Pearse Doherty (Donegal South West, Sinn Fein)
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I hope this matter will be more engaging than the last debate between the Minister for Justice and Equality and the former Minister who was shamed out of office because of the false affidavit he provided against a colleague of mine.

This issue is one I have been raising in the House nearly every sitting day for the last three weeks and I am delighted it has been selected. It concerns a number of community hospitals across Donegal. We have seen in recent months a huge turnout of ordinary people who are seriously concerned about the future of their community hospitals and the services they have provided and will provide into the future. They have come out in support of Dungloe Community Hospital, Carndonagh Community Hospital and St. Joseph's Community Hospital in Stranorlar as these vital community services are faced with further cutbacks.

I am not sure if the Minister of State is aware of Dungloe Community Hospital but it is a fine facility with 35 beds. The Minister for Health, Deputy James Reilly, visited that hospital last year to open a new wing, which cost €600,000, including the equipment that was needed for it. While there, the Minister acknowledged the impeccable care, staff and services at the hospital. Barely a year later, however, ten beds in that hospital are lying empty, two of which were provided by the community through fundraising efforts over a long period. Those two beds were traditionally used for palliative care due to the fact they were in private single rooms. The local HSE management explained to me in May of this year that the decision taken to temporarily close the beds was due to an increase in long-term sick leave, a number of staff retirements and planned maternity leave, with the moratorium on recruitment restricting its ability to replace these staff. The HSE was very clear as to why these beds were lying empty and closed.

Meanwhile, St. Joseph's Community Hospital in Stranorlar, which is the largest community hospital in Donegal, is also faced with the loss of ten beds, which is in addition to the 13 beds this hospital has seen closed in recent years. Since the recruitment moratorium was introduced, the level of nursing staff at St. Joseph's Community Hospital in Stranorlar has reduced from 37 whole-time equivalents to 25, and in non-nursing grades there has been a reduction of six front-line workers. A recently published HIQA report on St. Joseph's stated: "At the time of inspection there were 10 staff off through illness, five nurses and five carers", in addition to one retirement. The confidential HSE public service agreement, PSA, document, to which I have access, states that the St. Joseph's management team has indicated its staffing levels are an increased risk and that this increases the potential risk of an adverse incident to a client. That is a stark warning in a HSE document on staffing levels and the impact of the moratorium. While the document is confidential, it has thankfully seen the light of day.

My question, which I ask on behalf of the many hundreds of people in Donegal who have turned out at community meetings to express their concern, is how the Government expects community hospitals to maintain the highest standards of patient care if it will not provide the resources required. Local HSE management confirmed to Oireachtas Members recently that the population of over 65s in County Donegal is set to double within ten years, so it is clear there is a greater need for community hospitals and extra beds if we are to avert the crisis that is facing us. However, that is not what we are seeing on the ground. Carndonagh, Dungloe and St. Joseph's community hospital have all lost beds. This all comes on the back of beds that have been lost in these hospitals in the past two years.

I ask the Minister to take urgent steps to address the situation. While we understand the pressures the Government is under, it is wrong to cut front-line resources and impose a moratorium so strictly where we know the need exists to open these beds, some of which were funded by the community. Beds in our hospitals are lying empty and the reason for this is the recruitment moratorium. I ask the Minister to consider that the necessary supports be put in place to allow our public sector workers to carry out the task they are qualified to do, which is to look after our elderly and not so elderly in the community hospitals in Donegal.

Kathleen Lynch (Cork North Central, Labour)
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I thank Deputy Doherty for raising this issue, which I feel I know by heart as Senator Jimmy Harte raised it just last week and I gave virtually the same answer.

Government policy is to support older people to live in dignity and independence in their own homes and communities for as long as possible. Where this is not feasible, the health service supports access to appropriate high-quality long-term residential care, including the provision of financial assistance under the nursing homes support scheme. In 2012, with a budget of almost €1 billion, financial support was provided to over 22,000 people in nursing homes. As the Deputy is aware, these are challenging times for the Health Service Executive in respect of all services. In the case of community nursing units, these include challenges regarding staffing, funding and the age and structure of its units. In this regard, all developments have to be addressed in the light of the current economic and budgetary pressures and Government policy to reduce the numbers employed in the public sector.

This policy requires that, by the end of 2013, the health service achieves a workforce of 98,955 whole-time equivalents. Staff appointments may be made only where an inescapable service need has been identified which cannot be addressed by other means, such as the redeployment of staff or reorganisation of services.

The recently concluded Haddington Road agreement increased the working week of nurses from 37.5 to 39 hours and also provided for increased hours for all other staff who were working less than a 39 hour week. This will have the effect of increasing the overall staff capacity available to management to deploy in service delivery.

There are 11 community hospitals in County Donegal providing 400 public beds, of which 238 are short-stay, while the remaining 162 are long-stay beds. These are supported by a wide range of community-based services. Six units have primary care centres attached, with access to services, including a public health nurse service, a community psychiatric nursing service, a home help service and an old age psychiatry service. These services are available to residents of the units as need requires.

