Éamon Ó Cuív (Galway West, Fianna Fail)
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Gabhaim buíochas leis an Aire Stáit as ucht a theacht isteach inniu agus éisteacht linn. Mar a thuigeann an Leas-Cheann Comhairle agus an bheirt Teachta atá ag tógáil na ceiste seo inniu, tá fíorthábhacht ag baint leis an ospidéal ar an gClochán. Ní mór a chinntiú go mairfidh sé, go bhfásfaidh sé agus go mbeidh sé ann go dtí go mbeidh an t-ionad nua curtha ar fáil ar an gClochán.

It is very hard to do total justice to this issue in two minutes each for Deputy Farrell and me but I will try to be brief and cut to the chase. The solution is to speed up the building of the new community nursing unit, CNU. Planning is to be lodged during this quarter. I cannot for the life of me understand why it will take three years to build and commission and the unit. I just do not get that. I think Ardnacrusha was started within four weeks of a decision being taken. It is time we went back to moving things forward.

In the meantime we need a full complement of staff in the hospital in Clifden, including physiotherapists. Our understanding is that the jobs to date have only been advertised locally in the local newspapers and radio. Not only is it not possible to get people locally but in many cases nurses and other skilled professionals are coming in from outside Ireland and the European Union. It is time Saolta University Health Care Group and the HSE got together to address international recruitment and ensure people are available to provide services here. HR also needs to be improved.

I will make a final point, and I would other points but I do not have time to do so. To visit Merlin Park University Hospital in Galway or a respite or step-down facility if one were provided in Galway would require a five-and-a-half hour return journey. That is intolerable.

Mairead Farrell (Galway West, Sinn Fein)
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Tá mé an-sásta go bhfuil an tAire Stáit, an Teachta Rabbitte, anseo chun an cheist seo a phlé mar tuigfidh sé cé chomh tábhachtach is atá an t-ospidéal seo, ní hamháin i gcomhair mhuintir an Chlocháin ach i gcomhair mhuintir Chonamara go ginearálta. Tá an Teachta Ó Cuív tar éis go leor de na deacrachtaí a lua ach is minic go mbíonn daoine ar thralaithe san ospidéal i nGaillimh faoi láthair. Ní dhéanann sé ciall, beag ná mór, nach féidir an t-ionad seo a úsáid. Mar a luadh cheana féin, breathnaíonn sé ar nós go bhfuil fadhb earcaíochta ann agus go gcaithfimid breathnú air sin ar bhonn idirnáisiúnta, go háirithe ó thaobh fisiteiripeoir a earcú. Chomh maith leis sin, caithfear brú ar aghaidh leis an ionad nua.

I am very pleased it is the Minister of State, Deputy Rabbitte, who is taking this Topical Issue matter because I know she understands the importance of this facility in Clifden, not only for the town but for the wider Connemara community. It is very clear that all the Oireachtas Members in Galway West are speaking with one voice on this matter. The Leas-Cheann Comhairle, Deputy Connolly, is bringing it forward with Deputy Ó Cuív and me. Everyone is singing from the same hymn sheet on this.

There is an issue with recruitment, particularly in the area of physiotherapy. This needs to be looked at on a wider international scale. This facility is of great importance. If we are looking internationally for other places, we also need to do that in this case. As Deputy Ó Cuív stated, we also need to push the new facility forward. While people are on trolleys in Galway University Hospital, it makes no sense that recruitment and the new facility are not being prioritised.

Anne Rabbitte (Galway East, Fianna Fail)
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I am taking this matter on behalf of the Minister of State, Deputy Butler. I wish her a speedy recovery.

I thank the Deputies for raising this important matter. I acknowledge that they are speaking with one voice and that everyone is singing from the same hymn sheet on this. I acknowledge the vital healthcare role that Clifden District Hospital plays and the excellent level of care and support which it provides to patients and their families in the local community and surrounding areas.

As Minister of State with responsibility for mental health and older people, Deputy Butler, is acutely aware of the challenges that Clifden hospital is currently facing. She assures the Deputies that she is committed to working alongside HSE Community healthcare west to address these issues.

As Deputies will be aware Clifden has been primarily designated to provide convalescence care to patients stepping down from acute hospitals. However, with the evolution of Sláintecare and the transition of care from acute to community settings, the need for step-down beds has reduced. In fact, the demand for step-down care is currently an average of less than one patient a day.

Clifden District Hospital also provides respite beds to allow family carers in the community a welcome break. The Minister of State has been advised by the HSE that the average respite demand and occupancy is approximately three beds per night. This brings the total average occupancy of Clifden District Hospital to 3.2 beds per night.

In the Clifden area, St. Anne's community nursing unit is a designated centre registered with HIQA to provide a home for older people. Unfortunately, St. Anne's has faced significant challenges over many years to secure sufficient nursing staff, despite national, international and local recruitment drives. To address this issue, there needs to be a dedicated approach to recruit staff in the short term to continue these vital services. In making that statement, the Minister of State is acknowledging what the Deputies have said about recruitment. In recognition of the service needs in the Clifden area and to seek to redress the nurse staffing shortage, HSE community healthcare west commenced a process two years ago under the Croke Park public service agreement.

