Mary Butler (Waterford, Fianna Fail)
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The people of Dungarvan in west Waterford were shocked by the sudden and unforeseen closure of 16 beds in the Sacred Heart unit at Dungarvan Community Hospital at the weekend. Like everyone else, I was taken aback by the announcement at the weekend that the remaining 16 beds would be closed at the unit as a result of staff shortages. The way it was announced on the eve of a bank holiday weekend was an attempt to bury the story in the hope it might just go away. Families were contacted last Thursday and Friday and told the unit was closing with immediate effect. The 16 beds closed comprised 11 rehab beds, three long-stay beds and two respite beds. This unit provides vital rehab services and physiotherapy for people recovering from stroke and accident, allowing patients to convalesce on a short-term basis. The importance of the two respite beds cannot be underestimated with families availing of these vital services two weeks of the year when their loved ones get excellent care and the carers get a much needed break. These facilities are a key factor in dealing with overcrowding in our acute hospitals. If we see further reduction in capacity in places such as Dungarvan, how can we possibly deal with the overcrowding in UHW and our other acute hospitals? The hospital in Dungarvan is a vital step-down unit. In January 2017, seven beds were closed in the unit and the closure of the 16 remaining beds is a major blow to Dungarvan and west Waterford. Family members of patients contacted me at the weekend because they are deeply concerned about where their loved ones will be moved to. The unit allowed people from the west Waterford area to stay close to their families. One of the issues cited was a shortage of nurses, which is now at critical stage. There are issues with nursing recruitment and retention but not letting those who will be directly affected by a decision to close know in advance has resulted in serious disturbance and upset among patients, families, staff and the wider community.

Mattie McGrath (Tipperary, Independent)
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Ar an gcéad dul síos, I thank the Ceann Comhairle for allowing us to raise this Topical Issue this evening. It is a very important issue. The Minister has been down to Cashel in Tipperary. He saw the wonderful unit in the old Our Lady's which is lying idle; €23 million was spent on it and there is not a bed inside it. There are managers galore but not a bed. The Minister told me he would do something, yet he has done nothing. Deputy Butler lives in Dungarvan and I am 20 miles away in Newcastle. South Tipperary General Hospital in Clonmel is in the middle of the two, about 20 miles from each place. It is unbelievable. There is bedlam every day of the week on the corridors. It is a retrograde step. It is only an excuse for the HSE to say it cannot get nurses. There are plenty of managers there to get nurses. They have had plenty of time to get them. The HSE is telling us this is only temporary in the Sacred Heart in Dungarvan and in Cashel. We lost a ward in Cashel already when it was transferred to the back of Our Lady's. We lost 12 respite beds for women when that transfer occurred. We hoped it would be a modern, new facility, which it is, but we lost 12 respite beds in the system in south Tipperary. Many of the people in west Waterford come to Clonmel and Ardkeen. They get their procedures in Clonmel under awful pressure. They cannot be released because there is no place to which to be discharged. This is total madness. Is the Minister going to allow himself to be captured by the officials? I do not say that lightly. I wished the Minister well in his position but the officials are ruling the roost and doing a damn bad job of it. The Minister can smile all he likes. Closing respite beds is madness; it contributes to the problem. There is a wonderful facility in the Sacred Heart in Dungarvan and a wonderful facility in St Patrick's in Cashel under Mary Prendergast, who is doing her best. Officialdom is ruling the roost. There are dozens of officials in the new hospital where €21 million was spent but not a bed. It is a bed-free zone and a patient-free zone. The Minister said he would do something about it but he has done nothing. It will cause chaos coming into summer. It will cause absolute chaos when it comes to the winter because these beds in Dungarvan have been lost and we will lose 15 to 18 further respite beds on top of the 12 we have lost already in St Patrick's in Cashel. Where have people to go? Will they go on the streets or the roads? This is pathetic. It is ineptitude by the HSE. It is scandalous. Temporary measures will not work because they are not temporary. Nothing is temporary with the HSE. The only thing permanent with the HSE are the managers and lazy bureaucracy.

