Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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I welcome the Minister of State, Deputy Byrne, and thank her for taking the time to hear about this matter. It relates to the Alzheimer's disease unit in Sligo, which covers the north-west region. The unit is based on the campus of St. John's Community Hospital there. It was opened as a dedicated unit some 20 years ago. The backdrop here is that the Mental Health Commission or HIQA did a report some time ago and found in the region of 13 non-compliances with regard to upgrades that might be required and so on. Since then, it seems that a HSE or Government decision was made to wind down and close this unit, thus leaving the entire north-west region without a suitable unit for respite or long-stay residents with Alzheimer's disease with a dedicated staff as this one was. There are now four of the 36 residents remaining. I got an email from the HSE last week stating that these people would be transitioned out and so on. In reality, what has happened up to Monday of this week is that families were effectively coerced and told to remove their loved ones, that it was a matter for them to deal with, that the unit was closing and that was the end of the story, which is totally unacceptable. The loved ones of some of these families have been living in this particular unit quite happily, including one for ten years and another for the 20 years it has existed.

I appreciate the need for and welcome inspections to ensure all our facilities are up to standard. However, it seems to increasingly be Government practice that when HIQA, the Mental Health Commission or another body does, for want of a better expression, the dirty work of finding flaws with a particular unit, instead of applying the necessary investment to get the unit up to standard and ensure the region still has that service available, it sets about closing the unit down. In effect, the Health Act 2004 is being used by the Government to subcontract the entire running of our health service and the €15 billion of taxpayers' money involved to the HSE. The HSE now seems to be hell-bent on subcontracting out the provision of those services and acting like a broker, pushing families into the private sector to get care. One could be forgiven for asking what we pay social insurance for. Where is that €15 billion going? If that is going to continue, then the HSE is clearly a very expensive broker for the procurement of private sector services. There was no consultation with the Alzheimer Society of Ireland or with the patients. As I said, up to Monday of this week, two of the four families who loved ones still live there were simply told to move on, that they had to take their loved one home, put the person somewhere else, and that the hospital had nowhere else to put them. It is not acceptable, in any event, that the north-west region will be left without a dedicated Alzheimer's unit. What is next? Will it be Dungloe Community Hospital near the Leas-Cheann Comhairle, Sheil Hospital, the Rock community nursing unit, St. John's Community Hospital itself or countless others throughout the north west?

People in the north west of the country, just like people in Dublin or in any other part of the country, are entitled to services and we are increasingly stripping them out and forcing people to deal with the private sector when there was a perfectly good functioning public service in operation. It may have needed some level of upgrade and continuing investment, as rightly highlighted by the Mental Health Commission, HIQA and other bodies, but that does not mean we should not apply those resources. We should not use it as an excuse to close services down. At some stage, we need to put the people, patients and families at the centre of our consideration of this process because, sadly, under the euphemism of "the best interest of the patient", the HSE is being budget-driven to close down and cut back services, and to push it back onto vulnerable families which have to dig deep for funds they do not have to procure these services in the private sector.

Catherine Byrne (Dublin South Central, Fine Gael)
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On behalf of the Minister of State, Deputy Jim Daly, I thank Deputy MacSharry for raising this issue. The rehabilitation and recovery mental health unit, formerly known as the Alzheimer’s unit, is located within the grounds of St. John's Community Hospital, Sligo, and serves patients with both dementia-related illness and mental health difficulties, as the Deputy has said. The Mental Health Commission carried out an inspection report on this unit on 17 November 2016. The inspection report highlighted that the rehabilitation and recovery mental health unit did not operate as a rehabilitation unit but as a continuing care unit, with a number of residents inappropriately placed there. Care and treatment was limited to that provided by a nursing staff and general practitioner, GP, only, with a lack of further clinicians available. There was no consultant psychiatrist or multidisciplinary team available for the approved centre. The Mental Health Commission approved registration of this unit in November 2016 on the basis of two conditions. These were that there would be no further new admissions or transfers of persons to the unit, and that the needs of the current residents of unit were assessed and residents were appropriately placed in accordance with this by 31 December 2016. As a result, no new patients have been admitted to the unit since 21 November 2016. Many residents have since been transferred to more appropriate care and facilities. By the end of March 2018, all remaining residents will be transferred to other placements more appropriate to their care needs. The HSE has assured the Minister of State, Deputy Daly, that all transitions will be fully inclusive and will respect the individual needs of the residents involved. This is also in keeping with the Irish National Dementia Strategy 2014.

