Martin Browne (Tipperary, Sinn Fein)
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We have had this discussion on numerous occasions in recent months. I want answers from the Minister of State, Deputy Butler, this evening because a public meeting is being held in Cashel tomorrow night. The public of the town and the staff in St. Patrick's Hospital deserve answers at this stage. Public representatives belonging to the party of the Minister of State and other Government parties have been giving false information, as far as I am concerned, in Cashel about money being ring-fenced and parking facilities being too small in the area.

Let us get this out there at the start. In 2019, this project went to design stage. Three weeks ago, we were told it was moving along. Now, the unit is being moved out of the grounds of St. Patrick's Hospital, Cashel. Last week, the Minister of State referred to commercially sensitive information. There is none. We were told this at a meeting of the HSE the other day, at which Deputy Mattie McGrath was present. The Government is talking now about a site the HSE owns. I can guarantee it, and I said this to the representatives of the HSE the other day, that no unit will ever go up on that site. I do not even know if the Minister of State knows where the site is located. There is not much more room there for a car, never mind an ambulance or anything like that, to get up to that site. This is all the misinformation that is out there in public. The people of Cashel and County Tipperary deserve better.

Last Friday, we discovered that no cost analysis was done regarding moving this unit from St. Patrick's Hospital. There also seems to be no engineer's report stating this unit is too small. I asked the Minister of State for this review last week, but I have still not got it. There must have been a meeting where it was decided to move the unit out of its current site at St. Patrick's Hospital. These documents have not been forthcoming. What kind of situation is going on in the HSE that meetings seem to be going on where vital decisions are being made about people's lives, but where there are no minutes? We are being told about reports from HIQA, etc., saying that the site is too small and that there is no parking. When St. Patrick's Hospital was going full belt, there were 300 patients and staff on site and there was never an issue with parking. An issue with parking came up three weeks ago, and that was about the end of it. I will come back in after Deputy Mattie McGrath.

Mattie McGrath (Tipperary, Independent)
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I thank Deputy Martin Browne for letting me share time. We want answers about St. Patrick's Hospital in Cashel. We want reassurance and something definite in respect of this matter.

St. Patrick's Hospital is a wonderful institution. My late mum did some time there. I cannot say enough about the staff and all the people there, including in the chapels and the church. I often attended mass there, when we had a church. We were expecting a 60-bed community unit to be delivered. That is what we were told all the way along at meetings and briefings and everything else, until a bombshell landed two or three weeks ago regarding the site now being too small. This is simply not true. I cannot use the word "lie" here, but this is a porky of the highest order. As Deputy Martin Browne said, there were 350 staff and patients there, many of them driving, and there was plenty of room for parking. I ask the Minister of State to pick some other issue besides this one.

Something else is going on here. The Minister of State closed the beautiful hospital in Carrick-on-Suir. It was shocking to do that to a community hospital with three hospice beds. I am worried too now about there being plenty of hospital beds in University Hospital Waterford. I worry because we were told the other day we are in competition now with Dungarvan, if you do not mind, for this community hospital. I am watching this matter very carefully. The Minister of State should not dare to take this facility out of County Tipperary, because it is needed. The community hospital is needed and the staff and everybody else is committed to it. Cashel lost too much back in the 1980s, when it lost to Clonmel, as well as the last time. It is not going to lose this time. The people there are ready for the Minister of State.

It has been stated that the greenfield site is suitable. It is not, and it is not accessible. We have a site, just let us build on it. This is a listed building but it can easily be adapted. There was no problem before with engineers' reports or anything else. Costings in this regard have not even been done. What the Minister of State is overseeing in the HSE, along with the Minister, Deputy Stephen Donnelly, and the Minister of State, Deputy Rabbitte, is nothing short of outrageous. I refer to officials being able to do what they like and tell us what they want to any time they like and different stories then being presented by politicians from the Minister of State's party. This is just not acceptable. The people of Cashel deserve this facility and they are going to get it.

Mary Butler (Waterford, Fianna Fail)
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I thank Deputies Martin Browne and Mattie McGrath for the opportunity to update the House on the new 60-bed community nursing unit in Cashel. I hope we are not going to make a political football out of a good news story.

The HSE is committed to the development of a new community nursing unit for older persons in 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. To date, 43 of these centres have been delivered. Both Deputies will be well aware that a centre is under construction in Clonmel and that we are going to build one in Cashel.

In 2019, the HSE engaged a design team, as the Deputy said, to progress a new 60-bed community nursing unit project on the site of St. Patrick's Hospital, Cashel. A design was completed in 2019, which was brought through stage one design, that showed a detailed layout to the rear of the site. This accommodated the 60 beds. This site, however, is very limited in size, with challenges regarding the number of parking spaces and access to the building.

The emergence of the Covid-19 pandemic in March 2020 interrupted work 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, suitable for long-stay residential use. Residents from St. Patrick's Hospital were moved to facilities on Our Lady's Hospital campus in June 2020. HIQA registers all community nursing units for a three-year period. Six months prior to the registration expiring, a community nursing unit is obliged to submit an application to reregister the facility. This process is being undertaken with HIQA by Cashel residential older persons services to ensure reregistration for another three years from June 2023. This is to ensure continuity while the new community nursing unit is being built. An assessment and rehabilitation unit, and a day hospital for older persons services, continue to operate at St. Patrick's Hospital.

