Martin Browne (Tipperary, Sinn Fein)
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I am raising this matter because of the lack of clarity I received in reply to a parliamentary question about a 60-bed unit that was supposed to be built in St. Patrick’s Hospital, Cashel. We were told the money for the project was ring-fenced years ago. The response I received to that parliamentary question moved to discuss a 50-bed unit. I received an amended reply today that has returned to discussion of a 60-bed unit. I want to know what commitment has been given. Is the 60-bed unit going ahead? I need clarity on that point and perhaps the Minister of State could offer that clarity.

My second issue relates to a reference in the reply that stated this project went to the design stage in 2019. I understand there was a pandemic and I can see how that caused some delay. However, we are now four years down the road. It should not take four years to design a 60-bed unit, even with that delay. The reply also referred to an overview of the situation or a review of options.

Anybody will tell you that any review of options should be done before any design is put together. We worry whether something underhand is going on here because, all of a shot, we are being told about plans being reviewed when they were supposed to be at design stage in 2019. The reply goes on to outline the development of facilities for the children's disability network team, CDNT, but there is no indication elsewhere in the response that the design of the unit has resumed. Will the Minister of State fill us in on that? Has it resumed and at what stage is it? Will she clarify the timeframe for the delivery of the project? Will she explain what precisely the intention behind this statement is? Is it a warning that a U-turn could be in the offing? The purpose of parliamentary questions is to acquire information for the benefit of the public. We are being asked to find out what is the situation in my own town of Cashel. I will be fair; the former councillor in Cashel, Tom Wood, has been talking about this for a long time. He is on the ground every day but neither we nor he are getting any answers. We need clarity on this.

In the reply we got back, there was suddenly mention of a 60-bed unit at St. Anthony's in Clonmel, 18 miles away. We appreciate every bed that comes into County Tipperary but my parliamentary question was not about St. Anthony's in Clonmel but about a 60-bed hospital in Cashel. We were told the money had been ring-fenced for it but now all these doubts are popping up. To be fair, the HSE's record of provision in Tipperary has been very poor. A lot of things have been pulled by stealth. The worry is that this is another attempt to do a U-turn and get out of building this 60-bed unit. There is talk of reducing the 60 beds to 50 and of reviewing the options. We are asking the Minister of State to clear up the situation.

Anne Rabbitte (Galway East, Fianna Fail)
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I thank the Deputy for raising this issue and allowing me the opportunity to update the House on the plans to develop a 60-bed residential care centre at St. Patrick's Hospital, Cashel. In early 2016, a capital programme for older persons residential centres was developed in response to the introduction of HIQA's national residential care standards for older people and the requirement that all facilities providing long-stay beds be registered with HIQA. This is a programme to replace, upgrade and refurbish, as appropriate, care facilities at 90 locations. The vast majority of the projects relate to replacement capacity.

I am aware that, as he said in his contribution, the Deputy recently received a response to a parliamentary question stating that the development at St. Patrick's Hospital in Cashel was a new 50-bed community nursing unit. It has since been confirmed with the HSE that this was noted in error. It is, in fact, a 60-bed unit. An amended response was issued to the Deputy earlier today.

The HSE is committed to the development of a new community nursing unit for older persons in Cashel. Provision has been made in the capital programme 2023 to progress a 60-bed community nursing unit for Cashel. In 2019, the HSE engaged a design team to progress a new 60-bed community nursing unit project on the site of St. Patrick's Hospital, Cashel. The emergence of the Covid pandemic in March 2020 interrupted works on this project. As a response to Covid-19 risks, upgrade works were carried out to make facilities located on the campus of the nearby Our Lady's Hospital, Cashel, which is now named Cashel Residential Older Persons Services, suitable for long-stay residential use. Residents from St. Patrick's Hospital were moved to facilities on the campus of Our Lady's Hospital in June 2020. The HSE recognises that the move to the campus of Our Lady's Hospital was an interim solution due to a critical need caused by the pandemic. An assessment and rehabilitation unit and a day hospital for older persons services continue to operate at St. Patrick's Hospital.

Specialist renovation works have been carried out on some of the vacated space at St. Patrick's Hospital for the development of new facilities for the children's disability network team for Cashel, Tipperary and surrounding areas. This will also accommodate children's disability services originally based at Our Lady's Hospital. Other available space at St. Patrick's Hospital is being considered for the development of facilities for the HSE roll-out of the enhanced community care programme.

