Martin Browne (Tipperary, Sinn Fein)
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As I mentioned earlier in the Chamber, plans have been announced to repurpose the new community care nursing unit in Nenagh. The decision to change it from a public facility to a privately run stepdown facility, in order to take pressure off UHL, is a prime example of robbing Peter to pay Paul and moving the deckchairs around. Again, it is the elderly in the area who will suffer. It appears the Minister believes it is appropriate to deal with a shortage of beds in the mid-west by transferring that shortage elsewhere in the same region. It will be at a cost to the elderly. It is an unacceptable way of running any health service, as anybody with any bit of common sense would agree.

More than 20 people currently reside in the existing St. Conlon's facility, which has been declared not fit for purpose by HIQA. People have very little space in their rooms. I will give an example. As things stand at St. Conlon's, if someone has to use a hoist furniture has to be moved out of the way. Visitors have to sit on the bed. That is how small the units are at the minute. The floors are rising which is unacceptable in a facility that houses elderly people. My God, surely that should not be happening in 2024.

HIQA previously reported the need for a new nursing home and that is what St. Conlon's was getting. News of the new nursing home was received with great joy by the families and residents because they had been waiting for more than a decade for this. Since its inception and throughout the build, those residing or working there alongside the unions engaged with the HSE, to a certain extent. Some 20 residents are ready to move in. A further 40 people are on the waiting list for the new St. Conlon's facility. They are waiting to get in there at some stage. Their hope and optimism for the future has been snatched from under their noses by the announcement I mentioned at the outset. It has been done with no meaningful engagement.

The HSE and the Department are trying to give the impression that there has been widespread engagement with the unions, the residents and the workers, but that has not happened. Nothing could be further from the truth. This misconception has outraged the residents and the unions. The public is not happy either because of the way this is being pushed on them. The Taoiseach said in the House that there should be engagement at local level between the HSE, families, staff, residents and local representatives. We have had no engagement with anybody from the Department on this. I spoke to a union representative who told me that the HSE engaged with him at the start but after that, it cancelled meetings on numerous occasions and all of that engagement stopped. There has been no engagement worth talking about. It is another example of the elderly being expected to shoulder the burden of a health system that appears to put them last while it struggles with the consequences of the reconfiguration in the mid-west.

Where will the people who would be accommodated in this 50-bed unit go? This is a disastrous decision. It just shifts the problem from UHL to elderly people who happen to live in the mid-west. The existing St. Conlon's facility takes pressure off UHL, as would the new unit. This decision only shifts the deckchairs. There is justifiable fear that if the keys are handed over to a privately run company, as has been suggested, those keys will never come back. We have seen that in numerous places such as Carrick-on-Suir and the Dean Maxwell community nursing unit, both of which are in my own county of Tipperary. This is a replica of that as far as I am concerned. That is why a rally is being held in Nenagh this weekend. There will be a massive crowd at it. Can the Minister of State with responsibility for older people stand over the decision that has been made here?

Mary Butler (Waterford, Fianna Fail)
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There are two sides to the coin here. When one is in government, sometimes difficult decisions have to be made for the greater good. This was not a decision that was arrived at lightly. We have two situations. On the one hand, the Government has committed to improving access to acute services across the mid-west region. This includes significant and sustained investment in a range of measures to increase capacity at University Hospital Limerick and reduce unnecessary admissions. On many occasions over the last four years, the Deputy has lambasted the Government about the situation in Limerick, and rightly so, because too many people are waiting on trolleys in Limerick and a solution has to be found. On the other hand, we have the long-term continuum of care. I do not think you will get any better advocate for older persons than myself. I am standing up here this evening. I deliberately stayed to answer this question.

I am very conscious of the importance of strengthening the capacity and resilience of our public health system through the delivery of health and social care infrastructure. This investment includes the community nursing unit programme, which was launched in 2016 to ensure that up to 90 of our public community nursing units, CNUs, and community hospitals would be refurbished or replaced to ensure the best quality environments for our older people. A significant investment of €20.2 million has been allocated to the new CNU, in Nenagh under the CNU programme. Older person's services in the north Tipperary area will be enhanced by the opening of a new state-of-the-art 50-bed CNU in Nenagh, replacing the St. Conlon's CNU. It will have a complement of 50 beds providing long-stay care, respite care and palliative care services. The CNU will provide a high-quality living environment in line with all regulatory requirements.

I have to correct the Deputy on one point. St. Conlon's as it currently stands is registered with HIQA. The Deputy gave the impression that it is not. It is currently registered with HIQA for the current 20 residents who are there.

