Thursday, 25 January 2018
Topical Issue Debate
I thank the Ceann Comhairle for giving me the opportunity to raise an issue relating to medical health care in Tipperary, particularly the position regarding the former acute hospital, Our Lady's hospital in Cashel. The position in respect of Cashel is that many people in Tipperary are baffled and bewildered as to why we have a magnificent building, on which the HSE spent €20 million since 2007 and which is under-utilised.
We have three floors that are empty that could take 30 to 35 beds. They are in excellent condition. I am asking that the unit be re-opened and developed as a primary and community care centre. It is lying idle, which is shameful, and it is mind-boggling that the Health Service Executive, HSE, is not getting on with utilising the building to its maximum potential.
Since the last election, I have focused much of my attention on ensuring this unit can be properly utilised in the interests of delivering health care in Tipperary. We have had numerous meetings about it and the Minister, Deputy Harris, visited the hospital. He said he was bewildered by the fact that the unit was not being used to its full extent. He committed to establishing a working group within the HSE to consider ways and means as to how best to avail of facilities in the interests of the patient public in Tipperary. The HSE has since carried out a thorough evaluation of the necessary structures and supports to enable Our Lady's Hospital, Cashel to function as a day hospital and community care centre with particular emphasis on the medical needs of older people.
The HSE must accept that utilising community hospital facilities to support and care for non-acute patients is the way forward. In Our Lady's Hospital, Cashel, we have an ideal and top of the range facility that is there to care for patients and, in particular, people who do not need intensive and acute support. I have discussed this with the Minister, Deputy Harris, on numerous occasions. I ask the Minister opposite, who speaks on behalf of the Minister, Deputy Harris, and the Government to outline the plans for the future of the hospital. We have been waiting in expectation of a response to our queries for a considerable period. A number of weeks ago, the Minister told me he would be in a position shortly to make a decision so I hope the Minister opposite will be able to communicate that decision to me this evening.
I thank Deputy Lowry for raising this matter. I apologise to the Deputy as the Minister of State with responsibility for older people is not present but I will convey the Deputy's remarks to him. I will also convey the remarks to the senior Minister. I am well aware of the Deputy's long interest in this hospital in Cashel. I seem to be on the opposite side from people from Tipperary all week but I hope I will be able to give the Deputy a satisfactory answer on this occasion.
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 want and only those in genuine need of residential care should go down that route. The HSE is responsible for the delivery of health and personal social services, including those at facilities such as Our Lady's Hospital, Cashel. Our Lady’s Hospital, Cashel, was originally part of acute health service delivery in the south Tipperary area. In 2007, the former South Eastern Health Board decided that acute hospital services for the area should be centralised on one site, that being South Tipperary General Hospital, Clonmel. This led in turn to the redevelopment, over two phases, of the former Our Lady’s Hospital into Cashel health campus, a centre for non-acute health care services. There is, however, a compelling need to develop hospital avoidance and early discharge facilities in south Tipperary, particularly for the growing elderly population. That is why the HSE is focused on developing a range of diverse primary care and community-oriented services to best serve the people of Cashel and surrounding areas.
The services range from those operating on a 24-hour day, seven days a week basis to those that use the facility as a base to provide care in peoples' homes and communities. The health care professionals based in Cashel health campus provide services across a number of care groups to the population of Cashel and surrounding areas. The community intervention team located on the campus is a nurse-led professional team that provides nursing care to patients in a community setting. The service provides high-quality nursing care in the community for a short period by working together with patients, carers and other professionals. Thanks to the provision of this service, many patients can return to their homes earlier from hospital. It also provides GPs with another option of care within the community as an alternative to the acute hospital. Additionally, HSE community services provide support for people who are at home via the primary care team and home support services, which are based in Cashel health campus. These services continue to have a significant role in supporting older adults who are discharged from hospital with ongoing non-acute care needs and in preventing admission to hospital.
As part of winter funding measures for 2018 and 2019 introduced to improve access to unscheduled care, €450,000 has been approved by the HSE to further develop community services for older people in south Tipperary. This follows the commitment of the Minister, Deputy Harris, on a visit to Tipperary in September to a 40-bed modular extension to South Tipperary General Hospital and his support for a day hospital at Cashel. That was at the invitation of the Deputy. I know the Minister would wish to acknowledge Deputy Lowry's advocacy on this matter and the use of Cashel, and indeed he accompanied the Minister on his visit there. Discussions are planned for the development of further initiatives, working in an integrated way with South Tipperary General Hospital and existing community services, which will provide a continuum of care for the local population, with particular emphasis on the provision of a model of care pathway for older people in line with the integrated care programme for older people.
I thank the Minister. I welcome that an additional €450,000 is included by the Health Service Executive for the funding in 2018 and 2019. I am sure it will contribute to the enhancement of services, particularly for older people in south Tipperary. I also welcome that consultation and discussions have been taking place with consultants and key personnel in the general hospital in Clonmel with a view to outsourcing some of the services currently being delivered from there. As the Minister is aware, there is a problem in Clonmel with overcrowding and that is compounded with the number of people attending clinic consultations at the general hospital there.
I very much welcome the commitment of the Minister, Deputy Harris, to Tipperary and to resolving the problems we have at South Tipperary General Hospital. A new 40-bed unit has gone to tender and other measures include a community intervention team to be based at Cashel. The reality is we have a unit in Cashel that is modern and vacant and that should be fully utilised for the benefit of patients on waiting lists or who encounter delays at outpatient clinics at Clonmel. I welcome the Minister's commitment to re-opening Cashel and I hope the ongoing discussions can be completed in the short term. This building has for many years been associated with the delivery of health care in Tipperary and I hope it can be fully re-opened so the people of Tipperary can utilise it to its maximum potential.
I once again take the opportunity to apologise on behalf of the Minister of State with responsibility for mental health and older people, Deputy Jim Daly, and acknowledge the case made by the Deputy. We may have political differences but everybody in the House acknowledges the needs of older people and those with mental problems, as well as the underprivileged and vulnerable. This certainly comes into that category. I will certainly convey everything the Deputy has said to both the Minister of State, Deputy Daly, and the Minister, Deputy Harris, who has a particular interest in this hospital.
The Minister and the HSE recognise that Cashel health campus is vital for the provision of community based services that help people to stay in their communities and homes and that assist those people who require emergency department hospital admission to be discharged as early as possible from acute care back to their home environment. While the campus is being used for day and primary care services, the additional funding provided this year as part of the winter measures to improve access to unscheduled care will form a basis to allow local services to further develop an action plan for a range of services to support older people in the south Tipperary area. This will help both to avoid hospital admission in the first instance and also to facilitate early discharge should a stay in an acute hospital be necessary.