Timmy Dooley (Clare, Fianna Fail)
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The Minister may be aware that two day care facilities in County Clare, namely, in Raheen and Kilrush, are to be closed from Monday for a period of two weeks and possibly more. This is creating significant stress among the population who use these facilities on a daily basis. They collectively cater for some 200 elderly individuals in the community on a weekly basis. I do not need to remind the Minister of the importance of day care centres, not just to the residents but also to the entire health system. They can act as an early warning device in recognising illness in residents, ensure any minor illness is picked up at an early stage to prevent from it developing and sometimes avert the necessity for long-stay care. The facilities in question do an immense amount of good work and are a great basis on which to provide an adequate health care system for the people in question..

It appears that the Government has not done enough in advance planning. We have been given excuses by the Department of Health, through the HSE at local level, that they do not have an adequate supply of nurses and that there is no supply of agency nurses. I have to believe this reflects negatively on the Department and the Minister for Health. It was the then Minister, Deputy James Reilly, who abolished the HSE and took full responsibility back within the control of the Minister for Health and the Department. Therefore, the blame lies at their door, not at that of the HSE or local management. We are led to believe this is not about financial resources but about the deployment of personnel. It is incumbent, therefore, on the Government to ensure there is enough advance planning. Everybody recognises that this is the holiday period and that people get sick. Therefore, there should be capacity to put in place a proper HR management system that will identify requirements and ensure staff will be available to meet the need.

Michael McNamara (Clare, Labour)
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I will not reiterate what my constituency colleague has said, except to say there is significant distress because of this issue, caused not just by the announcement but also by its nature. This is not the first time we have had such an announcement. In this forum I raised the issue of the closure of a ward in St. Joseph's Hospital in Ennis, a facility which also treats elderly people. The ward was closed without notice and people were moved throughout the evening and early the next day. Thankfully, it was reopened after two weeks.

I do not think it can come as a surprise that people take holidays. In any work environment or management setting it is something managers have to deal with. Even those who manage one or two people have to take account of the fact that they will take holidays. The date on which tenders were received for the first phase of work to bring Raheen Hospital into compliance with HIQA standards was 10 July, which was good news. It was a statement of intent that Raheen Hospital would continue into the future, but then the news came, on what was otherwise a good news day, that the day care centre would not be open on Monday. If there are shortages, surely the very least that should happen is that people should be told a couple of weeks before in order that those patients reliant on the service and their family members can make plans. It is not just the announcement that is worrying but its timing. It does not cover the HSE in glory in the way it has been managed. I appreciate the reasons, namely, that it is based on sick leave, because people do get sick, but we also know that there is an increased tendency for nurses and medical personnel to get sick because they deal with people who are sick. That is inevitable in managing a health service.

Joe Carey (Clare, Fine Gael)
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I join colleagues in raising genuine concerns about the discontinuation of vital day services at the Raheen and Regina House community nursing home units. Yesterday I received a response from the chief executive officer of the mid-west community health care team which confirmed that the temporary closure of these units had not been influenced by the availability of financial resources but by the unavailability of nursing staff in the next few weeks.

Factors such as annual leave, sick leave and the unavailability of agency staff were cited.

The day care centres at Raheen and Regina House community nursing units provide wonderful services to older people in both east and west Clare. Not enough credit or priority is given to day care centres in terms of their role in delivering our national health service. The provision and development of community-friendly day care services offers a real and significant win-win situation to the client and the State as keeping people at home for longer avoids clogging up residential care settings.

It is highly regrettable that staff and clients at Raheen and Regina House community nursing units were informed at 2.30 p.m. last Friday that their respective day care centres would not open the following Monday. This action poses questions in terms of the staffing roster. Surely the roster for these day care centres are put together monthly. Why could the clients and staff not be told earlier? What efforts are being made to recruit new nursing staff? The bottom line is when these units will be reopened. Will the Minister of State assure the House today that these temporary closures will not happen again?

Kathleen Lynch (Cork North Central, Labour)
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The overarching policy of the Government is to support older people to live in dignity and independence in their own homes and communities for as long as possible. It is clear this is what older people want and only those in genuine need of residential care should go down that route, which is why services such as day care, meals on wheels and the availability of respite facilities are so important. I agree with each of the Deputies who have spoken on this issue in that regard.

The Health Service Executive is responsible for the delivery of health and personal social services, including those at facilities such as Raheen community nursing unit and Regina House community nursing unit. Both centres are registered with the Health Information and Quality Authority. The services provided at these units are a vital part of the supports for older people that allow them to maintain their independence and quality of life in a way that meets their own wishes. Raheen community nursing unit, which was originally a private house, has been used since 1973 to provide services for older people in south-east Clare. The centre can accommodate up to 25 residents, including 15 long-stay places and ten short-stay beds comprising respite, palliative care and rehabilitation beds. There are supported living units in the grounds of the building. Raheen community nursing unit also provides day care for up to 20 people on weekdays. Regina House community nursing unit, which opened in 1972 as a welfare house, is now a residential centre for older people and is also registered with HIQA for up to 30 residents. There is a separate day care service for older people in the adjoining building which caters for up to 25 people from the local community on weekdays.