Simon Harris (Wicklow, Fine Gael)
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I thank Deputies Butler and McGrath for raising this important issue. 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. This is clearly what older people and everybody in this House wants. We also have patients who are in genuine need of residential care either on a long-stay or short-stay basis. The HSE is responsible for the delivery of health and personal social services, including those at facilities such as Dungarvan Community Hospital and St Patrick's community nursing unit in Cashel. Both hospitals provide long-stay residential, respite, palliative care and rehabilitation services for older people. As with the health service In general, Dungarvan Community Hospital and St. Patrick’s, Cashel are experiencing significant challenges with recruiting and retaining nursing staff. Dungarvan has 16 whole-time equivalent vacancies, eight of which are required for the Sacred Heart ward. St. Patrick's has vacancies for ten whole-time equivalents. While there have been a number of national recruitment campaigns for nurses, unfortunately a serious challenge has arisen in recruiting nurses to fill vacancies in these facilities. These two examples in Dungarvan and Cashel highlight the absolute importance of ensuring we hire the 1,208 more nurses we are fully funded to hire this year. Nurses, through their representative bodies, the INMO and SIPTU, voted overwhelmingly a number of weeks ago to accept the proposals we put in place. I will be talking to the INMO at its annual conference tomorrow about how we turn the plan into absolute action so that facilities like this can be adequately staffed because this is a very acute problem.

As a result of the nurse recruitment shortages, in order to maintain the delivery of safe, high quality services in compliance with standards and the laws of the land to look after people, which is what is most important, the HSE has decided to move residents internally from the Sacred Heart ward to alternative accommodation within Dungarvan Community Hospital and to amalgamate wards within St. Patrick's. This is a temporary measure and staff will be reorganised to optimise patient safety. Long-stay and short-stay care, including palliative and dementia care all continue to be provided. I assure Deputies Butler and McGrath there is no decision in any way, shape or form to close these facilities or beds. It is a short-term measure whilst recruitment is under way. I say that on the record of the House to give assurances to the people of Dungarvan and the people of Cashel and beyond on this. It is a staffing shortage that we are determined to fix so these beds can reopen. I understand the decision has caused a great deal of upset for residents, families and the local community. I hope further clarity has been and will continue to be brought to the situation by the HSE. I fully accept the point made by Deputies Butler and McGrath about the panic, upset and confusion it caused over the bank holiday weekend.

Mattie McGrath (Tipperary, Independent)
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There was no notice.

Simon Harris (Wicklow, Fine Gael)
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The HSE has assured me that patient welfare is a priority for staff and management, which none of us doubts, and has expressed its deep appreciation of the support the hospitals receive from families and the wider community. Both of these facilities are held in high esteem. The HSE acknowledges the concerns expressed on this subject in recent days and apologises to residents and their families for any inconvenience and will work to ensure there is minimum disruption to normal services during this interim arrangement. It is important to note there is no negative impact on existing staffing numbers whilst this interim safety arrangement is in place at both hospitals. Representatives of hospital management are available at all times to residents and their families to discuss any matters of concern to them. They assure me they will continue to work closely with staff representatives to bring both units back to full operating capacity.

My Department will monitor the situation carefully and I have asked the HSE to keep me directly updated on progress. Another factor that has contributed to the temporary closure in St. Patrick's is the structural issues associated with the building, which I acknowledge do not meet the standards one would expect to find in a modem nursing home. Deputy McGrath and I have discussed this before. A replacement for St. Patrick's is, like Dungarvan, included in the five-year capital investment programme for public nursing homes announced last year.

Mary Butler (Waterford, Fianna Fail)
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5 o’clock

I thought - as I am sure the Minister did - that we had turned the corner and that the closure of wards was in the past. The trend of nurses leaving Ireland has become very worrying. Terms and conditions for new graduates must be improved to ensure that they stay here. The Minister mentioned that he will be attending an INMO conference tomorrow. Last week, that organisation published research showing that upwards of 85% of all soon-to-graduate nursing students are contemplating going overseas to work rather than staying in the Irish health system. Coupled with that is the length of time it takes for nurses who return home to work to be registered with An Bord Altranais, an issue I have raised with the Minister previously. Such registration can take up to 90 days and I know of one nurse who actually gave up and went back to England.

I am glad that the Minister has asserted that this is a temporary rather than a permanent measure and I will be holding him to account on that. This is a vital service for the people of Dungarvan and west Waterford.