Many of the vacated areas of St. Patrick's Hospital have been refurbished to accommodate children's therapy services. In addition, it is planned to locate enhanced community care, ECC, services at the rear of the site at St. Patrick's Hospital, Cashel. Site options for the new 60-bed unit for Cashel are under consideration. A HSE-owned site in Cashel town is being reviewed by HSE estates for suitability for a new community nursing unit. Representatives of HSE estates have advised that this site review should be completed in the coming weeks. We can discuss this issue again then. A final decision has not formally been made on sites because optimum solutions for the provision of the services are still being appraised.

To put the concerns of both Deputies to bed, the capital plan will be launched in the next couple of weeks. I have seen it. The new community nursing unit for Cashel is included in it, in appendix 2, to go to the detailed design stage. It is there in black and white. No one intends to not to build this community nursing unit run by the HSE in Cashel. What HSE estates is examining now is where this unit might be located. I said at the start of my reply that I hope this issue does not become a political football. I say this because the last thing I want to see is the new community nursing unit being held up in Cashel because the Deputies are arguing over the site. It is not up to politicians to determine where the nursing home will be built. The most important thing for me is that the community nursing home which will have 60 beds en suite in Cashel, which I know is needed, is built as soon as possible. The one in Clonmel and the crisis house there will both be finished next year.

Many community nursing units are currently being built. As I said, we have built 43 so far, and Cashel is next on the list. Nobody is going to stop the unit in Cashel from being built. A community nursing unit will be built in Cashel.

Martin Browne (Tipperary, Sinn Fein)
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I do not accept what the Minister of State has said. The only ones playing political football are local representatives belonging to the Government. They are on local radio and other media looking for special meetings with the Minister of State. She said the HSE has committed to the development of a new community nursing unit for older persons in Cashel. I received a reply to a parliamentary question on 9 March 2023 stating that the HSE continues to review options regarding the development of a new community nursing home in Cashel. Only a month and half ago, it said it is reviewing the situation.

Mary Butler (Waterford, Fianna Fail)
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It is reviewing the site.

Martin Browne (Tipperary, Sinn Fein)
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When will the design stage finish? We were told recently that funding depends on the design stage. When did the issues with the suitability of the site first emerge? Will reports that back up the HSE's decision that the St. Patrick's site is too small be provided? Do they even exist? How much has been spent on the preliminary stages of St. Patrick's to date? How far along are negotiations on the greenfield site? Can any indication be given to us how close to the town the greenfield site is? Will the Minister of State give a commitment that other services such as the assessment unit and rehabilitation services are not lost in a couple of months' time?

Mattie McGrath (Tipperary, Independent)
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The Minister of State is the only one who has dropped the ball, whether it is ludo, draughts or poker. The stakes are high for the people in Cashel. As we heard from Deputy Browne, it is the HSE that is engaged in subterfuge and causing people to have a belief with the different answers it gives. Is there no joined-up thinking in the HSE? There is none whatsoever. We receive replies to parliamentary questions, one of the strongest mechanisms we have at our disposal in the Dáil. We are holding the Minister of State to account. We want this facility built in Cashel. She and the HSE are the ones who two weeks ago introduced a different site. We are not playing football with any sites. We have a site on St Patrick's. I told the Minister of State that my mother was there. I was at many Christmas parties, masses and functions and visited people there. It is fully functional and could fit 350 staff, plus patients. It is a red herring to say the site does not have space for parking.

Mary Butler (Waterford, Fianna Fail)
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The HSE is committed to the development of a new community nursing unit for Cashel. Provision has been made in the capital programme 2023 to progress a 60-bed community nursing unit for Cashel. I cannot be clearer. A HSE-owned site in Cashel is being reviewed by the HSE for suitability.

Martin Browne (Tipperary, Sinn Fein)
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It is not suitable

Mary Butler (Waterford, Fianna Fail)
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The review is expected to be completed in the coming weeks and we will then look at it. Services are still being provided in St. Patrick's Hospital Cashel. An assessment and rehabilitation unit and a day hospital for older persons services continue to operate. It is planned to include new interim enhanced community care in St. Patrick's Hospital, which will be a welcome addition to the provision of healthcare in Cashel.

The intention of the HSE is that a new community nursing unit will be built in Cashel, like the one currently being built in Clonmel which comprises 50 en-suite bedrooms. The unit in Cashel will comprise 60 en-suite bedrooms. All current residents of Our Lady's campus will transfer to the new unit when it is completed.

A final decision has not been formally made and site options are still being appraised to identify an optimum service solution for service provision. However, the building of a new community nursing unit in Cashel is a service priority for capital plans. As I said, it is in the capital plan and funding will be provided. It will be a focus throughout 2023. There is no suggestion that there will not be a community nursing unit built in Cashel.

Martin Browne (Tipperary, Sinn Fein)
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The parliamentary reply we got a month and a half ago-----

Mary Butler (Waterford, Fianna Fail)
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I am entitled to answer under Standing Orders. There will be a community nursing unit built in Cashel. The HSE is currently appraising a couple of sites and will have a report in the next few weeks. There will be a community nursing unit constructed in Cashel, comprising 60 en-suite bedrooms, to support older people in the area.