Pat Gallagher (Donegal, Fianna Fail)
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I am grateful for the opportunity to raise the very important issue of three community hospitals in Donegal - St. Joseph's Community Hospital in Stranorlar, Lifford Community Hospital and Ramelton Community Hospital. This matter has been ongoing for some years. It first arose in January 2016 when the then Government thought it was unveiling a capital plan for hospitals. We discovered at the time that there was no money in the capital plan for these three hospitals. The Government realised in the course of the general election campaign that something had gone wrong and that was not what the Government intended. The Minister for Education and Skills, Deputy McHugh, who was a Minister of State at the time, stated that the matter was so serious that the then Taoiseach, Deputy Enda Kenny, would begin an investigation. The investigation has now gone on longer than any tribunal and we have never been informed of the outcome.

There have been numerous announcements by Ministers of State over the time, including Deputies Jim Daly and McHugh, but there has been very little progress. We had a meeting here last year and it was promised that we would meet the Minister for Health, the Secretary General and the chief officers of the HSE but that never happened. The Minister of State at the Department of health, Deputy Jim Daly, attended that meeting and gave what he thought was good news but nothing has happened since. It was stated at the time that there would be regular contact with the action group but there has been none.

We want to stop the nonsense and put in place a strategy to proceed with the development, refurbishment and extension of these three hospitals.

Pearse Doherty (Donegal, Sinn Fein)
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I am delighted to be sharing this matter with Deputies Gallagher and McConalogue. It is a pity that the Minister for State, Deputy Jim Daly, is not here. He called the people of Donegal strange last week. He stated that he wanted the opportunity to answer this question and, when we give him the opportunity to do so, he is not here. It is a bit strange that he is not here to outline the future of the three hospitals.

This issue first arose three years ago. The HSE and Government stated very clearly that long-stay beds were to close at St. Joseph's and Ramelton and that the same thing was close to happening at Lifford Community Hospital. It is now three years later. Up to 2,000 people took to the streets last week and there was a packed hall of community representatives who wanted answers. They have been fobbed off for the past three years. The then Minister of State, Deputy McHugh, went on Highland Radio and other stations in Donegal to inform people about multimillion euro sanctioning of grants, yet we know that not a red penny was sanctioned for those projects at that time.

We need to put our money where our mouth is. The community will only believe that the old plan is in the bin, where it belongs, and that the future of these hospitals is viable when the funding is granted and refurbishment is carried out. Get rid of all the spin and let us deal in substance. Has funding been approved by the HSE for the upgrade of St. Joseph's and Ramelton in order to maintain long-stay and short-stay beds? What is the current position in respect of Lifford? That is a campaign that needs to be mounted and won because we need those beds in our community in Lifford to complement what we already have in St. Joseph's and Ramelton and what we will have in Letterkenny.

Charlie McConalogue (Donegal, Fianna Fail)
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People across County Donegal are proud of their community hospitals. Those who work in them provide a tremendous service to people within their community. The last Government decided, in 2016, to close the long-stay beds in St. Joseph's in Stranorlar, Ramelton and Lifford and that they would not be reopened. It is only because of the work that has been carried out since then by the "Save our St. Joseph's" action group under the leadership of Fr. John Joe Duffy and community hospital action groups in Ramelton and Lifford that the Government has reversed its policy position on closing the three hospitals. We still do not have a hard and fast commitment from the Government on funding, or a start on the work at St. Joseph's and Ramelton hospitals that the Government has committed to in theory in order to bring them up to HIQA standards.

The Minister of State, Deputy Jim Daly, was very sensitive when I raised the issue with him in the House last week. He claimed not to understand Donegal politics after I brought to his attention the march which was attended by Deputies Gallagher, Pearse Doherty and other public representatives and local community members in the Stranorlar and Ballybofey areas. The Minister of State and his colleagues, the Minister of State, Deputy Finian McGrath, who is present, and the Minister for Health, need to show they will come forward and stop the types of false promises we have seen in the past and deliver the funding to ensure these hospitals are brought up to HIQA standards and those long-stay beds are secured for the future. We also need to increase the capacity of long-stay beds within our community hospital sector in Donegal in order to meet the demand that will arise in the years ahead.

