Séamus Kirk (Louth, Fianna Fail)
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I thank the Ceann Comhairle for the opportunity to raise this important issue affecting the Louth-East Meath constituency. The threat to close St Joseph's Hospital, Ardee, and the Cottage Hospital, Drogheda, will have a profound and serious implication for the patients and staff of both institutions. Both hospitals have given magnificent service to patients for many years. Closure is unacceptable to the patients, staff and the communities they serve.

Given the economic context, while we must have austerity at this time, we need austerity with compassion, sympathy and consideration for the vulnerable sectors in our community. There is no more vulnerable sector than the elderly. Those who have worked hard and served our nation well in its formative years now find themselves in some instances needing nursing home accommodation. Unfortunately, as per the recent budget, they find themselves threatened with the closure of these homes.

The HSE service plan for 2012 states that a minimum of 550 public beds will close in the course of the year. However, if we examine the document more closely, we find the HSE reveals that the true number could be as high as 898 beds, which represents approximately an 11% cut in the number of beds in public residential care. This has profound implications throughout the country.

My particular concern today is St Joseph's Hospital, Ardee, the Cottage Hospital, Drogheda, and the rumoured reduction in the numbers of bed accommodation available in what is a state-of-the-art facility at St Oliver's, Dundalk, which was built as recently as the 1980s or early 1990s. I ask the Minister of State, Deputy Kathleen Lynch, to advise us whether there is any basis to the rumours and, if not, to put at rest the concerns of the patients and the staff at the hospital. If there is no basis to the rumours I ask her to put at rest the concerns of the patients and the staff in the hospital.

There is no justification for the closure of these hospitals and there will be no benefit to the HSE because under the Croke Park agreement staff will have to be allocated to other HSE facilities in the area. There is a high quality of care in the hospitals earmarked for closure and as far as I am aware HIQA has not reported any cause for concern in any of them.

The treatment of the elderly by the Government is totally unacceptable. The brunt of cuts will be borne by the sickest and poorest old people. They are on low fixed incomes, have health needs and are dependent on the State for essential services. This raises the fundamental question - how do we as a society treat our older people? Do we cast them aside and forget about them? Is the State dismissing care for the elderly as one of its core functions? If the planned closure of so many community hospitals and nursing homes throughout the country proceeds as is apparently intended there will be profound implications. Finding alternative accommodation in the private sector for those who, in many instances, have lived for years in those hospitals, will be extremely difficult. It begs the question in a county such as County Louth where there are an estimated 16,000 people aged over 65 years. I readily admit that the 16,000 will not all need institutional care but a percentage will at some stage. More and more people are living to a much older age. If I walk through any of the towns in my constituency I regularly meet people aged 90 and over. Inevitably, they will need accommodation.

I ask the Minister for State to put the concerns of elderly people in County Louth to rest by telling us she will not close the hospitals I mentioned.

Kathleen Lynch (Cork North Central, Labour)
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I thank the Deputy. From my additional notes I see the estimated population of people aged over 65 years in his county is 12,636. There is a myth abroad which tells us that now we are living longer we will need additional nursing home beds. The percentage of those of us who will need nursing home beds in the future will remain the same. We are living longer and are healthier but this does not mean we will all end up in nursing home beds - nor will all the 90 year olds Deputy Kirk meets. The percentage who do is 4.5% and I believe we should be able to deal with that.

I have known the Deputy for some considerable time and it is not usually his form to make claims such as that people will have their nursing homes closed down. That is scaring very vulnerable people. As I know from my in-laws, people listen to and watch the proceedings in this House during the day. It is unfair to frighten them. I know the Deputy a long time but that is not his form.

St. Joseph's nursing home, Ardee, is a listed Georgian building that is over 150 years old. It provides accommodation on two floors for 23 people. There are currently 19 long-term residents and four respite beds at the home. I am sure the Deputy knows this better than I do. The Cottage Hospital, Drogheda, was founded in 1908 and was taken over as a nursing centre by the HSE in 1988. It provides 14 long-term care beds and 15 respite beds. St. Oliver's Hospital is situated in the grounds of the Louth County Hospital. It is a single-storey building that opened in 1987. Accommodation is available for 92 residents in four separate units. Two beds have been temporarily closed to conform to fire regulations. The remaining 90 beds comprise 87 long-term care beds, 16 of which are specifically for people with dementia. In addition, three beds provide a respite service to clients in the community.

