Charlie McConalogue (Donegal North East, Fianna Fail)
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I thank the Ceann Comhairle's office for selecting this Topical Issue on what could be the last day of the Dáil. It is particularly important that we get the opportunity to discuss it because the news that there is no funding planned as part of the capital investment programme for Ramelton Community Hospital, St. Joseph's Community Hospital, Stranorlar and Lifford Community Hospital is exceptionally concerning.

I welcome the fact funding is to be granted to a number of community hospitals across County Donegal to ensure they are brought up to the Health Information and Quality Authority, HIQA, standards. For example, Carndonagh Community Hospital is to receive €2.5 million, Buncrana Community Hospital is to receive €2.9 million and a new community hospital is planned for Letterkenny to increase capacity. However, it is exceptionally concerning that when that announcement of capital investment was being made by the Minister of State, Deputy Kathleen Lynch, it was made clear that there is no planned expenditure to ensure that the three hospitals I mentioned, namely, Ramelton, Stranorlar and Lifford, can be brought up to the required standard also to ensure they can continue operating as long-term residential nursing care units. I ask the Minister, Deputy Varadkar, to give a guarantee to the public today that they will get the investment required to ensure they can continue to operate.

It is essential that we see capacity increase in Donegal in terms of long-term nursing residential care units. The population of the county is increasing and it is due to increase rapidly in the next few years. Instead of increasing capacity what is planned for in this capital investment plan will see three hospitals being shut down and that capacity replaced by a new community hospital in Letterkenny, which instead should be increasing capacity to cater for future needs.

I have raised this issue to give the Minister an opportunity to give that guarantee to the public in Donegal, in particular to the people who are served by the Ramelton, Lifford and Stranorlar community hospitals, that those hospitals will be protected into the future and funded to ensure that can be achieved.

Pearse Doherty (Donegal South West, Sinn Fein)
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I echo what Deputy McConalogue has said. It is important we represent the best interests in Donegal and this cross-party approach is welcome. There is huge fear in these communities as a result of the announcement made two days ago. The announcement of that level of investment should have been positive news in terms of refurbishing the existing community hospitals to bring them up to HIQA standards so that they are able to be licensed post-2021 but it is not a positive news story in certain areas. The community will not stand for the ending of long-stay beds in Ramelton, Lifford and St. Joseph's community hospitals. I want to be clear because we have been speaking to people working within those institutions and communities on the ground and they will not allow an end to long-stay beds in the community hospitals in those areas. We are asking the Minister that instead of generating fear and panic about those three institutions he would confirm to this House that long-stay beds will remain open in those three areas and will not be closed down once the new facility in Letterkenny opens in 2018, which is the projected date.

There is also another problem in Donegal. We are already at peak capacity in the county. I have seen internal documentation within the Health Service Executive, HSE, which refers to people in long-stay beds going into hospital for routine surgery in Letterkenny General Hospital and when their surgery is complete and they have been released from the hospital, their long-stay bed is no longer available. Why is that happening? It is because we are already at peak capacity.

The HSE pointed out to me and to other Members four years ago that we needed 500 additional beds in the county within five years. We are now about a year away from meeting that target. We cannot accept closure of beds and facilities on a county-wide basis that have been operating for many years. We do not want to hear "if", "but", and-or "maybe" from the Minister.

We do not want to hear about rehabilitative or step-down facilities, or respite care in these institutions. What we want to know is that the community hospitals in Lifford, St. Joseph's and Ramelton will have long-stay beds in the future, and those people who call these community hospitals their homes will be there for the foreseeable future, and that people from these areas will not have to travel for long-stay beds in the years ahead.

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 the Minister of State, Deputy Lynch, who is unavailable.

Public residential care units are a significant and crucial part of our services for older people. They provide more than 5,000 long-stay beds, amounting to approximately 20% of the total stock of nursing home beds nationally. The standard of care delivered to residents in these units is generally very good, but we recognise that many of our public units are housed in buildings which are no longer up to modern standards and some are very old indeed. For this reason, Deputy Kathleen Lynch, the Minister of State with responsibility for services for older persons at the Department, recently announced an extensive national programme of investment in public residential units, which will bring them into compliance with national standards by 2021 at the latest.

The plan provides for indicative Exchequer funding of more than €41 million for the counties in the HSE's community health care organisation area one, which include Donegal. A further €38.5 million has been identified for a possible public private partnership, or alternative funding mechanisms in the same area, with details of this to be finalised. The investment will see the provision of two new centres in Donegal, in Ballyshannon and Letterkenny. It will consolidate residential care bed capacity in the county and will provide an additional 25 beds in Ballyshannon. The development of a new 130 bed centre, centrally located in Letterkenny, is intended to ensure that bed capacity in the region, which includes Ramelton, Lifford and Stranorlar, is secured on a sustainable basis.

Given the requirement for additional services to provide for the needs of older people throughout the country, including in Donegal, there will also be an ongoing need for the provision of short-stay beds for rehabilitation, respite, step up and step down, all with a view to keeping older people in their own homes and communities for as long as possible. This is what our senior citizens want in the main.