Finian McGrath (Dublin Bay North, Independent)
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I thank Deputies Gallagher, Pearse Doherty and McConalogue for raising this important issue, which I am taking on behalf of my colleague, the Minister of State with responsibility for mental health and older people, Deputy Jim Daly. Unfortunately, the Minister of State is unable to be here because he is attending an important meeting with senior officials about scheduled and unscheduled care and delayed discharges. He has asked me to convey his apologies to the Deputies.

The HSE is responsible for the delivery of health and personal social services, including those at facilities such as St. Joseph's Community Hospital in Stranorlar, Ramelton Community Hospital and Lifford Community Hospital. Community hospitals are an essential part of our national infrastructure and we are determined to maintain our public stock. The standard of care delivered to residents in these units is generally very high but we do recognise that many public units are housed in buildings that are less than ideal in the modern context. However, without these units, many older people would not have access to the care they need. On that basis, we need to upgrade our public bed stock. This is the aim behind the five-year capital investment programme for community and nursing units announced in 2016.

This provides the framework to replace, upgrade and refurbish these care facilities, as appropriate. Significant work was undertaken to determine the most optimum scheduling of projects within the phased provision of funding to achieve compliance and registration with the Health Information and Quality Authority.

At a meeting on 7 November 2018 with public representatives and local delegations, the Minister of State, Deputy Jim Daly, advised that the policy position to replace St. Joseph's, Stranorlar, and Ramelton community nursing unit had been revised. The HSE's social care directorate and its national capital and property steering group accepted recommendations from HSE CHO1 to retain and upgrade both facilities, in the context of future capacity requirements. This revises the original decision to replace the existing long-stay residential beds on both sites. It further revises the scale of the proposed new unit at Letterkenny from the original 130 beds to 110 beds. Importantly, the decision to revise the proposals was informed not just by the technical and feasibility studies on the physical infrastructure at these two sites but also a broader analysis of population projections and national planning norms carried out by the HSE.

The redevelopment of the Lifford unit on the existing site is not deemed viable. The need for additional beds and the potential to develop a new facility on a greenfield site will be reviewed further post-2021, when new census data are available and the capital programme has been advanced. The existing unit at Lifford will continue to operate in the intervening period. As the Minister of State, Deputy Jim Daly, advised at the November meeting, he welcomes the community continuing to engage with the HSE at local level, as appropriate, regarding further ideas and proposals for community-based options that may be considered.

The Department and the HSE are engaged in a process to finalise the HSE's capital plan for 2019. In developing its capital plan for 2019 and future years, the HSE must consider a range of issues, including the expenditure that is contractually committed, the HSE's annual requirement for meeting risks associated with clinical equipment, ambulances and healthcare infrastructure and the total capital Exchequer funding required for major capital projects. The HSE's capital plan will determine the projects that can progress in 2019 and beyond and this plan is being finalised. Once the HSE has finalised its capital plan for 2019, it will then be submitted to the Minister for consideration.

Pat Gallagher (Donegal, Fianna Fail)
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I want to bring to the attention of the Minister of State the fact that approximately 1,000 people came out on 23 March, a cold spring day, to express their concerns, culminating with the meeting in the hotel. The issue is becoming muddier and muddier. I refer the Minister of State to his script, which is from the office of the Minister of State, Deputy Jim Daly. It states the HSE is still working on the plan for 2019 and also refers to expenditure on contractual commitments. There is nothing clear in it to state funding will be provided for any of the units in Donegal. I hope the Minister of State will bring it to the attention of the Minister of State, Deputy Jim Daly, that while he tried to impress on us that it was totally clear it would be moving in 2019, he also stated there were contractual commitments and annual requirements on meeting risks with associated clinical equipment. This is not clear. We are looking for a very clear and unambiguous statement that money will be provided for a design team to be appointed as quickly as possible. The Minister of State, Deputy Finian McGrath, has made it very clear, and I admire his honesty, that the decision was reversed. We know the initial decision was to close these hospitals at the expense of another. Where will the patients go if they must be discommoded while works are being carried out in these hospitals?