The Health Service Executive is currently examining the future use and development of public nursing homes in County Louth, taking into account the potential of these units to comply with HIQA standards. In this regard a project group held its first meeting on Tuesday, 24 January. The group is starting work on an optimal appraisal for the most appropriate service delivery model for elderly residential care in County Louth. It has agreed a framework, with mid-March as the expected time for completion. During the process, the project team will be in regular communication with all stakeholders - patients, families, staff and the wider community.

The moratorium on recruitment and compliance with national quality standards are both impacting on the public nursing homes in Louth. These pressures are mirrored across the country and are well documented. I acknowledge there is a great deal of concern about the future of our community nursing units. There is no doubt we are facing challenges in this sector due to staffing, funding and the age and structure of the existing units. However, I can confirm that no decision will be made to close a public nursing home without a full consultation having taken place with all stakeholders.

It is clear that, on a business-as-usual basis, the HSE would have to close further beds across a range of public community nursing units in 2012. In the absence of reform, this would increase the cost of caring for older persons within the public system. Consequently, this would undermine the viability of public community nursing units and reduce the overall number of older persons who can be supported within the budget available for the fair deal scheme. This is not a sustainable way forward and would not meet the needs of older persons, local communities, the taxpayer or those working in the public service. Instead we need a more proactive approach to the provision of community nursing home units which seeks to protect the viability of as many units as possible within the funding and staffing resources available. That includes smaller units where challenges of scale may require more innovative approaches to service delivery. This is likely to require a combination of actions such as consolidation of services and changes in staffing, skill mix and work practices.

All developments have to be addressed in the light of the current economic and budgetary pressures and any decisions taken by the HSE must have regard to this and to the current moratorium. I trust the Deputy and those listening will agree that we need to ensure the highest standard of care will continue to be provided to all residents in a safe and secure environment. Providing quality and safe care will always remain at the heart of any considerations.

Séamus Kirk (Louth, Fianna Fail)
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I thank the Minister of State for her reply. I am not heightening the concerns of the patients in the hospitals.

Kathleen Lynch (Cork North Central, Labour)
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I accept that.

Séamus Kirk (Louth, Fianna Fail)
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The reality is that in recent weeks in County Louth, on the streets of Drogheda and Ardee, thousands of people have marched. They have listened to Oireachtas Members and the various support and save committees, in both instances. They say "hands off" the Cottage Hospital in Drogheda which is an iconic institution in the town. Similarly with St. Joseph's in Ardee which at one stage had a much wider health care spectrum than it does nowadays. However, it is a real institution in the town of Ardee and there is considerable attachment to it. There is shock that consideration is being given to closing these hospitals. At any of these meetings and protestations patients on wheelchairs are coming out and stating they want this accommodation to be retained in the nursing home service in County Louth.

I ask the Minister of State to go back to the Department and report that the people and community of County Louth wish both nursing homes to be retained in the service.

Kathleen Lynch (Cork North Central, Labour)
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I fully accept that. That was the point I was trying to make. I realise the Deputy is not doing this on his own, that it is a wider issue. Equally, however, if we are to care for the percentage of older people who will eventually need the type of long-term care we are now providing we must look at things in a completely different way. If one looks at any of the surveys, people will state they want to stay in their own community. They want to live not only their active life but the end of their life in their own community. There will always be people who will need the acute and ongoing care which exists at present in the hospitals the Deputy mentioned. However, we cannot continue providing this care in the same way we always did. We will have to look at alternatives. We have groups of people looking at how we will provide that care in the future in a different way.

This is probably the only area where we have not come up with a five-year plan for the future and we will need to do that. We should be able to forecast how many people will need long-term care in a hospital setting and come up with an appropriate plan for them. However, Deputy Kirk accepts when it comes to the country's finances we are in a very dark place. I accept the people in question are not responsible for this. That is where we are at, however, and we have to look at service provision differently. It can be done. People need to be reassured the provision of hospital services is being examined seriously and not let lapse in some kind of a vacuum.