In order to alleviate the significant pressures at UHL, a decision has been made to utilise the new Nenagh CNU building on an interim basis as a stepdown sub-acute and rehabilitation facility for UHL. It will be run by a private provider with expertise in such services. A procurement process is under way. A new 96-bed unit is being built in Limerick at the moment, which will mean 70 new, additional beds. While that is being built, in the short term a decision has been made to use the new CNU, which is currently lying empty because it would take 100 staff to staff it. There are only 31 staff in St. Conlon's who can move with it. In the short term, while that premises is empty a decision has been made to utilise it to support 50 beds in order to support the emergency department in Limerick. I have been given a guarantee that 12 months after the contract commences with the private provider, this will be reviewed. As soon as the new 96-bed unit in Limerick opens its doors, the new facility in Nenagh will revert back to the CNU. Recruitment will commence this year to provide the additional staff for the new 50-bed facility, which has en suite rooms. It will need 100 staff members for safe staffing. There are currently 31 staff in St. Conlon's so even if they moved, they would not be able to facilitate the full unit at the moment. This is a short-term measure for the greater good. The Deputy spoke about older people in the area. Many of those older people who could potentially be on a trolley in Limerick will now be diverted to the CNU in Nenagh. They will be able to get the nursing care they need and avoid the emergency department.

Martin Browne (Tipperary, Sinn Fein)
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On the Minister of State's last point, 50 patients will come from UHL to the new unit. Twenty patients in the existing St. Conlon's facility are waiting to move into the kind of facility that the Minister of State is talking about. They will be left in the old St. Conlon's. I did not give the impression that HIQA turned down St. Conlon's. All I said was that HIQA had previously reported the need for a new nursing home in the area. The 96-bed unit mentioned by the Minister of State needs to be supplied. She spoke about the short term, 12 months and 18 months. In the case of St. Brigid's, we were told it would be 12 months. It is now four or five years down the line and it is never coming back. Four years ago, we were told there were plans in place for the Dean Maxwell facility, but there are not. The fear in Nenagh is that this is what will happen to St. Conlon's. That is the big worry. We have lambasted the Government and it was well deserved because of the conditions at UHL, but it needs to sort out the crisis there by carrying out the emergency care capacity review, providing the 96 beds that are needed and staffing them accordingly. If it could lift the embargo in the first place, that would help. As I said earlier, it does not make sense to start taking patients from UHL out to St. Conlon's. It is shifting the deckchairs. There is no common sense involved here. That unit that has been rejected by HIQA.

Mary Butler (Waterford, Fianna Fail)
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It is registered so it is compliant.

Martin Browne (Tipperary, Sinn Fein)
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I accept that "rejected" is probably the wrong word.

They have been told the unit is not fit-for-purpose anymore. I do not want my parents or other people having to walk on unsafe floorboards in a nursing home. I want them to have toilets in their room and visitors not having to sit on beds. If hoists have to be used for elderly people, I do not want lockers and so on to have to be moved out of people's way. It is nonsensical that a purpose-built unit for 20 patients and others on the waiting list has been taken away.

Mary Butler (Waterford, Fianna Fail)
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As I said, sometimes difficult decisions have to be taken for the greater good. The decision to utilise the new Nenagh community nursing unit building, on an interim basis, as a step-down, sub-acute and rehabilitation facility was taken to alleviate the significant pressures on University Hospital Limerick. The intention is that the arrangement will be reviewed within one year - I have been given a guarantee of that - and the Nenagh community nursing unit will open for long-term residential care services 12 months after the contract with the private provider commences.

I do not want people to have the impression that older people in St. Conlon's are not being looked after The current community nursing unit at St. Conlon’s in Nenagh will continue to provide the same excellent care to its residents during this interim period. The new Nenagh community nursing unit will ultimately replace St. Conlon’s community nursing unit.

The regional executive officer, Ms Sandra Broderick, and HSE mid-west chief officer, Ms Maria Bridgeman, together with Ms Colette Cowan, UHL, are committed to ongoing engagement with the unions in regard to the temporary use of the Nenagh community nursing unit as a step-down unit and have met union representatives on three occasions, with a further meeting scheduled for 13 May.

There is also ongoing engagement between the director of nursing in St. Conlon’s community nursing unit and residents and their families to address informal queries that have arisen regarding the temporary postponement of the move to the new Nenagh community nursing unit. The community nursing unit is being repurposed temporarily for 12 months and I guarantee the Deputy that the keys will be handed back.

Martin Browne (Tipperary, Sinn Fein)
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It is dependent on the 96-bed unit being finished.

Mary Butler (Waterford, Fianna Fail)
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An older person with a urinary tract or kidney infection who needs intravenous drugs and fluids can be brought to the community nursing unit and avoid the emergency department in Limerick. Please God, they will be back home with their loved ones within 48 to 72 hours. It is not a decision that was taken lightly, but it was taken for the greater good to try to support the emergency department in Limerick. I will give the Deputy a guarantee on the floor of the House that I have been given a firm commitment that as soon as the 96-bed unit in Limerick opens, which will provide 71 additional beds, families and their loved ones will be able to move from St. Conlon's into the new unit when it is staffed.