Dáil debates
Wednesday, 22 November 2023
Saincheisteanna Tráthúla - Topical Issue Debate
Nursing Homes
9:10 am
Bríd Smith (Dublin South Central, People Before Profit Alliance)
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I thank the Minister of State for taking the debate this morning. I will pre-empt it by saying I hope by the end of the discussion she will strongly consider meeting representatives of the families of the 68 patients in Cherry Orchard Hospital who are due to be moved, mostly against their will, to the Bartra Healthcare centre in Clondalkin to allow the refurbishment of two units, namely, Sycamore and Willow.
Many of us have been forced to drill down into detail that we are not familiar with. From the outset, answers to the very serious questions we have been asking have been vague, too short or not forthcoming. Trying to equip ourselves with reports and documents we think we need to see is certainly not possible. Some of them have not been given to us.
What we are concerned with today is that a few weeks before Christmas, 68 very vulnerable patients are being told at the eleventh hour that because of a health, safety and fire concern about the structure of the units they inhabit, they will have to move to a for-profit privately run healthcare centre in Clondalkin. This is worth noting. Cherry Orchard Hospital is a not-for-profit HSE centre. It is very well-staffed by some of the best of those who care for others. They have been working there for years. This transfer is cruel, to put it mildly, to many patients or residents and their families. The families have been protesting outside the hospital. I say, "Well done", to them for not going quietly and putting up with a proposed transfer that has serious question marks around it, which I will come back to later.
I ask the Minister of State to try to halt or delay the transfer to make sure there is room and space for everybody's questions to be answered. I also ask that it does not happen before Christmas. Will she agree to meet representatives of the families?
Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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It was a shock to the staff in the complex to hear the units were being closed and a double shock to the families and those residents who have any understanding - and some of them do not - of what is ahead of them. Some of the residents have been there for 20 years. They are well cared for. There is absolutely no question about their care. It is one of the care centres in the area where people want to go, which is a good sign.
Nobody is taking issue with HIQA stating there is a health and safety issue. We are not experts in fire control. However, there is alternative accommodation on site that could be fixed up a lot faster than a year. We are speaking about moving patients out of the comfort of where they have been for 20 years to another site. Some of these people have very complex needs. Some people are bipolar and others have Alzheimer's disease. There are also people with other issues.
There is a range of questions. Can this be delayed? Can works be done on other empty buildings on site, which could accelerate the time it will take? Can remedial measures be taken initially? There has been discussion about uneven floors but the HIQA report suggests things are a lot worse.
The families have been asking questions. How much access will they have to this private facility? Will they have the same access as they do now? Everybody knows when they work with a HSE centre that the staff will bend over backwards and do everything they can so that people can visit their loved ones. This is not the same in most private centres that I know of.
Mary Butler (Waterford, Fianna Fail)
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I thank the Deputies for raising this issue. I know it has caused a lot of concern for families and residents. If it becomes necessary for an older person to move to a nursing home their safety and well-being is of paramount concern. We have to ensure the highest standards of care are provided to all residents in a safe and secure environment.
Cherry Orchard is a designated centre for the care of older people located in the hospital campus in Ballyfermot, Dublin 10. The centre comprises five units, namely, Beech, Aspen, Hazel, Willow and Sycamore, housing 95 residents in total. There are 68 residents in the Willow and Sycamore units.
In May 2023, a HIQA inspection identified concerns about the flooring in the Sycamore and Willow units in Cherry Orchard Hospital. These presented a potential health and safety risk. A subsequent HSE review indicated the flooring has underlying structural issues, including a newly identified lack of fire compartmentalisation in the walls at a subfloor level and in the subfloor, which require immediate remedial work. A fire risk assessment report has identified that while the risk of fire is relatively low a maximum rating has been assigned to the potential impact of any fire, which would be severe due to a combination of factors including the dependency level of the residents.
The HSE has assured the Department there is ongoing monitoring and risk assessment by the service to ensure there is no immediate hazard to residents. In consultation with HIQA the HSE considered several plans to address the required works that would have allowed residents to remain on site during their completion. However, it was agreed that to ensure the health and safety of residents, to minimise disruption during these works, and to comply with a requirement for a shorter timeline for completion of works, the Sycamore and Window units will close for a minimum of 12 months. I have been advised that there is no impact on other structures on the campus as the issues relate solely to the two modular buildings that are Window and Sycamore.
The safety and well-being of residents and staff is our primary concern. Residents and their families will continue to be consulted, informed and reassured regularly about the move. There will be a medical social worker and an assisted decision making lead available on site for the duration of the move. In addition, all residents have the on-site details of an independent advocacy service should they wish to contact it.