The closure of this unit is in line with the mental health policy, A Vision for Change, which set out a comprehensive policy framework for the development of mental health services. It recommends a move away from the traditional institutional based model of care to a more patient-centred, flexible and community based service, where the need for hospital admission is reduced while still providing inpatient care, as appropriate. The closure of this unit creates further opportunity to develop additional services which will be available to more people in their homes and other community care settings in Sligo. This Government has prioritised the reform and resourcing of our mental health services in line with A Vision for Change. This can be seen in the mental health budget increase from €711 million in 2012 to over €910 million in 2018, an increase of around €200 million, or 28%, in six years.

I thank the Deputy for raising this issue. I will come back in on some of the concerns he has raised.

Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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I thank the Minister of State. Sadly, the response prepared for her on behalf of the Minister of State, Deputy Daly, is inadequate. The Minister of State, Deputy Byrne, said that the report showed there were anomalies in the service, that it was GP-only, that there was no psychiatrist, multidisciplinary team or clinical staff beyond a GP. There were chipped tiles and other issues. At no point did the report say that these services should not be provided. Our responsibility is to provide psychiatry, a multidisciplinary team, and a GP, to change the tiles, to clean the place up and to make the improvements and investments required. We have not done that but have decided to close it. What does the euphemism "more appropriate to the care needs of the family" mean? The families I have spoken to have been told to get their loved ones out of the place. That has nothing to do with A Vision for Change. Of course we want to support people to remain in their own homes when they can be cared for at home but we are talking about people who have been there for ten or 20 years. How could a place decide that a person is going somewhere else? As of Monday, the HSE was not in a position to tell the two families who I am in contact with where those people are even going.

This is driven by the budget under the cover of a lie that it is associated with A Vision for Change. It certainly is not associated with A Vision for Change and it is no excuse for the lack of investment in resources and clinical support that was identified by the Mental Health Commission in 2016. We cannot use these as excuses for our ineptness - something needs to be done. I appeal to the Minister of State to raise this at the highest level in Cabinet to ensure this unit remains open. The investment, resources and required clinical support should be made available and the people in the north-west region should have a support, not just for respite for those Alzheimer's disease patients, but also for those patients who are not capable of being looked after in their own home any more. I thank the Minister of State for her time but I must say, without any disrespect to her, that the response prepared is totally inadequate in the circumstances.

Catherine Byrne (Dublin South Central, Fine Gael)
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I do not know the location and have been given a prepared response, and it is unfortunate that the response has not facilitated the Deputy's frustrations and concerns. I will not comment on the service there because I am not familiar with it but it is unacceptable for any family to be asked at short notice to remove a family member, especially somebody who has been in long-term care, from such a unit.

The families should not have to decide where their loved ones will go; that is a matter for the provider or the HSE. I do not propose to comment on the sum of €15 million or private sector service provision, but I will bring the Deputy's concerns to the attention of the Minister of State, Deputy Jim Daly.

I again assure the Deputy that the Government is committed to facilitating people through the provision of services which meet their needs and also in their homes. Where the latter is not possible, the responsibility is on us to provide adequate services where people can live in comfort and, above all, be cared for well. I agree with the Deputy in his remarks about the painting of walls and the washing of floors. I will bring not only his concerns in that regard but also his frustration at the response I have given to the attention of the Minister of State.