are many who have no spouse or children living with them to make that possible or they may have medical needs such that they cannot stay at home. These people need local palliative care services. Many local people whose loved ones are in the palliative care beds in St. Teresa's Hospital in Clogheen or in University Hospital Waterford are more than a 40-minute drive away. People are very anxious about leaving the patients in case they die in their end-of-life beds while they are travelling to or from the hospital. There is no public transport from Carrick-on-Suir to St. Teresa's in Clogheen which is an added difficulty. The stress the journey adds to people whose loved ones are dying cannot be overstated. The fear that if or when they leave, they may miss their loved one passing while they are travelling is unconscionable.

Given our rapidly-growing ageing population, it is incumbent on the HSE to review its policy of closing small district hospitals and backtrack. We need more beds for our elderly population and we need them sooner rather than later. More thought and creative innovation needs to go into making the smaller district hospitals work. We can see how the new children’s hospital costs are spiralling out of control. If extensions are needed to modernise these smaller hospitals then let the HSE investigate whether it is possible and give the job to find out if it will work to an open-minded person. It should not make the policy first and then say it does not work without any proper effort going into making it work, and without there being an adequate alternative in place before closing down a district hospital which had trained staff in situ.

It is apparent from the national news throughout last year and this year that current HSE policy is not working, between patients on trolleys in acute hospitals - and there is no patient dignity there - to a lack of supports for older people and a lack of step-down facilities. From the HSE’s responses to this committee’s inquiries, no proper consideration was given to trying to make St. Brigid’s work. For example, no costings were carried out on modernising or extending the building. We, as a community, desperately need our services back. The basis of Sláintecare is to bring healthcare back to the community. We are open to a new site if St. Brigid's cannot work as it is but we need the HSE to be open-minded too. It is never too late to do the right thing.

We are extremely grateful to have our concerns listened to and that this committee invited the HSE to explain its reasoning for closing our district hospital. This meant so much to the 11,000 signatories of our petition. I thank the Cathaoirleach and members for their time and consideration.