Last week I met the national director and assistant director of community operation services for older people in the HSE. They are in charge of the community nursing units.
All residents will remain under the overall care of the HSE. I have stressed the importance of communicating with families and residents so that they are aware of what is happening.
It is proposed to move the residents to Clondalkin Lodge nursing home on a phased basis. This phased move will pay due regard to the residents' needs, their current proximity to one another and relationships within the unit. Medical officers will follow and review each resident on transfer and for a minimum of three months after that. The HSE has assured my Department that each care plan for this temporary move will include the therapeutic inputs required as well as a review of charges to ensure that no one experiences adverse financial exposure. All additional charges will be covered by the HSE for the duration of the works. When these extensive structural works are complete, everyone will move back to the Cherry Orchard site. All residents will remain in the care of the HSE at all times, even when they are located off site. We all know how there are extra charges in private nursing homes but there will be no additional charges for these residents. All supports, such as physiotherapy and occupational therapy, will be provided to the residents, which I have made crystal clear.
An initial visit to the new nursing home was well attended by residents and families and further visits are planned.
9:20 am
Bríd Smith (Dublin South Central, People Before Profit Alliance)
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I do not doubt that the Minister of State’s statement that all residents will remain in the care of the HSE is true. Unfortunately, the transfer on a like-for-like basis will not actually be like for like. For example, it jumps out at me immediately that there is a 24-7 medical team on site in Cherry Orchard. A GP will only be present one day per week in the Bartra Healthcare centre in Clondalkin. If our fathers or mothers were residents in Cherry Orchard and got sick there, they would go to the hospital they normally attended. For most residents, that would be St. James’s Hospital. If they got sick in Clondalkin, they would be sent to Tallaght, a place they have not attended and where their records are not kept. They may be in the care of the HSE in theory but the truth is there will not be like-for-like care.
The Minister of State has repeated that there is no immediate hazard to residents. I appeal to her to put a halt to this transfer so that we can dig deeper and ask more questions. For example, is it not a conflict of interest that one of the chief movers and shakers in Bartra Healthcare in Clondalkin is a former HIQA inspector?
Catherine Connolly (Galway West, Independent)
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I thank the Deputy, but we are way over time.
Bríd Smith (Dublin South Central, People Before Profit Alliance)
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Is it not a conflict of interest that those who carried out the inspection on the Willow and Sycamore units do not have engineering qualifications? We need answers that go much deeper than what we are getting.
Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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One of the Minister of State’s key comments was that there was a low risk of fire. Any risk of fire is dangerous but there is a risk everywhere we go. There is a building in Dublin that houses hundreds of workers every day and has been getting a fire certificate once per month for years. If that building went on fire, there would be chaos in this city. I am not saying that we take the same approach with our elderly population in this instance but there must be some way to address the problem while they arein situ, for example, by moving a very small number out. The Minister of State referred to a minimum of 12 months, which is crazy. There is a golf tournament that will manage to get a road built ahead of schedule. Why can we not consider other possibilities?
I visited patients in these units a number of years ago and, as far as I remember, the units had been refurbished. Why was this issue not spotted at that stage? The units are perfect for this role. Where will the staff end up? It also needs to be taken into account that there are residents who are wards of court and who have no one to advocate for them.
Mary Butler (Waterford, Fianna Fail)
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My primary focus is the health and well-being of the residents and I have to listen to what HIQA says. HIQA will deregister the building if these works are not carried out. I have to put that information on the floor of the Dáil.
Several older units at Cherry Orchard that are used for storage were reviewed. They could not be considered because they were not habitable, they were deregistered and they would require substantial work and time to bring them to a point where they were habitable and registrable.
HIQA has advised my Department that the HSE is required to undertake structural and fire safety works in the buildings. We owe the residents a duty of care and quality care, and patient safety has to come first. I know the Deputies are not disputing this for one second, given that they said so.
Many of the residents and their families visited the new site last week. Some more visited it this week. I have spoken to families. I have a constituent in Waterford who is the main contact for her uncle. She attended those meetings. I will be honest and say that communication at the outset was poor. That is why I met the national director and assistant national director to find out what was happening.
We have to put the health and safety of the residents first. They will be moved off site. They will remain in the care of the HSE and there will be none of the extra charges that are normally seen in a private nursing home. I have been assured that all medical supports currently available to the residents will follow. I will keep this matter under review. I have been contacted by several of the families and I have written back to them to explain the situation.
The Deputies asked me to put a pause to this. I will not request a pause. I have to listen to HIQA and ensure that the residents are safe.