Catherine Connolly (Galway West, Independent)
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Faraor, táimid ar ais arís go dtí an t-ábhar seo. Tá a fhios agam go bhfuil suim ag an Aire Stáit, an Teachta Rabbitte, sa scéal seo ach táim ar ais arís ag ardú na ceiste seo, ceist a d'ardaigh mo bheirt comhghleacaí as Gaillimh, an Teachta Ó Cuív agus an Teachta Mairéad Farrell, nuair a bhí mise sa Chathaoir siar i nDeireadh Fómhair. Faraor, níl aon dul chun cinn déanta. Táimid ag leanúint ar aghaidh agus an baol ann i gcónaí go ndúnfaidh an t-ospidéal, ospidéal atá lárnach don cheantar, atá thar a bheith tábhachtach chun an brú ar an ospidéal i nGaillimh a laghdú agus lena mbaineann an méid sin buntáistí eile. Unfortunately, I am raising the issue of Clifden District Hospital again. I am hoping the Minister of State might have some good news today. I doubt it, but I hope she does, because we are still in the same situation as we were previously. As the Minister of State is aware, my two colleagues raised the issue back in October when I was in the Chair. We did that as one voice. We had meetings with staff and the union.

I will put it into context for the Minister of State. HIQA visited Clifden District Hospital in the middle of the Covid pandemic. Its conclusions on six measures were that the hospital was fully compliant on three of them, substantially compliant on two of them and partially compliant on one of them. That is a pretty good judgment from HIQA. It went on to point out that the feedback from the patients was positive. It noted some difficulties with the infrastructure. In particular, it was brought to the hospital's attention that there were not enough showers or enough showers geared towards gender, there was a lack of sinks and problems like that. Overall, the hospital got a thumbs-up from HIQA in the middle of Covid. Of the six measures, it was completely compliant on three measures, substantially complaint on two measures and partially compliant on one measure. The one that is was partially compliant was eminently in relation to-----

Catherine Connolly (Galway West, Independent)
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On the day that HIQA visited, it was noted that the hospital comprised 21 beds, 19 of which were occupied. Everybody was glad in a sense, because it left more room for manoeuvre in relation to Covid. It is interesting that the report noted that the hospital accommodated patients requiring rehabilitation, convalescent and palliative care. The report stated that patients were admitted to Clifden District Hospital from University Hospital Galway. Inspectors were informed that admissions direct from the community to the hospital were stopped, but only because of Covid. Up to that point, there were referrals from the community and referrals from the hospital. I do not know where else the referrals were coming from. That is HIQA. Then there are the local doctors who the Minister of State is very familiar with. GPs do not often go out on a limb, do they? I know of a local GP, Dr. Casey, who has been there for 50 years and his son practises with him now. He has begged and implored the HSE to restore the hospital and the functions it had. I do not feel it is my place or that of the Minister of State to be in between unions and employers, but the nurses are saying that the HSE has orchestrated this downgrading of the hospital because they believe it wants it for another purpose that has not yet been revealed.

If they do not advertise that they are open for business, they will not get the business. We have been given many contradictory reasons by the HSE on this. One reason is that it cannot get staff. It launched a special recruitment campaign and got more than 20 applications. A number of individuals were shortlisted. In the end, it got one nurse who will not be available until 2024. There is something seriously wrong. Am I over time?

Bernard Durkan (Kildare North, Fine Gael)
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Slightly.

Catherine Connolly (Galway West, Independent)
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I will stop now.

Bernard Durkan (Kildare North, Fine Gael)
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It is seldom we hear a Minister of State say that a Deputy should continue. I am taking this important matter on behalf of the Minister of State, Deputy Butler, who has a dose of flu. I thank Deputy Connolly for raising it.

I will begin by acknowledging 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 Clifden community and surrounding areas. I assure Deputy Connolly that there are no plans to close Clifden District Hospital. However, we are aware of the various challenges that the facility is facing. I assure the Deputy that the Minister of State, Deputy Butler, is committed to working alongside HSE Community Healthcare West to address these issues. As Deputy Connolly is aware, Clifden District Hospital has been primarily designated to provide convalescent step-down care to patients discharged from acute hospitals. It also provides respite beds to allow family carers in the community a welcome break. However, with the evolution of Sláintecare and the transition of care from acute to community settings, the need for these step-down beds has reduced.

In the Clifden area, there have also been significant challenges over many years to secure sufficient nursing staff, despite national, international, and local recruitment drives. This is the case both in Clifden District Hospital and in St. Anne's Community Nursing Unit, a designated centre registered with HIQA to provide a home for older people. HSE Community healthcare west, in keeping with its commitments to political representatives, its staff, and their representatives, undertook a bespoke nurse recruitment process in October. At a minimum, four additional nurses are required to sustain the current residential older people services in both St. Anne's Community Nursing Unit and Clifden District Hospital. The HSE will continue to undertake bespoke campaigns to fill these vacancies but continues to face challenges filling these posts. HSE Community healthcare west has assured the Minister of State, Deputy Butler, that it will continue to review service needs and what services can be provided based on the available staffing. It will also continue to engage with staff, unions, GPs and political representatives in this regard.