Pearse Doherty (Donegal, Sinn Fein)
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When we met at the beginning of November, we thought there was good news and we cautiously welcomed it. At least the old plan to close down the hospitals is gone officially but the problem is we have been told things over and over again by Ministers that simply are not true. Ministers told us on the radio that the answers given in reply to parliamentary questions from Deputy Gallagher and others were not accurate statements of events and that comments made outside the House are the accurate statements. People are saying, "show me the money". The problem is that not a penny has been sanctioned for the work to be carried out in Ramelton or at St. Joseph's. This is the issue. It is the start of April and it still has not been sanctioned. In December, the Cabinet met for three hours and sanctioned hundreds of millions of additional euro for the national children's hospital. For three years, people have been taken to the streets in Ramelton, in Stranorlar with regard to St. Joseph's and in Lifford and they have not got a bean from the Government in terms of a commitment. When will the project be signed off? Will there be a commitment in it that the design team can be allocated?

Charlie McConalogue (Donegal, Fianna Fail)
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While it is welcome that the Government has revised its plans to close the three hospitals, in particular with regard to St. Joseph's and Ramelton until such time as we actually see the funding allocated to bring them up to HIQA standards, the Minister of State will forgive the people of Donegal, in particular in Ballybofey, Stranorlar and its surrounding area and Ramelton for not having faith in the Government. They need to see the works commenced, the plans designed and the funding allocated. I want to zone in specifically on the situation with regard to Lifford Community Hospital. The response from the Minister of State today, and the responses we received previously, indicate that the Government does not plan to upgrade the existing hospital on the existing site, that the Government does not see it as viable but that it has no plans to look until after 2021 at what the future might hold. Councillor Gerry Crawford in the area has done lot of work on this. He raised it as recently as the March meeting of the HSE's health forum. Again, he was told it will be 2021 before the Government looks at future plans for Lifford Community Hospital. I ask the Minister of State to go back to the Minister of State, Deputy Jim Daly, the Minister, Deputy Harris, and the HSE to start to identify a new site in Lifford so work and planning can commence to ensure there is a community hospital and long-term beds in the Lifford area to serve the community there as well as the communities in Stranorlar and Ramelton.

Finian McGrath (Dublin Bay North, Independent)
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I apologise that the Minister of State, Deputy Jim Daly, cannot be here. I understand he was to respond to the Deputies last week but the debate was withdrawn. I will deal with the points raised. Deputy Gallagher spoke about the 1,000 people on the streets. Of course, we must listen to their views and I will bring his concerns to the Minister. His fundamental question on where those patients will go is very relevant.

With regard to what Deputy Doherty has said, we accept the old plan has gone. He said the local people need to see where the money is and when it will happen. It will have to be some time in 2019. The Deputy wants more specific dates and timelines and I accept that point.

The Minister of State, Deputy Jim Daly, asked me to stress that St. Joseph's Community Hospital in Stranorlar and Ramelton Community Hospital will be redeveloped through the HSE's capital programme, while the potential for redevelopment in Lifford will be further reviewed after 2021, when new census data will be available and the capital programme will have been advanced. The national development plan provides for the continuation of the programme of replacement and refurbishment of community nursing units and long-term residential care facilities for older people. The Department has consistently stated that the HSE is responsible for the delivery of healthcare infrastructure projects and it is a matter for the HSE in the first instance to prioritise and plan projects, subject to available funding in the coming years. The Department and the HSE are engaged in a process to finalise the HSE's capital plan for 2019. The HSE's capital plan will determine the projects that can progress in 2019 and beyond, having regard to the total available capital funding and relevant priority of each project. All health capital projects at various stages of development, such as community nursing units in Donegal, are included as part of this process. Once the HSE has finalised its capital plan for 2019, it will be submitted to the Minister for consideration. Of course, I will bring back the points raised by the Deputies today, particularly on the new site in Lifford and all of the other concerns.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I am sure the Deputies will return with this issue when greater clarity can be had.