Olwyn Enright (Laois-Offaly, Fine Gael)
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I welcome the opportunity to raise an issue of extreme importance to the people of my constituency of Laois-Offaly and it will be of immense importance to some people in south Offaly who may be in the constituency of the Minister of State, who is replying, depending on what happens; hopefully not, but one never knows.

The issue has affected several day care centres around Laois-Offaly. It became public last weekend, after staff in Birr community nursing unit were told on Friday that day care services were to be suspended for the summer. It appears there were some attempts this week to say staff were not told that, but they were most definitely told last Friday that services were to be suspended from 16 June. I believe it was also to happen in several other centres in the constituency, including Abbeyleix, Mountmellick and Edenderry. I understand from a telephone call I received today that it has been announced that the day care services in Mullingar will close for five weeks. Senator Nicky McFadden, with whom I discussed the issue today, has expressed her concerns. The Minister of State may not have an answer in regard to that area but this seems to be a trend in the midlands.

It appears the situation has arisen because of the recruitment embargo. Posts of those who have retired, or who are on maternity or sick leave have not been filled because of the tight budgetary position. The staff in all these units work extremely hard to try to make ends meet. Given that many of the units are doing a good job, I do not accept that this argument should come into play.

I am sure the Minister of State appreciates the importance of these facilities. For example, 115 people use the service at the unit in Birr for different amounts of time during the week. These people have very different levels of care need. Some are extremely vulnerable and many have no direct families. For many it is their only social interaction during the week. It is not just about the social interaction; it is also about the care needs and the medical needs that are fulfilled in the day care service. The service is so crucial that a few years ago a decision was taken in Laois-Offaly not to suspend the service for the month of August. Given that people depended on it so much, closing it for that month was found to be cruel and to cause a degree of difficulty.

In a local radio interview yesterday the HSE indicated that there is a lesser demand for its services during the summer. I do not accept that argument. Very few of the 115 people who use the unit in Birr are able to go on a two-week holiday. They need the service and use it constantly. The number of people using the unit in recent years shows clearly that the demand does not change during the summer. The cessation of the service, if it goes ahead, will lead to a virtual collapse of the public health nurse service also. The nurses are already stretched to the limit and cannot possibly take an additional 115 people on to their books for the summer months. There is no back-up plan or plan B if this goes ahead.

On Tuesday morning we were told the decision was on hold. Some politicians have interpreted this as meaning that the closures will not take place. I am not so convinced and I wonder whether they actually read the e-mail from the local health manager. What is the precise position? According to the statement from the health manager, while a final decision has not been taken on curtailment of services in Laois-Offaly PCCC, the Health Service Executive will keep the matter under regular review. The letter gives no indication that the plan will not proceed. Although the decision taken on Friday appears to be on hold, I seek a commitment that services will not be suspended either in the summer or at any other time. I ask the Minister of State exactly what the HSE means by the comment in the same statement that plans are being considered which may result in alterations to the current level of service in the near future. What services will be curtailed?

This week I was contacted by a woman from County Offaly who was unable, due to the severity of her injury and her medical condition, to use crutches and a walking frame given to her when she broke her leg. When her son approached the hospital to try to secure a wheelchair — the family was prepared to hire one from the hospital — he was told to go to Argos. This case arose because the hospital is so stretched it is unable to provide basic services such as a wheelchair.

I am concerned about what the HSE means when it refers to "alterations" in current levels of service. While I am aware local staff are trying to implement cuts in areas which do not affect members of the public, the phrase "as a last resort" always seems to enter the equation. Cutting services to people in serious need of care and medical attention is not a last resort, nor is it acceptable to me or my constituents. I hope the Minister of State bears good news and will be able to inform the House that vital services will not be curtailed.

Máire Hoctor (Tipperary North, Fianna Fail)
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I will take this Adjournment debate on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

A keystone of the Government's policy on older people is to support them to live in dignity and independence in their own homes and communities for as long as possible. To cater for the needs of older people the Government has invested heavily in this important area, resulting in significant service improvements in community supports in recent years. In budgets 2006 and 2007, funding of more than €400 million was provided to enhance service developments across the sector. Of this sum, €190 million was specifically earmarked for community-based services. This covered, for example, home helps, home care packages, day-respite care, meals on wheels and sheltered housing initiatives at regional and local level.

With regard to day and respite care, an additional €9 million was provided in 2006 for a wide range of new and increased services at local level, including improved therapy services for specific needs. A further €3.5 million was provided the following year, which allowed the Health Service Executive provide in excess of 21,000 day places in 2007.

I am informed by the HSE that it is committed to providing high quality services to the population of Laois-Offaly and has committed €1.79 million to day care services in the area this year. In this context, all services are subject to constant monitoring and review bearing in mind the executive's requirement to keep expenditure levels within budget.

Olwyn Enright (Laois-Offaly, Fine Gael)
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That is €4.5 million less than last year.