Site options for the new 60-bed unit for Cashel are under consideration. These options include building on the existing site and building on a new site. The HSE has engaged a design team to progress the new 60-bed community nursing unit for Cashel. Stage 1 design has been completed and is under review. HIQA registers all community nursing units for a three-year period. Six months prior to its registration expiring, a community nursing unit is obliged to submit an application to re-register the unit. Cashel Residential Older Persons Services have commenced this process with HIQA in order to ensure registration for another three years from June 2023.

Martin Browne (Tipperary, Sinn Fein)
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I am not sure. I thought the Minister for Health was going to be here. He knows the situation. I am not having a go at the Minister of State but it is a joke that we are here again asking questions of a Minister for Health who has not appeared. The Minister of State has confirmed that it is a 60-bed unit. This reply states that it may be built on the existing site or on a new site. That throws everything up in the air again. There has never been mention of another site. It was always expected that this 60-bed extension would be on the St. Patrick's Hospital site. If we are to go to another site, how much longer will planning and so on drag on before this 60-bed unit is built in Cashel?

The Minister of State has not answered my question about what stage design is at. When can we expect to see work started? It should not be built on a new site because that throws everything in the air again. It actually maddens me at this stage to think that we have been waiting this long and there is now talk of a new site. What was the intention behind the statement that the HSE continues to review the options? I asked the Minister of State what that was about. That is one of the questions we wanted to ask the Minister regarding this development. Why is something that has gone to design now being reviewed? Anybody building anything will review options and decide what they want to put on a site before they go to the design stage. I have no doubt that the HSE has spent a fortune designing this 60-bed unit and it is now talking about reviewing it. It seems crazy and shows a total lack of respect for people in Cashel who have been expecting this unit all along.

The Minister of State still has not answered me as to why the Minister or the HSE decided to tell us about St. Anthony's in Clonmel. Is it to soften us up before dragging on with the unit at St. Patrick's Hospital for as long as possible, as there is a 60-bed unit 18 miles down the road, before finally pulling the plug, as happened with St. Brigid's Hospital in Carrick-on-Suir?

Anne Rabbitte (Galway East, Fianna Fail)
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I am not one to defend the HSE but it has said that it got this wrong and apologised for that. Let us not go into conspiracy theories.

Martin Browne (Tipperary, Sinn Fein)
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What did it get wrong?

Anne Rabbitte (Galway East, Fianna Fail)
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The HSE answered a parliamentary question incorrectly. It rectified that answer today. I am now answering the Deputy's question so that he can tell his constituents that the design of a 60-bed unit is under review. That is important.

Martin Browne (Tipperary, Sinn Fein)
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In the response to the parliamentary question, there is no mention of the other site raised in the reply the Minister of State has given me today.

Anne Rabbitte (Galway East, Fianna Fail)
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I will read the closing statement because I am only the pigeon in the middle. Is that all right?

Martin Browne (Tipperary, Sinn Fein)
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I know. I appreciate that. I said that. It is a disgrace that the Minister has not turned up again.

Anne Rabbitte (Galway East, Fianna Fail)
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I again thank the Deputy for raising this issue. Work under the capital programme is progressing across the country to replace, upgrade and refurbish our current stock of community nursing units in response to the introduction of HIQA's national residential care standards for older people. The HSE is committed to the development of a new community nursing unit for Cashel. Provision has been made in the capital plan 2023 to progress a 60-bed community nursing unit for Cashel. The emergence of the Covid-19 pandemic impacted on all elements of life. Unfortunately, the 60-bed residential care centre at St. Patrick's Hospital, Cashel, was delayed by the pandemic. An interim solution to move the facilities located on the campus to Our Lady's Hospital, Cashel, was implemented. Services will be provided in St. Patrick's Hospital, Cashel. An assessment and rehabilitation unit and a day hospital for older persons continue to operate. Work has been carried out to accommodate new facilities for children's disability services and the enhanced community care programme. Older persons services and the estates unit of the HSE are progressing work on the plan for a community nursing unit for Cashel.

Cashel residential older persons service has commenced the community nursing registration process with HIQA in order to ensure reregistration for another three years from June 2023.