I would like to inform the Deputy that last November HSE Community Healthcare West met local GPs. The GP engagement involved an initial meeting with HSE management and a follow-up meeting with a consultant geriatrician. The consultant geriatrician outlined the integrated care programme for older persons, ICPOP, services being rolled out as part of the enhanced community care programme, including the visiting satellite clinics based in Clifden District Hospital. The Minister of State, Deputy Butler, was delighted to hear that the visiting clinic commenced last month with an expected monthly service from the consultant geriatrician and a twice monthly service from the ICPOP team, incorporating physiotherapy, occupational therapy, dietetics and nursing. This is a welcome addition to services provided in Clifden District Hospital.

The day service at Clifden District Hospital remains in operation, and a new bus service is available to those seeking to access it. HSE Community healthcare west is aiming to expand this service. It is important to highlight again that there are no plans to cease services or close Clifden District Hospital at present . The Minister of State, Deputy Butler, will continue to engage with the chief officer in HSE Community healthcare west to ensure the continuation and possible expansion of services in Clifden.

As a Minister of State who represents Galway, I would certainly like to see Clifden District Hospital remain in full operation. I give my full endorsement to its operation, knowing the geography of the county as I do. I can leave my house in Portumna and be in Leinster House quicker than I would ever be on the far side of Galway city. It is very important to understand the size of Galway and the geographical need. There is also the ageing population and the valuable role that Clifden District Hospital plays in the community.

Catherine Connolly (Galway West, Independent)
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I thank the Minister of State. I acknowledge positive comments she made and the information she put on the record. To put this in the context I will speak about the number of people on trolleys in a centre of excellence in Galway, although I have been corrected for calling it a centre of excellence because that is only with regard to cancer care. Nevertheless it serves an area of between 800,000 and 1 million people. There were 42 patients on trolleys there today. Clifden District Hospital closed over Christmas. It also closed in November because it had no staff or could not staff the nursing home. Staff are being moved back and forth. As I understand it, there is an ongoing dispute with the union on this. What I am most unhappy with is that the hospital has closed twice. This is in an area where it is vital as the Minister of State recognises. It is vital to take the pressure off the regional hospital. It is vital because of the elderly population, which is increasing as Dr. Casey has repeatedly pointed out. He has also pointed out the range of services that could be provided in Clifden to take the pressure off other hospitals.

I worry when I hear that there are no plans to close Clifden District Hospital. It worries me how language is used when we get a little lecture on primary care and a geriatrician telling us the good things. We know this, and it is brilliant. I praised those involved when we had a meeting and learned about primary care on the ground. I worked in primary care. However, it is no substitute for a hospital that provides services. When I ask why services are not available in Carraroe or why there are no respite beds there I am told that they are in Clifden. Merlin Park is the primary place for respite beds, with 13. I am told that Clifden has 12 respite beds. I go around in circles with all of my pieces of paper. Even on the issue of respite beds alone there is a need for Clifden District Hospital based on the figures, not to mention for convalescence and other possible services that should be there.

Anne Rabbitte (Galway East, Fianna Fail)
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The provision of short-stay beds, including respite beds, is an integral part of the integrated model of care for the provision of services for older persons. I am aware the services provided in Clifden District Hospital are highly valued by the wider community and in older person services in HSE Community healthcare west. Unfortunately, short-stay capacity in public hospitals and community nursing units can be impacted for a number of reasons. These include HIQA. As Deputy Connolly said earlier, HIQA has found no fault in Clifden District Hospital. Short-stay capacity can also be impacted because of infection prevention and control and staffing challenges.

As I have already outlined, we are very aware of the challenges that Clifden District Hospital faces. I advise Deputy Connolly that the HSE has assured the Department that it is committed to providing services to older people to meet the demands for short- and long-term services for people in Galway. The Minister of State, Deputy Butler, was delighted to hear the integrated care programme for older persons was launched at Clifden District Hospital last month. ICPOP services ensure that older people with complex care needs can access care quickly or near home through care pathways specifically designed for older people. They target frailty, falls and dementia. This is a welcome addition to the Clifden District Hospital. I assure the Deputy there are no plans to close Clifden District Hospital. I reiterate that the Minister of State, Deputy Butler, is fully committed to working alongside the HSE to ensure that services at Clifden District Hospital continue.

I must compliment Breda Crehan-Roche on the work she does. If I were to lean on her, it would be in the context of saying that it is vital that the service stays open at all times. We cannot have an ad hoc approach whereby it opens and closes. We need to ensure the staffing, even if it is relief staff coming from community healthcare in the city, must be provided. We need a pragmatic approach to ensure that at all times Clifden District Hospital remains open and that the people in the community are reassured that the service is stable and responding to the needs.