Frank Feighan (Roscommon-South Leitrim, Fine Gael)
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Deputies Brian Stanley and Sean Fleming have four minutes in total to make initial statements. I understand they are sharing time and Deputy Stanley is first.

Brian Stanley (Laois-Offaly, Sinn Fein)
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I welcome the opportunity to raise with the Minister the important issue of what has happened in respect of St. Vincent's Community Nursing Unit in Mountmellick. The cessation of admissions has had serious consequences because there is a major shortage of public nursing home beds in County Laois. Only a handful of long-stay beds are available now in Abbeyleix and Shaen. The units there are mainly respite facilities. The unit in Mountmellick had been taking the bulk of long-stay patients. There is a need for a major initiative on the part of the Government. The unit in Mountmellick was already operating under capacity due to the closure of St. Joseph's ward a little over six years ago.

While it is important that proper standards are met, I have some questions about some of HIQA's requirements, particularly those regarding single occupancy rooms. I am unsure whether it is a question of being practical or if they are the best for patients. Certainly, many people who work in the profession see them as a bad thing because they isolate patients.

The findings in the report on the unit at Mountmellick included a reference to an inadequate number of toilets and inadequate washing facilities to meet the needs of residents. This must be addressed. Only two toilets are available in some areas along with a shower room. These facilities are to cater for 22 patients. Staff and patients have had to use commodes and that is not satisfactory.

The HSE has submitted a national plan to the Department of Health, including plans to upgrade Mountmellick and the other two nursing hospitals in the county at Abbeyleix and Shaen. These have been neglected by successive Governments. The Government has earmarked €300 million in the capital plan for upgrading facilities. Now is the time to move and prioritise the matter. It is badly needed. There is a chronic shortage of long-stay beds in the county.

Seán Fleming (Laois-Offaly, Fianna Fail)
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I wish to raise directly with the Minister the question of what action will be taken by him, the Department of Health and the HSE in respect of St. Vincent's Community Nursing Unit in Mountmellick in order that it can admit patients again.

Some weeks ago I received a telephone call from a lady whose elderly mother was due to go in for respite care the following Tuesday. This was on the previous Thursday and they were told the elderly woman could not come in. The daughter asked what would happen and she was told that the woman could go to St. Brigid's Hospital in Shaen in the interim. However, works are under way in St. Brigid's Hospital in Shaen as well. That In itself is a good thing but it meant there was nowhere for the woman to go at the time.

Word filtered out and hit the local media sometime later. Patients were being told on a one-to-one basis and it would have been far better if personnel had been more upfront about it at the beginning rather than people picking it up through the grapevine. It was a bombshell when this information broke, but some were aware of it at that point.

The main issue has been referred to and well documented. There are some large wards in these facilities and HIQA has said there was a lack of dignity for patients. That should not be the case. I know it will cost money to correct. We have had difficulties in Shaen and Abbeyleix in recent years as well as difficulties in the Midland Regional Hospital, Portlaoise. All of this information has been filtering into every HSE hospital in the county. This is undermining public confidence in the HSE. It is our job to help us restore confidence in these institutions. They have served people well in the past and we want them to continue operating. The fact that Mountmellick has been closed for admissions in recent times is causing difficulties in the Midland Regional Hospital, Portlaoise due to delayed discharges. That issue needs to be raised also.

HIQA pointed to some good things in Mountmellick. The report stated that hygiene, cleaning and many other things under the control of the staff in respect of the environment were working well. It is not all bad news, but we want to eliminate the problems.

Leo Varadkar (Dublin West, Fine Gael)
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I thank the Deputies for raising this issue. I am taking the debate on behalf of my colleague, the Minister of State, Deputy Kathleen Lynch, who is on Government business elsewhere.

St. Vincent's Community Nursing Unit is located on the outskirts of Mountmellick and provides much-needed residential services for the people of Laois. It comes under the remit of the HSE. Deputies will be aware that the Health Information and Quality Authority, HIQA, registers and inspects residential care facilities throughout the country. The current registration status of the hospital includes a condition that no new residents may be admitted, except to the palliative care suite, until a funded plan to reconfigure the physical environment has been submitted to HIQA.

While the issue raised refers specifically to the admissions restriction at St. Vincent's unit, I am aware that at a wider level there are concerns about the implications of the national standards for residential facilities more generally. The Minister of State, Deputy Kathleen Lynch, who has responsibility for services for older people in my Department, addressed this issue in the House last week in a response during a Topical Issue debate. I will briefly restate what she said on that occasion, and I endorse her comments.

The Government's recently published capital programme, Building on Recovery: Infrastructure and Capital Investment 2016-2021, commits to a major multiannual programme of capital investment in public and voluntary social care facilities. The overall programme includes €300 million for the development of community nursing units for older people and new improved models of accommodation for people with a disability, particularly in respect of de-congregation. There is further potential to develop more projects through public private partnerships. Building on investments already scheduled, this additional funding will allow the relevant facilities to comply with the national standards by the end of the new capital plan period, that is, by 2021. A major national programme will now be put in place to address on a prioritised basis the refurbishment and new-build requirement.

