Wednesday, 7 March 2012
Topical Issue Matters
Care of the Elderly
This issue relates to the loss of 41 long-term care beds at St. Mary's Hospital in the Phoenix Park, which is located in my constituency. The closure of these beds follows on from a recommendation from the Health Information Quality Authority, HIQA. I am sure the Minister of State, Deputy Kathleen Lynch, can imagine the concern and stress to which this has given rise among the residents and patients at St. Mary's and among their families and members of the wider community.
Bed closures have been causing chaos throughout the hospital system for many years. We have reached the point where not only are adults being left on trolleys but now children are also being left on them. There are reports of sick children lying on trolleys in hospital corridors for up to 24 days. I am sure the Minister of State is fully aware that there is a direct correlation between delayed discharges from hospitals, on one hand, and waiting lists for those who require long-term care beds in hospitals such as St. Mary's, on the other.
We all know that the cost of placing a person in a long-term care bed is only a fraction of the cost of keeping them in a regular hospital bed. The Minister for Health, Deputy Reilly, and his special adviser, who is extremely well paid, are both aware of this. It is worth noting that the Minister's most senior adviser, Dr. Martin Connor - the man responsible for the special delivery unit - was awarded a three-year contract worth €480,00 in December. Dr. Connor devotes 80% of his working hours to the Minister and I understand the remainder are dedicated to his position as a research fellow at Stanford University in California. Sara Burke, a health analyst and journalist, recently noted that Dr. Connor has attended just four of the 13 HSE board meetings held since his appointment last June.
The HSE's regional service plan 2012 states that across the entire north-east region - which covers Louth, Meath, Cavan, Monaghan and Dublin city and county - between 200 to 250 additional long-term care beds will be provided in the current year. The same document also states that in view of the staffing and financial challenges which the HSE faces, the closure of some beds is unavoidable. It further states that it is not expected that closures of public long-term care beds will exceed 105 for the north-east region. We are just over two months into 2012 and now one hospital in north Dublin is due to lost 41 beds. Is the Minister of State in a position to make a commitment to our citizens that the net loss of public long-term care beds will not exceed 105? I suspect that she will not be in a position to give an undertaking in this regard. In the context of St. Mary's Hospital in the Phoenix Park, the Minister of State must indicate how the 41 beds that are due to be lost will be replaced. She must also state whether these beds will be replaced within the north Dublin catchment area.
I will adhere strictly to the script with which I have been provided when making my initial reply but I hope the Deputy and I might be able to engage in a little more free-flowing exchange of views thereafter. I thank her for raising this matter.
St. Mary's Hospital was built in 1769. It was originally the Royal Hibernian Military School. The building was subsequently developed as a hospital by the Irish Army. In 1948 it was transferred to the Dublin Health Authority and developed as a chest hospital. In 1964 the hospital became a facility for older people. St. Mary's primarily provides accommodation to dependent older persons aged 65 years or over who require admission, assessment, rehabilitation, respite and continuing care. Following an inspection by HIQA towards the end of 2011, the HSE decided to close two wards at the hospital. The Deputy will appreciate that certain wards in the older parts of the facility are extremely antiquated and are, by their nature, unfit for purpose. It should be noted also that at the time of building the new community nursing units at St. Mary's Hospital in 2008, it was envisaged that bed numbers in the older part of the facility would be reduced. One such ward has closed and the residents have been transferred to more appropriate residential care facilities in the area. A second ward is being closed, bringing the total reduction to 41 beds. Staff are working with the residents and their families to ensure residents are placed in the most appropriate care settings for their needs.
As the Deputy is aware, the HSE is facing challenges in respect of all services in 2012. In the case of community nursing units, these include challenges regarding staffing, funding and the age and structure of its units. The HSE national service plan anticipates that between a minimum of 555 and maximum of 898 residential beds in public nursing homes could close during 2012. We are working very intently on that issue.
The Minister, Deputy Reilly, has requested that the HSE provide him with a plan which seeks to protect the viability of as many units as possible within the funding and staffing resources available. It is accepted that this will require a combination of actions such as consolidation of services and changes in staffing, skill mix and work practices. The plan will also have to take into account different types of services required, the age and structure of public units and the capacity available within an area. 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 the current moratorium. I trust the House and the Deputy will agree that we need to ensure that 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 consideration.
Quality and safe care must be at the heart of service provision. The manner in which very many of the families discovered the news that beds were being lost and a second ward was to be closed was much less than satisfactory. It began as a sort of whisper and rumour and I should reiterate the level of anxiety that this caused. I appreciate entirely that budgetary considerations are real and the moratorium and other strands of Government policy are causing significant difficulties in the health service. In the case of care for older people, other factors must also be calculated, including the attachment of the person in question to their place of residence, the concerns and anxieties of the families and the adverse consequences of moving an older, weaker and perhaps vulnerable individual. It is all very well to say that people have been moved to other appropriate facilities but one must also calculate the ability of families to access those facilities, and in this case those matters have not been properly calculated.
I asked the Minister of State during the course of my remarks about the HSE service plans, which were mentioned in the response. The HSE indicated that closure of some beds would be unavoidable and it did not expect that in the case of the north-east Dublin region the closures would exceed 105 beds. Nevertheless we are 41 beds down in March. Does the Government stand by the 105-bed figure and is it the case that those 41 beds will be replaced elsewhere? Have they been counted out? Does the Minister of State share my view that in dealing with these particular circumstances for older people the HSE, specifically, must be mindful of the age of the people concerned and the sensitivities of the families, which was not the case this time?
As I do not have direct involvement in this issue, I am very much going on the information provided for me. The ideal is for nobody to be disturbed but the condition of certain units means that people will have to be moved as patients cannot stay in units unfit for purpose. This arises from independent evaluation from HIQA. Such issues will occur and will continue to do so.
I have no reason not to believe the HSE service plan despite the Deputy noting that we are already 41 beds down very early in the year. That had been planned since 2008 and the additional six new wards built on the site will accommodate 150 people. People may be attached to where they live despite the conditions of the unit, which I understand perfectly, but nevertheless the new environment is far better, which we must accept. I have no doubt the figure in the service plan will be adhered to.
I have just come from the Sue Ryder Foundation facility in Dalkey, which is an extraordinary complex dealing with older people who live independently but who are supervised with supports. There are people in our charge who need the type of long-term intensive care that people in nursing homes have; we must deal with them and be conscious of their needs and families. Nevertheless, we must begin to change our processes and leading from this we can speak to the people living in the Sue Ryder complex, for example. The Deputy knows them as well as I do. They are living very happily without the type of intensive medical model that can be seen in other areas. We must start to look at alternatives, including talking about stepping up as opposed to always talking about stepping down.
With regard to facilities like St. Mary's Hospital, the new facility is far superior to the older one; it must be when one considers the age of the building and the needs of older people now as opposed to then.