Máire Hoctor (Tipperary North, Fianna Fail)
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I understand from the HSE that, on the basis of detailed risk analysis and in the context of the requirement to maintain appropriate staffing and safety levels, plans are being considered which may result in alteration to current levels of service in the near future.

Olwyn Enright (Laois-Offaly, Fine Gael)
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I have a copy of the HSE statement.

Máire Hoctor (Tipperary North, Fianna Fail)
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The executive has indicated that no final decision has been taken at this point regarding any curtailment of primary or community services in Laois-Offaly and it will keep the matter under regular review.

Liz McManus (Wicklow, Labour)
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I am grateful for an opportunity to raise the plight of Kevin McCabe of Wicklow and Joseph Hogan of Dublin, both of whom are inpatients at the National Rehabilitation Hospital in Dún Laoghaire. It has been suggested that Kevin and Joseph will be discharged to the Mater Hospital from where they came, as they are included on the delayed discharge list. Both young men have nowhere else to go because the funds to provide personal assistants and carers have not been made available by the Health Service Executive.

The Mater Hospital is under pressure to transfer patients from its spinal injury unit to the National Rehabilitation Hospital's spinal programme and there is now pressure to move on Kevin and Joseph. Both men say they know of others who were discharged back to the Mater Hospital and remain there two years later. They are fearful that this will also be their fate and, as the years go by, they will become less visible to those who have a responsibility for funding.

In early 2007, the Minister for Health and Children, Deputy Mary Harney, visited the National Rehabilitation Hospital. During her visit she showed a special interest in the cases of Kevin and Joseph and requested that more information about them should be forwarded to Mr. Tom Kelly, her assistant at the time. However, despite her assurances on the day, Kevin and Joseph remain in hospital with little hope for discharge other than to the Mater Hospital.

Kevin has been in the National Rehabilitation Hospital since November 2006 and was due for discharge in 2007. Joseph, who became an inpatient in July 2006, was due for discharge in December 2006. Both men have been allocated a specially built house in St. Brigid's Park, Greystones, County Wicklow, owned and managed by Cheshire Ireland. Despite protracted lobbying and negotiations involving many sources, including Cheshire Ireland and the National Rehabilitation Hospital, funding for their care is not forthcoming from the HSE and a timescale has not been set for making such funding available. This is the second delay and a major disappointment for Kevin and Joseph.

The Cheshire Ireland housing initiative at St. Brigid's Park is funded through capital assistance grants provided by the Department of the Environment, Heritage and Local Government. Owing to delays in the Department's approval process, Cheshire Ireland was unable to provide the support housing within the timeframe expected, which resulted in a delay of up to one year until February 2008. The lack of HSE funding has affected a further four individuals with physical disabiities who have been allocated houses in St. Brigid's Park. Two of the individuals in question live in Cheshire Ireland homes, while a third is being cared for in a family home by her brother who is finding it increasingly difficult to cope financially.

Since the beginning of 2007, Cheshire Ireland has been having ongoing discussions on securing the new core revenue funding needed to provide the required services in St. Brigid's Park. The HSE has made clear to Cheshire Ireland that the required funding will be provided once the people move to their new services. However, the position is that two young men cannot go to their new home. I urge the Minister to resolve this terrible situation.

Máire Hoctor (Tipperary North, Fianna Fail)
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I take this Adjournment debate on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. I am pleased to have this opportunity to address the issue raised by the Deputy.

The Department of Health and Children has been informed by the Health Service Executive that the facilities referred to by the Deputy are new Cheshire Ireland supported accommodation which was funded through Wicklow County Council under the Department of the Environment, Heritage and Local Government's capital assistance scheme. I understand the bungalows were handed over to Cheshire Ireland in March this year. The HSE has informed the Department that the persons to whom the new bungalows are to be allocated have been identified through an assessment process undertaken by the executive and Cheshire Ireland. Four people have moved into their new homes.

As part of the multiannual investment programme under the national disability strategy, the Government provided the Health Service Executive with an additional €75 million in both 2006 and 2007. This funding included moneys to provide new and enhanced services for people with disabilities. A further €50 million investment was announced in budget 2008. This funding includes funds for the provision of additional residential places for people with a disability, which would include the residential places in the new Cheshire Ireland bungalows in County Wicklow. The HSE has informed the Department that this funding for additional services for people with a disability is under review in the context of the executive's overall service levels and funding position this year.

Liz McManus (Wicklow, Labour)
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What does that mean?

Pat Rabbitte (Dublin South West, Labour)
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This is the first time I have heard a reply which makes no reference to the issue raised.

Máire Hoctor (Tipperary North, Fianna Fail)
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I mentioned the bungalows to which Deputy McManus referred.

Pat Rabbitte (Dublin South West, Labour)
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This is an issue of two young paraplegics, not bungalows.

Máire Hoctor (Tipperary North, Fianna Fail)
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The two young men have been assessed.

Pat Rabbitte (Dublin South West, Labour)
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That is an insulting answer.