Dungloe Community Hospital has recently experienced an increased number of staff retirements, annual leave, long-term sick leave and maternity leave. In order to maintain a safe level of care for patients, the Health Service Executive decided to reduce temporarily the number of short-stay beds by ten. This was done to ensure there would be an adequate number of staff to meet all of the needs of the residents safely. It is proposed to reopen five beds by mid-July. Arising from a temporary staff shortage owing to sick leave and annual leave, it was also decided to reduce capacity at Carndonagh Community Hospital by four beds. I understand the HSE proposes to reopen these beds on a phased basis this month.

Services at St Joseph's Community Hospital in Stranorlar include respite, rehabilitation, palliative and intermediate care and long-term residential care services. When the hospital was last inspected by the Health Information and Quality Authority in April, inspectors observed that while staff provided care in a knowledgeable, competent and respectful manner, there was a concern that the complex mix of residents could make it more difficult for staff to meet the needs of long-term residents. In order to address this issue, one ward, with a dedicated staff, has now been designated for long-stay residents only. The changes mean St. Joseph's Community Hospital will now have an operational capacity of 67 beds.

Residents and their families can be assured that management and staff will continue to work to provide the highest standards of care in all community hospitals in County Donegal. The HSE has asked me to assure the House that the residents in all of these facilities are receiving a safe and high-quality service. Bed capacity across community hospitals in County Donegal will be kept under ongoing review. However, there are no current plans to reduce bed capacity further.

Pearse Doherty (Donegal South West, Sinn Fein)
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I am well aware of the proposal to reopen five beds at Dungloe Community Hospital and four beds at Carndonagh Community Hospital and I am pleased this will be done in the coming weeks. It shows the importance of trade unions that SIPTU was instrumental in putting forward the proposal regarding Dungloe Community Hospital. It can be done because the staff are non-nursing staff. The reality remains, however, that five beds will remain closed at Dungloe Community Hospital and up to ten in St. Joseph's Community Hospital. A difficulty will arise if a large number of patients get sick at the same time or there is an outbreak of the vomiting bug. In such a situation staff could not return to the hospital, even if they were healthy, and the beds currently open would have to be closed for patient safety reasons. The HSE has indicated to Oireachtas Members in County Donegal that the number of people aged over 65 years in the county will increase by 100% in the next ten years. In other words, the need for additional beds is known. It does not make any sense to have a situation where beds have to be closed if a member of staff goes on annual leave, retires or becomes ill.

I do not expect the Minister of State to produce a magic wand to solve this issue. The fundamental problem is that the system is absolutely broken. I feel sorry for the nurses who have to call in sick knowing their absence could mean that patients will not be given the bed they need. That is a consequence of the moratorium on recruitment. Regardless of whether one agrees with the moratorium, it should certainly not be so restrictive that beds in community hospitals must be closed because somebody has retired or fallen sick or is on maternity leave. It simply should not happen.

There must be greater flexibility within the system, especially when we know we are facing into a crisis. One of the issues of most concern to people in County Donegal is that the inevitable increase in demand comes at a time when the number of beds in the public system is decreasing and there are no plans to increase capacity in the private sector. There is no evidence of foresight or forward planning on the issue. People are fearful in the face of what happened in these hospitals two years ago. We are seeing further bed closures at Dungloe Community Hospital and the same at St. Joseph's Community Hospital. People know the recruitment moratorium is still in place and that more nurses and other staff will be sucked from the system. They are very worried that there will be another public meeting next year at which the closure of another three or four beds, whether temporarily or permanently, will be announced. The system is broken and it is the patients in need of long-term support and care in their own community who will suffer.

Kathleen Lynch (Cork North Central, Labour)
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The system is not broken and staff are doing an incredible job. In fact, we have a very good health service and the people availing of the 400 beds in County Donegal are receiving a good standard of care. There is a requirement for a different skills mix, with some people requiring more intensive care than others. I acknowledge that older people are more vulnerable to the vomiting bug, but the reality is that in hospitals throughout the country, whether patients are young or old, the same procedure kicks in.

As for the Deputy's claim that there is no plan, the reality is that there has never been more planning. We are very conscious of the demographics and what is going to happen to us as we age.

Pearse Doherty (Donegal South West, Sinn Fein)
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Why then is the Government closing beds?

Kathleen Lynch (Cork North Central, Labour)
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I am sure the Deputy will agree that none of us, when we come to a point where we need support, would like to have no option other than a bed in a long-stay facility. That is not where older people want to live. They want to live their lives in their own communities, the same as all of us. They have the same dreams as I do or the Deputy does. We are planning for all of this on a regular basis. The positive ageing strategy is in place and we are developing a dementia strategy. We have a whole range of strategies because we know the demographics better than anybody else. The notion of standing up and striking fear into the hearts of vulnerable people and their families is reprehensible.

Pearse Doherty (Donegal South West, Sinn Fein)
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Beds are being closed.

Kathleen Lynch (Cork North Central, Labour)
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It is utterly reprehensible.

Pearse Doherty (Donegal South West, Sinn Fein)
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The beds have been closed. What the Minister of State is saying is disgraceful.