Joe McHugh (Donegal North East, Fine Gael)

I welcome the Minister of State to the House. I will be parochial in my contribution and I hope it will be of value. I refer to the Donegal model of community service, assessment and intervention, of which the Minister of State will be well aware. The model is worth pursuing at a national level. Having spoken to practitioners within the sector and to stakeholders we should consider the all-encompassing model involving 11 community hospitals. While one provides community care, the remaining ten provide rehabilitation, assessment, respite and palliative care. There is so much evidence of good work that sometimes it goes unnoticed in the public domain. If there is one deficit, it is the lack of recognition of that good work. I would encourage some reflection on the Donegal model and an intervention by the Minister of State to add value to the national set-up.

With regard to assessment, each case is treated individually. Within the ten community hospitals, we have occupational therapists, public health nurse teams and multidisciplinary teams. We should emphasise the key statistic in this regard. Donegal has the highest percentage of people over 65 in the country but the lowest number of people in long-term care. This illustrates that we have a conveyor belt of continuity, whereby patients from Letterkenny General Hospital move on to convalescence, where the idea is not for them to convalesce in a community hospital ad nauseam, but to get them back into their homes. This is done through rehabilitation, assessment and working with the families, and that system is working well.

I want the Minister of State to intervene and examine the designation of long-term beds. There is no flexibility with regard to these beds and under the fair deal programme, the situation has arisen where community hospitals are losing money when these beds are not being used for long-term patients. There must be some intervention with regard to the flexibility of the designation of these beds. This is not about competition between private and community nursing homes. Private nursing homes probably accommodate about 75% of the needs of older people for long-term care. However, the community nursing home is vital to the attempt to keep patients moving within the system. It is not just about taking them from Letterkenny General Hospital and letting them convalesce in a community nursing home. If they need long-term care, that will be provided and it is right that flexibility should be there. However, if they need to come home, they need the support systems at home. They need the support packages through the public health nurse and other community supports. They should also have the option of returning to the community home for respite care, which they have in Donegal.

I know the Minister of State is well aware of the Donegal model and that she is up to speed on it. She must intervene with regard to the flexibility of redesignating long-term beds. If the onus is not put on the community hospital to move people on, the whole system will become clogged. Currently, the incentive is to keep them in long-term care in the community hospital and if that is the case, what will happen with regard to the convalescent potential from Letterkenny General Hospital? What will happen on that journey from broken leg, to hospital, to convalescence, to community hospital, back to the home and return to respite if necessary is that the whole continuum will break down. I have spoken to the Minister, Deputy Reilly, about this, but I make a specific request to the Minister of State today to re-examine the designation of long-term beds. The incentive should be to keep the system fluid, but that is being prevented currently.

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