Mattie McGrath (Tipperary, Independent)
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I thank the Minister for coming into the House to address this matter. He has said that this is temporary but nobody trusts the HSE. This is a case of sheer ineptitude on the part of senior management in the HSE. A blind woman or man could see that this was coming. The services did not have enough staff and were under chronic pressure. I want to pay tribute to the staff in both facilities for the fabulous work they do and for the excellent treatment they give to patients.

Nobody told me, as a public representative, about this. A patient's family phoned me and when I phoned the HSE, they said that they were going to tell me. This is nothing but subterfuge and deceit on the part of senior HSE management who do not care. They do not care about the patients. I know that the Minister means what he says but the HSE managers do not mean it. They go off on their holidays, tours and trips. They saw this coming and now the hospital in Clonmel will be totally swamped, as will University Hospital Waterford. Clonmel will be totally swamped and when winter comes, God help us. The Minister was there, he saw the facilities and rubbed his hands. He is still rubbing his hands but nothing has been done; rather, this is going to make a bad situation worse. I am glad that the Minister has said that money will be invested as part of the five-year programme because we need new beds in St. Patrick's. Will it happen, though? We will hold the Minister to account.

Finally, I ask the Minister to receive Ms Twomey at his office this evening to bring the current stand-off to an end. I asked him to do so earlier today, as did many other Deputies. The Minister should meet her for five minutes. He should have the good grace to inform her of the current situation.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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That is a different matter completely. I ask the Deputy not to go there now, please.

Mattie McGrath (Tipperary, Independent)
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I am not saying that he can solve the problem but I would ask him to meet her, as he has already committed to doing.

Simon Harris (Wicklow, Fine Gael)
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I thank both Deputies again for raising this matter. I want to begin by letting both Deputies and all Oireachtas Members and public representatives in Waterford and Tipperary know that I am not satisfied with the lack of communication by the HSE on this issue. I think it is disrespectful and I intend to convey that directly to the HSE. It is not good enough. The HSE needs to inform public representatives so that the truth can get out there.

Mattie McGrath (Tipperary, Independent)
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It needs to inform the families too.

Simon Harris (Wicklow, Fine Gael)
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Of course. Patients are of paramount importance. It is very important that the truth is put out there in a factual way. I know that there was a concern in both communities that these facilities were shutting but this is only a temporary measure. It makes sense to brief people and keep them factually aware of the situation so that myths and misinformation do not spread.

In terms of nurses, I fully agree with Deputy Butler. Obviously, we will have the public service pay commission report shortly. That is a broader process and one for my colleague, the Minister for Public Expenditure and Reform but that will provide an avenue for discussion. We have just agreed a number of exciting proposals with the INMO and SIPTU to help to recruit and retain nurses, including under the Bring Them Home campaign. Nurses were offered €1,500 to move back from the UK to Ireland and that sum has now been doubled to €3,000 and it does not just apply to the UK anymore. We also have a number of pre-retirement initiatives to enable older nurses who may wish to stay on and work part time rather than full time to do so without negatively impacting their pension entitlements.

Deputy Butler is right about the Nursing and Midwifery Board of Ireland, NMBI, registration process. I recently visited the NMBI's offices. The board is about to go fully digital which should help in making sure that the organisation is not swamped. It is quite busy in terms of receiving applications but digitisation should lead to a more streamlined process.

The beds provided by public nursing homes like Dungarvan Community Hospital and St. Patrick's in Cashel are an essential part of our health care infrastructure. Without them, many older people would not have access to the care that they need. However, as I said already, quality care and patient safety are priorities and all decisions must be made in the interests of patient safety. At present, these two units do not have sufficient nursing staff to safely maintain the full range of services. Therefore, the HSE is obliged to take the appropriate steps for the management of the patient profile and the staffing resources available.

I reiterate that I am assured that these are temporary measures. Any decisions to close beds are taken in the interest-----

Mattie McGrath (Tipperary, Independent)
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What does the word "temporary" mean in the HSE's vocabulary?

Simon Harris (Wicklow, Fine Gael)
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----- of safely maintaining services. The HSE will actively seek to recruit nurses as quickly as possible. I will keep in touch with both Deputies on this matter.