In August 2020, under the auspices of the Workplace Relations Commission and conciliation services, the HSE informed the Irish Nurses and Midwives Organisation, INMO, and SIPTU that it would issue a common roster, which commenced on 26 September of this year. This roster will cover both Clifden District Hospital and the St. Anne's community nursing unit site in order that the staff could be assigned to both sites, which are less than 1.3 km apart, based on service needs.

The Minister of State, Deputy Butler, was advised by the HSE that one of the staff representative bodies communicated with the HSE on Friday, 23 September, to say it had instructed its members not to co-operate with the revised roster. Community healthcare west is committed to ensuring the safety of its residents and patients and, accordingly, has put in place contingency arrangements in light of any potential action by staff from 26 September. Unfortunately, over the weekend of 23 September, the HSE was unable to secure cover to fill the rosters due to gaps in St. Anne's community nursing unit, which the HSE required to ensure the safe care of residents and patients. Community healthcare west, therefore, developed contingency arrangements for the patients in Clifden District Hospital. Patients and their families were contacted by HSE nurse management last week and were offered an alternative option of Merlin Park University Hospital. To clarify, the HSE has advised the current services will continue as normal.

The Minister of State, Deputy Butler, advises the Deputies that all those booked into respite in Clifden District Hospital last week and this week are receiving the service in Clifden. The HSE simply took contingency measures following advice it had received indicating that staff might not co-operate with the new roster. These measures will be implemented only if insufficient staff are available. The HSE will continuously review the staffing and operate services with safe staffing levels. There are no plans to cease services in Clifden hospital at present. The Minister of State will continue to engage with the chief officer in community healthcare west to ensure the continuation of the possible expansion of services in Clifden hospital.

Éamon Ó Cuív (Galway West, Fianna Fail)
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I am pleased, if it is actioned, that there is a commitment to continue services in Clifden hospital, but all the rest of the Minister of State's prepared reply gives the impression that we are all going in the other direction. I do not know how many other Deputies are like me, but I frequently get calls from people who are being pressurised to take loved ones out of the hospital, with nowhere for them to go. They may not be fit to go home or may live on their own. I find it strange, therefore, that this step-down facility is not required. My understanding is the lack of physiotherapy means they are not being referred to Clifden hospital. We need recruitment, as we have reiterated time and again. Nobody is proposing unsafe working conditions.

I join with the Minister of State, Deputy Rabbitte, in wishing the Minister of State, Deputy Butler, all the best in her recovery. The Minister of State, Deputy Rabbitte, hit the bull's eye on the previous occasion when the three of us Deputies were debating ambulance services. She might do it again this time.

Mairead Farrell (Galway West, Sinn Fein)
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Indeed, we hope this is a good omen. I too wish the Minister of State, Deputy Butler, a speedy recovery. As local Oireachtas Members, we have met representatives of the HSE and the unions. It angers me that what should be worked out between the unions and the HSE is being brought into this Chamber. At the end of the day, the unions are not here to defend what they feel. We need to find a solution to this but that is not for us to sort out; it needs to be sorted out between the unions and the HSE. We know how important respite services are, as we heard from the hundreds of people who attended the meeting in Clifden. If staffing and recruitment is the issue, we need to look at it on an international basis. That is the crux of it.

Anne Rabbitte (Galway East, Fianna Fail)
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HSE community healthcare west has informed the Minister of State that it is committed to a new 40-bed community unit, and that needs to be expedited, which would address the 1.3 km arrangement in regard to rosters. She welcomes the fact the HSE is examining the possibility of providing enhanced community care services in Clifden hospital. The integrated care programme for older persons, ICPOP, teams, as we all know, are fantastic. There is a multidisciplinary approach, with a physiotherapist, an occupational therapist, OT, and whatever else is needed as part of the integrated programme for older person services. ICPOP services ensure that older people with complex care needs can access care quickly or near their home through care pathways specifically designed for older people, targeting falls, frailty and dementia.

That is exactly what is required in Clifden hospital. It is the ICPOP team we should be looking for at the moment while the new build is going on. That is the ask, and I would support the Minister of State and all the Deputies from the west because I take on board exactly what they are saying. The five-and-a-half-hour round trip to Merlin Park is not satisfactory to the people of Clifden, not least on bad, frosty nights. We talk about catering to people as close to their home as possible and we need to support that concept. We did it previously with the ambulance base, when we got everyone sitting around the table, and I will continue to advocate for this given where Clifden is and where Merlin Park is, meaning people have to travel across the city and so on. Moving people with frailty from their natural habitat to Merlin Park is not good enough; in fact, it reduces their life expectancy. The HSE needs to look at itself in regard to what measures it needs to put in place to ensure people will get the care as close to home as possible and in a timely manner.

Catherine Connolly (Galway West, Independent)
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I too wish the Minister of State, Deputy Butler, a speedy recovery. She is a hardworking, multifunctional Minister of State, like Deputy Rabbitte.