The shortage of public capital funds in recent years due to the economic crisis has meant a significant number of publicly-provided or voluntary-provided services have not met the physical infrastructure standards within the previously agreed timeframe of 1 July 2015. The works required range from refurbishment to replacement of facilities concerned. As a result of the capital programme, the Minister of State, Deputy Lynch, outlined a revised policy and timeframe to ensure all public and voluntary services can demonstrate to HIQA that they will achieve the relevant national standards by 2021. In the coming weeks the HSE will submit to HIQA its plans, focused at individual service level, to meet the requirements of standard 25, the standard relating to physical infrastructure. These individual plans will be in line with the revised policy timeframe and will detail proposed capital expenditure at each individual centre. The HSE will assist the voluntary providers with which it has a service level agreement in submitting these individual plans.

This decision was absolutely necessary to ensure that older people continue to have access to the services they need. The imposition of a compliance timeline that was unachievable would have led to facilities closing throughout the country with others having to reducing their bed numbers. Older people and their families as well as others who need these services would not thank us if that were allowed to happen. It would certainly have exacerbated overcrowding in our acute hospitals - in some cases, this is already happening.

While compliance with this particular standard has been particularly problematic for our public units, I am keen to acknowledge the considerable financial investment made by private and independent nursing homes in recent years in an effort to meet these environmental and other standards. I hope that HIQA will give consideration to any similar plans to achieve full compliance that may be put forward by the private and independent sector where issues arise as well.

Brian Stanley (Laois-Offaly, Sinn Fein)
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The Minister referred to a revised timeframe. A revised timeframe is fine and it gives time for the hospital to comply. The problem is the build-up of long-stay patients requiring public nursing home care. They require high-dependency nursing home care in the meantime but we do not have places for them.

The three nursing units in County Laois are operating at under-capacity. The issue is the standard of the buildings. At the same time we have an increase in demand due to demographics and the increasing population in the county. There is an onus on the Government. I have no wish for the Government to simply restart admissions to Mountmellick. I realise it did not happen under the term of the current Government but the wards closed in Mountmellick need to be reopened. There is a major shortage of capacity in the county.

I would like to see that plan being advanced and a timeframe announced.

With the Minister give a commitment today that Mountmellick, Abbeyleix and Shaen will be included in the new capital programme? This cannot be delayed any further. It has been delayed for years and changes have been made. The deadline to comply with HIQA standards was 1 July this year. As the Minister mentioned, that has now been extended and there are individual plans. While the plans are being drawn up, the patients who need accommodation are coming forward to Deputies like myself and my constituency colleagues. Families are telling us there are no nursing home beds for their relatives. I ask the Minister to give a commitment to include the areas to which I referred in the capital programme.

Seán Fleming (Laois-Offaly, Fianna Fail)
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I acknowledge the Minister's reply and agree with the decision to extend the deadline for various institutions to comply with HIQA requirements to 2021, because it was not going to be possible to reach it in the short term. The Minister said the HSE would submit a plan to HIQA in the coming weeks. We expect something on the future of health care facilities over a six-year period to be a secret document, and I ask that it be published at that stage.

It is important that everything possible be done to reassure residents, their families and staff following the upset caused by the manner in which this matter has been handled in recent weeks. Some measure should be put in place to alleviate that. In view of the five-year timescale and given that places such as Abbeyleix could take up to 50 residents, there may be a solution. In recent years, 30 to 35 people have been accommodated, but that figure has now been reduced to a tiny number. There is a good case for allowing that number to increase to 30 or 35 as in recent years and to use the five-year breathing space to facilitate such a solution.

Leo Varadkar (Dublin West, Fine Gael)
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The details of the new capital plan running to 2021 are currently being finalised and should be ready in the next few weeks. In some places it will involve refurbishing an existing unit. In others, where it is not economical to carry out refurbishments, replacements will be provided and expansion can be considered in that context. Obviously, priority will be given to those that are most far behind, if that makes sense, in meeting HIQA building standards. I cannot give any specific commitment on any specific centre today for any part of the country because the plan will have to be carried out comprehensively on a national basis.

Deputy Stanley mentioned single-occupancy rooms. It is permitted under the standards to have dual occupancy rooms, but it is no longer possible to have rooms with four, six or 12 people. I have visited some units, including a very old one in Carrick-on-Shannon, for example, and listened to residents and family members. They were happy with the standard of care, but the quality of the building was not very good. I suggest that people visit new buildings such as the community nursing unit in the Phoenix Park, which used to be St. Mary's hospital. One can really see what the units should look like and what the modern standard of care for the elderly is. It is only when one sees this that one realises quite how inappropriate some of the older units are.

Many community nursing units are in buildings that are 100, 150 or 200 years old. Very many are old workhouses or county homes. While it was acceptable to have people living in rooms of six, ten or 12 beds on old-fashioned Florence Nightingale wards up to ten years ago, it is not acceptable now and into the future, and certainly not in ten years' time. It is not possible to replace 200 years' worth of infrastructure in a few years. We lost six or seven years as a consequence of the economic crisis. The economy is now growing and as long as we continue that, keep the recovery strong and protect it from those who would undermine it, we will have the possibility of catching up over the next six years on what we missed out on in the past six years and bringing all of these units for older people and people with disabilities up to standard.