John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I appreciate the matter I am about to raise is at an early stage in the context of its proposal relative to the sale of land in the ownership of the HSE. I know that throughout the country a considerable amount of land is available through the former health boards and now in the ownership of the HSE. As Vice Chairman of the Committee of Public Accounts, I recognise the opportunity to raise funds from the sale of these lands to reinvest in the health services.

Yesterday I sent an open letter to the chief executive of the HSE, Professor Brendan Drumm, and to the county manager of Kilkenny County Council regarding a site in Kilkenny at St. Canice's Hospital. I have asked that the widest consultation possible be engaged in on the issue of the site and that the consultation involve all the stakeholders in Kilkenny, the HSE, the local authority and the public. The site is important to Kilkenny city and there are many demands in the city and county for services such as an Alzheimer's unit, care for the elderly, which was mentioned in the Minister of State's previous reply, and services for those with autism. There are other issues relevant to the community such as the Butler Gallery, controlled private housing and the fact that because this site, which is almost central to the city, backs on to the River Nore, there is a possibility of private investment and a controlled private housing development. There is also a possibility of a public park. A wide range of activities and development could take place on that site. It is an unprecedented opportunity for Kilkenny to develop a site of this size.

I do not want it sold to the highest bidder. I do not want developers to come in and put in blocks and rows of houses. We need a radical approach that will realise the dreams of some on the services they provide for patients in Kilkenny. The funds from the sale of various pieces of the land should be invested in providing services directly to patients. There is an issue as regards the pitch and putt club, which forms part of that land. If the whole process is allowed to go too far there will be little room for consultation or debate and we will end up with another site that has high density housing, with very little regard for the civic and public interest in Kilkenny.

This is a unique opportunity. It is not one where we should seek the last euro from the developer, thus forcing him to opt for the highest possible density so that the profit bottom line may be upheld. The HSE should give a lead in this area. It should proactively involve the local authority. With the local authority it should set up some public forum. It should devise a plan relative to the community gain and the services that are needed. Arising from that, it should enter into the controlled sale and development of that enormous site. This is about the citizens of Kilkenny demanding that space be found for services, amenities and recreation that children and senior citizens' need.

In his last reply the Minister of State mentioned care of the elderly. That is one aspect of this development in which I am keenly interested. The HSE has invested in a care for the elderly unit — I believe the Minister of State was in it some time ago. It is time to extend that to a long-stay care unit for those in the community who are elderly and need that type of care now. We have a deficit as regards beds in that area. There is a heavy demand on the beds in Thomastown and Castlecomer. There are few if any beds in Kilkenny city for care of the elderly. Now that this opportunity has been presented, we should give the lead in this area. I urge the Minister of State to take the brave step and consult the local county manager, Kilkenny County Council, Kilkenny Borough Council and the other stakeholders in this area to make this plan a reality.

Tim O'Malley (Limerick East, Progressive Democrats)
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I thank Deputy Mc Guinness for raising this matter and assure him that the widest possible consultation will take place. I do not disagree with the comments he made because I am very clear as regards what we intend to do in this regard.

I have been advised by the HSE that all decisions regarding the disposal of lands attached to psychiatric hospitals will be taken in the context of the recommendations contained in the report of the expert group on mental health policy. This report, A Vision for Change, recommended that a plan to bring about the closure of all mental hospitals should be drawn up and implemented. The resources released by these closures should be protected for reinvestment in the mental health service. It also stated that the full economic value of psychiatric hospital buildings and lands should be professionally assessed and realised.

A Vision for Change envisions an active, flexible and community-based mental health service where the need for hospital admission will be greatly reduced. The expert group stated in the report that mental hospitals had been the mainstay of mental health services in Ireland for many years. It stated, however, that the type of person-centred, recovery-orientated care recommended could not be provided in institutions of this size or environment. On that basis, the group recommended that steps be taken to bring about the closure of all the remaining psychiatric hospitals which are a legacy of a bygone age and to reinvest the resources released by these closures in the mental health services.

The closure of large mental hospitals and the move to modern units attached to general hospitals, together with the expansion of community services, has been Government policy since the publication of Planning for the Future in 1984. A number of large psychiatric hospitals have already been closed — Our Lady's in Cork, St. Patrick's in Castlerea, St. Columba's in Sligo, St. Mary's in Castlebar and Our Lady's in Ennis. The reorganisation of services which these closures entailed has resulted in the expansion of community facilities, new acute psychiatric units attached to general hospitals, including St. Luke's Hospital in Kilkenny, and, most importantly, an overall improvement in the delivery of services for the service users, their families and carers. Most of the remaining stand-alone psychiatric hospitals cater in the main for long-stay patients, many of whom are over 65 years of age. I understand that this is also the case at St. Canice's Hospital, Kilkenny, where the majority of patients are cared for in wards for older people.

The report recommends that a plan be drawn up for the phased closure of each of the hospitals. It is recommended that this plan consist of a four-stage process, as follows: stage 1, identify measures required to enable admissions to cease and put these measures in place; stage 2, cease admissions to the hospital and draw up plans for relocation of existing patients; stage 3, implement plans for the relocation of existing patients; and stage 4, final closure of hospital.

It is emphasised that this process should take place on a phased basis, with wards closing sequentially. It also makes clear that the process will require funding for training and upskilling of staff who will subsequently be redeployed to work within the mental health services provided in the community.

The HSE has welcomed the publication of this report and has stated that its national mental health directorate will immediately establish an implementation group to ensure that the recommendations are realised in a timely and co-ordinated manner. The HSE has also emphasised that hospitals can only close when the clinical needs of the remaining patients have been addressed in more appropriate settings.

I assure Deputy McGuinness that the Government is fully committed to the implementation of this report, which has been accepted as the basis for the future development of mental health services. The programme of investment has begun with an additional €25 million allocated to the HSE in the Estimates for 2006 for mental health services and I am confident that this level of investment will continue in the coming years. Significant capital investment will also be required to implement A Vision for Change, estimated by the expert group to be in the order of €796 million, for the provision of new and replacement facilities for the mental health services, and much of this could be realised from the value of existing hospitals and lands.

I reassure the Deputy that I should be delighted to consult him and others in Kilkenny and the other regions where hospitals will be closed. Our priority, obviously, is to ensure that the patients get suitable accommodation, either in the same location or in others. We are mindful of the fact, however, that the lands we have available are health assets and that they will be converted into mental health and other health assets as needed in the community.