On the temporary closures, and people need to realise it is a temporary closure, of the day centres at Raheen and Regina House community nursing units, the Health Service Executive has confirmed that these are not influenced by the availability of financial resources. The decision to close the facilities temporarily was because of the unavailability of nursing staff over the next number of weeks. The contributory factors are annual leave, sick leave and the unavailability of agency staff. I stress this is a short-term measure for a couple of weeks only. I recognise the primary responsibility is to provide safe care to the residents of the units and to ensure the availability of access to respite residential services for the elderly population in the area. The HSE is committed to restoring the day care services at both centres as soon as possible. Every effort will be made to minimise disruption to service users. If any person using the services has particular difficulties, I urge them to contact Raheen or Regina House community nursing units directly and the HSE will do everything in its power to support him or her.

It is worthy of explanation to note that the difficulty in respect of nursing staff and the unavailability of nurses is not just in this area. We have considerable difficulties in other areas. As both centres are registered with HIQA, it is incumbent on us to stay within the guidelines set down by it. We have a difficulty recruiting a range of nursing staff, particularly nurses who work in psychiatric services and in the area of care for the elderly. They are not seen as the most attractive areas in which to nurse, although I often find it can be the most rewarding. Services such as this one provide, as the Deputies have already said, an invaluable service.

The reason for the late notice is the HSE was, until the last minute, trying desperately to recruit agency nurses. Even they are not available. I think it has something to do with the time of the year. Along with everything else, nurses within the agency sector are usually young and are off doing different things at this time of the year. It is not something we are letting rest. We will endeavour to put the service back as quickly as possible. I appeal to people to have a little patience but I understand fully the difficulties in which it places families.

Timmy Dooley (Clare, Fianna Fail)
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A couple of hundred people are being disenfranchised for the want of two nurses, which highlights the massive problem that is the shortage of nurses. If two nurses out of the system can have that big an impact, what happens if four or five nurses are sick tonight because of an outbreak of a bug in the mid-west? Could it lead to the closure of a number of wards at University Hospital Limerick? Is the line that fine at the moment? Is that what has been achieved? Is she telling me that, having dispensed with the HSE and its board and having taken control of the delivery of health services in this State for the past four years, the Department is still relying on excuses grounded in not knowing or expecting a couple of people would be off sick? Is that any way to run a health service? I am not directing this at the Minister of State personally but towards the Government and the senior Minister who hoodwinked the people. The Government lay the blame for the difficulties on the heads of the HSE when in truth it was a ruse to win an election. Taking control back into the Department of Health has made things worse. The Minister of State is saying it is not a financial resources issue. It is a result of massively poor planning, responsibility for which lies firmly and squarely at the feet of the Minister for Health and the Government.

Michael McNamara (Clare, Labour)
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I welcome the Minister's commitment to ensuring these services at Raheen and Regina House community nursing units open as soon as possible. There is a further problem, however, for people who receive these services. Some of these people would also hope to receive home help at some point. There is an incredible disparity in the distribution of home help hours in the mid-west. The population aged over 65 in Limerick is 21,032. In Clare, it is 13,292 and in the north Tipperary-east Limerick area it is slightly less, at just under 13,000. Despite this, when one looks at the number of people in receipt of home help hours per month in 2015, in Limerick, it is 1,437, in Clare, it is 961, and in north Tipperary-east Limerick, it is 1,241. When one looks at the actual hours allocated, there is a similar discrepancy, which is inexplicable. Why does the population in north Tipperary-east Limerick receive one and a half times the number of home help hours received by the population in Clare? It is an appalling inequality and one that needs to be addressed. Progress has been made in the lifetime of this Dáil in this regard but not enough progress. A lot more needs to be done.

Joe Carey (Clare, Fine Gael)
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I also welcome the commitment given by the Minister of State to work to restore the services as quickly as possible. She noted that there is a difficulty in recruiting additional nurses but what additional measures has she taken to recruit new nursing staff in settings such as Regina House and Raheen community nursing units and right across our health care provision network?

Kathleen Lynch (Cork North Central, Labour)
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I will be brief. At certain times of the year staff shortages are more acute than at other times. That is obvious. Certain periods used to bedevil the last Government, especially the Christmas and new year period, if I remember correctly. Anyway, it was always that winter period. That is always an issue. People have a right to take their holidays. I am not suggesting people have a right to be sick but, when they are sick, they have a right to take time off to recuperate. It is important when nurses are dealing with older and vulnerable people and they become ill that they can take the necessary time off. We do not want them to work in circumstances that are less than ideal. Equally, we do not want people getting infections from one another, as can often happen in this type of setting.

Home help is allocated on an individual basis. It used to be allocated on a block grant basis, but not anymore. Each individual is assessed for the amount of home help he or she needs. Obviously, it is not as much as we would like but nevertheless that is what happens.

I will set out for Deputy Carey what we are doing in respect of recruitment. I have said this so often in the House in respect of different areas. We are now into our second phase of recruiting overseas, in England, in particular, where many of our nurses went. We are there desperately trying to encourage people back. We are offering them a good standard of pay. I suppose the only thing any country can really offer is its environment and living and working conditions, and that is what we are doing.

This year we are targeting new graduates. We have stands in the universities and we are desperately trying to recruit people from that cohort. However, young people who are newly qualified want to work abroad as well. They want the adventure of it and we cannot stop them from doing that. Anyway, we remain hopeful that some of them will stay at home and work within the system. In case some Deputies believe Clare is the only area affected, according to the last information I have there are 40 vacancies for nurses in Cork University Hospital. Yet in the case of anyone who walks in the door looking for a job, we are offering them a contract and a job. Despite this we are finding it remarkably difficult. We are not the only country with this difficulty. The UK has this difficulty and that is why those responsible recruit here. Canada is offering such rewards that we cannot possibly compete, but it is because the services there have shortages too. This is something we all have to deal with, despite having increased the amount of people graduating every year.