Mattie McGrath (Tipperary, Independent)
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As happens in most Topical Issue debates now, with no disrespect to the Minister of State at the Department of Health, Deputy Catherine Byrne, the Minister for Health, Deputy Harris, has just left the building. He was here five minutes ago and he has just walked away, even though this Topical Issue Matter was down.

I demand that the Minister for Health provide immediate clarification regarding the future of St. Brigid's Hospital, Carrick-on-Suir. It is a wonderful institution and I salute the matron and staff there. It has a wonderful hospice suite. Only a few weeks ago a Fine Gael colleague of the Minister of State, former councillor John Fahey, spent his final weeks there. He was a decent fine public representative all his life. I offer sympathies to his wife and family. I have been trying to get clarification on rumours about this institution since I was contacted last Sunday. There is a new hospice suite and step-down beds. We know how hard it is to get a step-down place anywhere today in the country and the chronic problem that is making for our acute hospitals in south Tipperary, Westmeath and the region of Limerick. St. Brigid’s Hospital is like its sister hospital, St. Theresa's Hospital in Clogheen, which is a fabulous institution with a wonderful matron, Anne Walsh. The hospital in Cashel is a step-down facility as well. It is a tremendous institution.

We are beyond cuts. We cannot afford to lose one more bed. We have lost mental health beds and all kinds of beds, and the pressure that is putting on the acute service is silly. There is €17 billion annually going to into the HSE, with worse outcomes for respite and step-downs and convalescents. People go back there after having a hip done, if we have to send them up to Belfast or Ardkeen or Kilkenny, Cill Chainnigh. Serious concerns have been raised that the HSE may be considering closing the vitally important facility in Carrick-on Suir. Will the Minister of State clarify that for the sake of the staff, the patients, the matron and the community? Councillor Kieran Bourke and many others down there are asking that this facility be kept. Many people have contacted me.

I also ask the Minister to explain why the redevelopment of St. Patrick's Hospital in Cashel is not now expected to be complete until 2022. It is a wonderful institution and I pay tribute to its former manager, Mary Prendergast, and sympathise on her recent bereavement and the untimely loss of her husband. I pay tribute also the staff.

In June 2018, nurses at the hospital voted overwhelming for some form of industrial action to highlight the chronic staff shortage. The ballot for action was approved by 98% of them, citing growing fears for patient safety as their key concern. The nurses, care assistants and doctor we have thankfully found for the positions there do a tremendous job. However, they are not being supported. They are short-staffed and under pressure. Wards are being closed and cutbacks imposed. A massive redevelopment was announced there by the Minister, Deputy Harris, and by Deputy Kelly when he was in office. Indeed, Deputy Lowry has also made announcements. However nothing has happened. Planning permission has not even been applied for. There is no joined-up thinking. Beds are being closed yet they are vital to keep pressure off acute hospitals to allow people to convalesce or get physiotherapy.

St. Patrick's is an excellent institution in Cashel. There is a rehabilitation ward. My late mother was there and I know first-hand how many more patients there are. We need clarity and to have the building commence. Planning permission is not even applied for. We are going around in schemes and rhymes. Across the road, 400 yards away, Our Lady's Hospital is lying idle. That is why I was so adamant about the Minister being present tonight. I took him to the hospital to see it with other colleagues a year and a half ago and he was aghast to see that €21.5 million had been spent on that wonderful institution in which my appendix was removed years ago but it was lying idle but for offices. The top floor is splendidly redecorated and redeveloped but there are no step-down beds. It is a bed-free zone and a disgrace.

Catherine Byrne (Dublin South Central, Fine Gael)
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I am taking this matter on behalf of my ministerial colleague, Deputy Jim Daly. 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 standard of care delivered to residents in public units is generally high, but we recognise that many of our community hospitals are housed in buildings that are less than ideal in the modern context. Without them, though, many older people would not have access to the care that they need. It is important, therefore, that we upgrade our public bed stock and this is the aim of the five-year capital investment programme for community nursing units announced in 2016. This provides the framework to allow for an enhanced programme to replace, upgrade and refurbish these care facilities, as appropriate. Significant work was undertaken to determine the optimum scheduling of projects within the phased provision of funding to achieve compliance and registration with the Health information and Quality Authority, HIQA.

