Brian Stanley (Laois-Offaly, Sinn Fein)
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I thank the Minister of State at the Department of Health, Deputy Kathleen Lynch, for taking this Topical Issue. We are revisiting the question of nursing homes in County Laois. I want to deal directly with the nursing homes in Abbeyleix, Shaen and Mountmellick. More than two years ago a campaign was started to save Abbeyleix and Shaen hospitals. In the intervening period we have organised marches, petitions and meetings with Ministers in an effort to resolve the issues arising. On 9 December 2011 the HSE wrote to the relatives of patients stating that the HSE's decision to revoke its earlier decision to close the Abbeyleix unit was intended to enable a consultation process regarding the potential closure of the nursing homes. A long and protracted consultation process took place after that letter was issued and it was finally completed in August 2012. The Minister of State confirmed at that stage that all relevant documentation, information and submissions were presented to the designated officer in the HSE, who was to formulate recommendations for submission to the Department of Health. We were led to believe that once these recommendations had been submitted a decision would be made prior to Christmas. The Minister for Health was expected to make an announcement in advance of that date. Several other dates came and went on which announcements were expected regarding Abbeyleix and Shaen.

On 30 April the Minister of State noted in reply to a parliamentary question that the recommendations were being considered by the Minister and that it was anticipated an announcement would be made shortly in respect of both facilities. Nothing has happened in this regard. Government sources were letting it be known in the constituency that a decision would be made before the summer recess but that did not happen either.

According to HIQA, capacity for up to 34 beds is to be approved in Abbeyleix. The occupancy figure has fallen well below 20. The picture in Shaen is similar. I am concerned that the Department and the HSE is deliberately reducing the number of patients in each of these facilities in order to make them look uneconomical because the staff-patient ratio will result in a cost per patient that is high enough to justify their closure.

St. Joseph's ward in Mountmellick nursing home was closed during the term of the last Fianna Fáil Government. It is a modern facility which needs to be brought back into use for the growing number of elderly patients in the county. Patients and their families have been anxiously waiting. The hospital committees, which are very supportive, have also been waiting anxiously waiting. The staff are looking for answers. I cannot get an answer as a local representative even though I have been told repeatedly that the issue will be addressed. We should be getting certainty after waiting two years.

Kathleen Lynch (Cork North Central, Labour)
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I thank Deputy Stanley for raising this issue. He is correct that significant concerns have been expressed on this issue over the past two years but I think he will acknowledge that the reversal of the original decision was a good thing. It is important that we take our time when we make our decisions. There are six public nursing units in counties Laois and Offaly, namely, Abbeyleix Community Nursing Unit, St. Brigid's Hospital, Shaen, Birr Community Nursing Unit, St. Vincent's Hospital, Mountmellick, Riada House, Tullamore, and Ofalia House, Edenderry. All six were registered with the Health Information and Quality Authority in 2012 for a period of three years. In recent times the future of facilities at Shaen and Abbeyleix has been under consideration by the Health Service Executive. Mountmellick has not been considered in this context.

In October and November 2011 the HSE announced the closure of St. Brigid's Hospital, Shaen, and Abbeyleix Community Nursing Unit. However, in recognition of strong views held by residents and others, the HSE agreed to review the position for both facilities and to embark on an entirely new consideration of relevant issues. This new process began with a comprehensive consultation exercise. Central HSE protocol sets out how consultations and subsequent decision making should operate in this context. This protocol sets out the following - who should be consulted, including residents, next of kin, interested parties, action groups, public representatives, unions and staff representation; and a named HSE official, known as the designated officer should be given responsibility for considering all of the available views, information and evidence, and for proposing a course of action based on these considerations. The factors that should be considered by the designated officer are also specified in the protocol. These include issues arising from the range of views expressed through the consultation process, the context and validity of the submissions received, an assessment by the relevant managers of the position, a medical review of the residents and relevant additional information. This protocol was applied in May 2012 with the launch of a public consultation process regarding a proposal to consolidate the number of nursing units in the Midlands and the potential closure of Abbeyleix and St. Brigid's Hospital.

Arising from the public consultation, all relevant information and submissions were presented to the designated officer on 16 August 2012. Almost 100 submissions were received and over 60 meetings took place with interested parties, 55 of which were with residents or next-of-kin. In line with the HSE protocol, the designated officer confirmed that the relevant procedures and processes had been fully adhered to in considering these cases. He also confirmed that he reviewed all submissions received along with the other relevant documentation described above. All of the available relevant information is currently being re-examined by the HSE with a view to finalising a recommendation to the Department and this process is expected to conclude shortly. An announcement will be made at the earliest opportunity once the Minister receives the HSE's definitive position.

I agree with the Deputy that people find themselves in a type of limbo but the position is much better now than was the case two years ago. An announcement is expected shortly.

Brian Stanley (Laois-Offaly, Sinn Fein)
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I thank the Minister of State for her reply. It is good to see her in full health again. I heard that she had a bit of a mishap.

The Minister of State has outlined the process in a very comprehensive way. The problem is that the designated officer has had these papers since 16 August 2012. Today is 18 September 2013 and more than 13 months have elapsed. I agree with the Minister of State that it is good it was stalled because it gave us a chance to make the case. I note that she has stated an announcement will be made shortly which I welcome, but I have heard it before, as have many others. Does the Government have a comprehensive plan for efficient public nursing home provision in the State? The Minister for Finance is in the House and will state he does not have money to throw around. However, if the number of patients is reduced and we have a high ratio of staff to patients, the cost will increase. There is no need for this to happen in Abbeyleix because it has facilities for 34 people. Does the Government have a plan for a good and efficient network of public nursing homes? Is the plan to continue what the previous Government did, which was to run down and reduce the number of public nursing home beds in the State such that we would be left with a tiny number where only the highest dependency patients, those the private nursing homes will not touch with a barge pole, would be taken? That is my concern. Will the Minister of State give an indication as to whether we must wait another two years, two months or two weeks? The HSE has had the papers for 13 months. How long does it take it to make a decision?

Kathleen Lynch (Cork North Central, Labour)
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I agree that we cannot wait another two years for a decision, but I am not certain the decision will be made by the HSE. It will make a recommendation and ultimately the Minister will make the decision.

Brian Stanley (Laois-Offaly, Sinn Fein)
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I understand that.

Kathleen Lynch (Cork North Central, Labour)
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I hope it will be done very shortly, as people need to know exactly what the future holds for them. We have 129 public nursing units in the State. Very good research and work have been done in the past two years and we have discovered that we have sufficient beds for now, but I agree that there will come a point when we will not have enough because of our ageing population, which is a Europe-wide problem. We will eventually need additional public and private nursing home beds. We must ensure that when it comes to State-provided care which we must accept is more expensive because of a myriad of elements involved, older people are correctly placed. We know that in the past people were very inappropriately placed and we do not want this to happen again. As we age, we do not want this to happen to us. Work and research have been done and we are very conscious of our future needs.

Brian Stanley (Laois-Offaly, Sinn Fein)
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What about the timeframe involved?

Kathleen Lynch (Cork North Central, Labour)
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I cannot give an exact answer, but I will commit to making further inquiries as a result of this question and try to get an answer for the Deputy.