Over recent years, the HSE has developed and extended community services, focusing in particular on older people who can either be cared for in the community or whose capability can be built up to allow community living. Given the highly developed community services already in place in Donegal, including home care, day care and other short-stay facilities throughout the county, the continuation and expansion of services will be a big part of future service provision in the area. It is in the context of this planning for the coming years that the use and purpose of the buildings in Ramelton, Lifford and Stranorlar will be considered, to ensure that an appropriate service is provided for older people living in their own communities in Donegal.

Charlie McConalogue (Donegal North East, Fianna Fail)
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I thank the Minister for coming to the House to take this Topical Issue debate. However, I must say his response is in no way reassuring and leaves very much hanging in the air the scenario of these three hospitals being downgraded and closed. We need to see a guarantee that these hospitals will receive the funding required to ensure they are approved by HIQA and their beds continue to be provided in the local community.

I mentioned earlier how Ramelton Community Hospital has 30 beds, Lifford has 20 HIQA registered beds and St. Joseph's hospital in Stranorlar has 78 beds. This amounts to 128 beds, and the new community hospital in Letterkenny is expected to have 130 beds. Despite the fact we have an unprecedented growth in our over 65 population, the capital investment plan announced by the Minister of State, Deputy Lynch, will not see additional capacity brought to the Donegal area and will fail to meet demographic demand.

It may have been an accident that these plans were announced during the week as part of the Minister of State's capital investment announcement, but it was no accident the information was there in the first place, indicating the plan is to replace these three hospitals and their beds with a new unit in Letterkenny, rather than to use the unit in Letterkenny to increase capacity in the county.

As we enter a general election, and on the back of what we have seen in recent weeks, with one reheated announcement of future funding after another, funding which was expected and had been announced in the past, what has happened here is that in the rush to put out this information the Government has let the cat out of the bag on its plans not to invest in Lifford, Ramelton and St. Joseph's in Stranorlar. I ask the Minister for a cast iron guarantee there will be investment in these hospitals and they will continue to have the number of beds they have at present so they can continue to provide the essential services they have provided for many years to their local communities.

Pearse Doherty (Donegal South West, Sinn Fein)
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I say without fear of contradiction that I speak for the majority of people in the communities when I say they will not accept this. What the Minister has just announced to the House is that these facilities will be considered in the context of planning for short-stay rehabilitative, respite, step up and step down facilities. What the communities want is long-stay beds kept in their area. This is what they want. People have been going to St. Joseph's for generations. It is what is colloquially called the county home. People will not accept this. We have heard spin from the Government that this is not what it means, although the Minister of State, Deputy Kathleen Lynch, made it very clear in her statement that long-stay beds in these three facilities are being replaced by the beds in Letterkenny. The Minister has just confirmed this to us.

I am asking the Minister, who is noted for his straight talking, to explain in plain English that the plan for St. Joseph's, Lifford and Ramelton is not the continuation of long-stay beds. This plan will be resisted. I will resist it, along with communities and front-line services. We need investment in beds. What is the net number of beds that will become available in the county? How will we deal with the crisis at this time where people are being turned away from long-stay beds in the county? People lose their long-stay beds when they go for a simple operation in Letterkenny General Hospital. We cannot afford to close beds in these communities. Will the Minister please listen to my call and the calls and pleas of the communities involved? Will he also spell out in very clear language the plan for long-stay beds in the three institutions in Lifford, Ramelton and St. Joseph's in Stranorlar?

Leo Varadkar (Dublin West, Fine Gael)
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It is important to acknowledge that the Donegal model of having a large number of community hospitals in the county, with relatively well developed home-care and home help services, is a good model for the rest of the country. In addition to the ten beds provided in Letterkenny hospital, the model has helped us and is one of the factors which have allowed Letterkenny and Donegal to perform so well during this winter period. Letterkenny is one of the few places in the country where hospital overcrowding has reduced substantially on last year, which is evidence of the additional beds working and the strength of the community services.

The Deputies opposite may have the view this is the last ever announcement which will be made on investment in homes for elderly people. This is not the case. This is one announcement, and there will be future announcements in the coming months and years about the services. The points from the Deputies opposite on future capacity were very well made, and there will be need for additional capacity in Donegal and elsewhere. Most additional capacity in nursing homes is now provided by the private sector through the fair deal arrangements, and this is the case throughout the country. What the announcement was about in particular was replacing older facilities and bringing them up to compliance with HIQA regulations. This does not mean there will not be future announcements of future developments and future nursing homes and community hospitals being provided.

Specifically on Lifford, Ramelton and Stranorlar, I do not envisage they will be closed because of the reasons the Deputies stated, namely, rising demand. They will be needed. What will have to be worked out over the coming period is the mix of services to be provided. As the Deputies know, the standards for respite, short-stay and step up and step down facilities are different to those for long-stay facilities. It may very well be the case these units will have to be refurbished to allow them to continue to have long-stay beds and to provide for other needs, such as respite, short stay and step up.

Nobody in the House can give any cast iron guarantees because the Dáil will most likely be dissolved in the coming days and a new Government will be elected.

I cannot give the Deputy any cast iron guarantees, nor can anyone else in this House offer such guarantees about the future with any level of honesty, because we do not know what complexion the future Government will have. Suffice to say that what has been announced will be done. It is not intended to close any of these three units, but we will have to work out, in co-operation with the local HSE, how they can best be used and what mix of services will be there in the future.