The HSE is responsible for the delivery of health and personal social services, including those at facilities such as St. Patrick's Hospital in Cashel and St. Brigid's Hospital in Carrick-on-Suir, County Tipperary. St. Patrick's Hospital, Cashel, and its associated facility at St. Anthony's unit in Clonmel, have an excellent reputation as care facilities. The hospital provides residential, rehabilitation and respite care to older adults in the south Tipperary area. The hospital is registered with the HIQA and the maximum number of persons that can be accommodated at the designated centre is 102 residents. Under the five-year investment programme, it is proposed to deliver a new community nursing unit at St. Patrick's to replace existing beds where the physical environment requires significant improvement. The challenges associated with the redevelopment of St Patrick's must be viewed in the context of the presence of a listed building on the site and its status as a working hospital. These challenges will be managed by the HSE as with other developments where such challenges present and the HSE now propose to progress this project via the traditional capital process and not through a PPP as originally planned. The project is currently at appraisal stage and is proceeding according to capital planning guidelines with construction projected to begin in 2020.

St. Brigid's Hospital provides convalescent, respite and palliative care and is registered with HIQA to accommodate 16 residents. In the latest inspection report published by the authority, the inspector found that residents healthcare and nursing needs were met to a good standard. The feedback received from residents was generally positive and indicated that they were satisfied with the staff and care provided. The Deputy will be aware that the hospital is not included in the five-year plan for refurbishment and upgrading. However, I confirm that the HSE has advised the Department today that there are no plans to close St Brigid's.

Mattie McGrath (Tipperary, Independent)
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I asked the people in charge of older care and they reassured me by telephone. However, I wrote to them and they did not reply in writing. That is why there are worries. I want to allay fears; not create them. I thank the people who contacted me. They have the interests of the people of Carrick-on-Suir and the surrounding area in County Waterford and into County Kilkenny at heart. I thank them for contacting me and I praise the staff. Thankfully, the HIQA report was good. It is a wonderful institution but it is flat on the ground. I did not mention St. Anthony's, which is linked to St. Patrick’s. It is also a wonderful institution that deals with dementia care, people with Alzheimer's and acute cases. Cashel is not moving fast enough, however.

The Minister of State referred to the 2016 capital plan but it is almost 2019 and no planning has been applied for. She said works will start in 2020 or next year. We want to see that work start. It is not fair to the nursing staff, care staff and the doctor who are all dedicated. Dr. Willie Ryan has retired and we have a new doctor whom I wish well. We were lucky to get him and there were worries about that as well. There should not be scares on this. We should have the plan and proceed with it.

For that matter, St. Theresa's Hospital, Clogheen is short approximately €70,000 from the Department for its extension. I appeal to the Minister of State to allow the hospital to finish that extension. We need step-down facilities to take pressure off St. Joseph's in Clonmel, South Tipperary General Hospital, Waterford and all the other acute regional hospitals. We need the step-down facilities and not to have fears around them. I am, therefore, thankful that the Minister of State has said on the record that the HSE has informed her that it will not close St. Brigid's Hospital but I am disappointed it is not included in the five-year capital programme while the hospice suite is relatively new. A lot of funding was provided locally for that. St. Patrick's Hospital, Cashel, St. Brigid's Hospital, Carrick-on-Suir and St. Theresa's Hospital, Clogheen, are badly needed and I pay tribute to the staff in them. They do tremendous work. However, people are crying out when they get their hips done. The Government calls them bed blockers but they have no place to go for physiotherapy or respite care before or after operations. We need certainty around these facilities. There is no point talking about €17 billion in the HSE when there are issues like this. Above all is the madness of keeping Our Lady's in Cashel closed when other hospitals are under pressure. It is a state-of-the-art facility in which €21.5 million has been invested. It is a concern.

Catherine Byrne (Dublin South Central, Fine Gael)
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We all recognise the quality of work done in nursing homes and community care settings nationally, particularly by staff and doctors not to mention carers. Many people have taken up the role of carer in hospitals and become a central part of units, in particular units for older people. Public nursing units are central to our infrastructure. Without them, many older people would not have access to the care they need. These units will continue to be very necessary over the coming years. As the Minister has said, the number of older people is increasing in line with demographic trends. However, we must strive constantly to modernise and improve infrastructure and the settings in which these beds are being delivered by Government. It is, therefore, essential that these beds be put on a sustainable footing and that the fabric of the buildings in which they operate be modernised and improved. Having said that, it is expected that 4,500 additional short and long-term beds will be required across the public system and in community nursing units and other step-down faculties, as the Deputy said, and as identified by the health capacity review. Health capacity programmes under way include the planned investment in community nursing homes which will continue. I have been assured by Deputy Jim Daly that as Minister of State with responsibility for older people he is conscious of the work being done in many hospitals nationally. He realises the buildings may have become outdated but the staff have not. I thank Deputy McGrath.