Martin Daly (Roscommon-Galway, Fianna Fail)
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I wish to highlight the urgent need for the long-promised rehabilitation unit at Roscommon University Hospital. In 2015 a commitment was made for a €7.8 million investment to provide 20 dedicated rehabilitation beds, yet despite entering detailed design phase in 2021, the appointment of a design team in 2022 and further design assessments in 2023, the rehab unit was abruptly omitted from the HSE Capital Plan 2024 without explanation.

We face a 50% shortfall in neurorehabilitation beds nationwide with huge geographical disparities in bed availability, which ranges from 6.4 beds per 100,000 people to 45 beds per 100,000 people. I assume the latter applies in the Dublin area. Patients in the west of Ireland are left with limited or delayed access to specialist rehabilitation at a centre remote from them in Dublin. This is resulting in unsuitable care settings and long-term dependency. This is both clinically inappropriate and economically unsustainable.

The evidence is clear that specialised rehabilitation is the most cost-effective intervention. Data from intervention trials for sudden-onset neurological conditions, progressive or intermittent neurological conditions or limb absence show a significant reduction in dependency and ongoing care cost. The greatest savings are in the high-dependency group and the cost of intervention is recouped after only 16 months. This is in stark contrast to late intervention in non-specialised environments, which leads to significantly higher costs for the State. This is not simply a healthcare issue but an economic one. Investing in a dedicated rehabilitation unit in Roscommon University Hospital would be a proven, evidence-based solution that will improve accessibility and patients' outcomes, reduce long-term healthcare dependency and ultimately save the State millions in avoidable disability and ongoing care costs.

In spite of the deep disappointment at the reconfiguration in 2011, Roscommon University Hospital has reimagined itself as a very successful model 2 hospital. It has a successful medical assessment unit, which is a unit of choice for older people in the area. It has a successful regional gastrointestinal endoscopy unit and a minor injuries unit that serves not just Roscommon, but east Galway, Mayo, Longford and Westmeath.

The people of Roscommon-Galway were promised a model 2 hospital that would be developed to its maximum potential. However, the outpatient department, built in 1947, lacks a disabled toilet and adequate wheelchair access, which is astonishing. Given the current emphasis on disability in the programme for Government, one would expect all outpatient departments to be disability-proofed infrastructure.

I urge the Minister of State to expedite this long overdue project and ensure this regional rehabilitation infrastructure is delivered as planned in Roscommon University Hospital. The reasons for choosing Roscommon University Hospital in 2015 could not have changed substantially in the intervening years. The people of Roscommon-Galway deserve a transparent explanation as to why this piece of critical infrastructure appears to have been mothballed.

Kieran O'Donnell (Limerick City, Fine Gael)
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I thank Deputy Daly for giving me the opportunity to update the house on behalf of the Minister for Health on the developments at Roscommon University Hospital.

To ensure delivery of the right care in the right place at the right time, there are robust systems and procedures to appraise, manage and deliver infrastructure projects required for the provision of health services. Projects are appraised by the national capital and property steering committee of the HSE. This is to ensure compliance with service priorities and policies and the feasibility of delivery. It also ensures alignment with the national service and capital plans. The national capital and property steering committee then recommends projects for inclusion in the capital investment programme. A prioritisation process is conducted to inform the annual capital plan.

A review of the spatial plan at Roscommon University Hospital was re-initiated in 2024 following the completion of the hospice built off the hospital site, the need to update site ward expansion and the replacement of existing facilities with modern and compliant accommodation. A possible site for the replacement acute adult mental health unit was to be considered.

The Minister for Health has been informed by the HSE that the physical review of space has been substantially completed, based on a brief confirmed by the hospital service. In recent weeks, HSE capital and estates and integrated health area management have requested that clinical planning consultants be engaged to verify service brief requirements included in the updated version of the spatial plan 2024-25 and in alignment with other hospitals in the catchment and national programmes. The rehabilitation unit at Roscommon University Hospital is a project currently included in the updated exercise of the spatial plan 2024-25.

The development of new or refurbished healthcare facilities anywhere in the country cannot be seen in isolation or separate from the delivery of related healthcare services. Projects are approved by HSE services before being submitted to a HSE central steering committee for approval and then progressing through the capital process. Once approved by the HSE central steering committee, the project is eligible for prioritisation and inclusion in the capital plan, subject to the level of funding.

In addition to the above process, and to enhance capital investment, the Department of Health has developed and published a strategic health investment framework to ensure investments are evidence based and equitable and that Sláintecare reforms are achieved, with the overall objective of having better health outcomes for the population of Ireland.

The strategic health investment framework is a high-level framework which sets out the investment criteria and an intervention hierarchy based on the principle of continuity of care by which all capital investment proposals in the public health sector are to be assessed. The capital plan is an annual document that sets out the planned health infrastructure investment within a given year. Capital investment plays a critical role in enabling and enhancing health service provision. The capital plan 2025 will outline the planned investment in health infrastructure throughout the country. It is expected the capital plan will be published the coming weeks in line with established procedures.

Martin Daly (Roscommon-Galway, Fianna Fail)
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I can take it that the Minister of State is confirming that the rehabilitation unit in Roscommon University Hospital is still planned for the area and is undergoing review in the spatial assessment he described. The people of Roscommon have reason to be suspicious. They feel that, after reconfiguration, for which a whole host of new services were developed, including a successful medical assessment unit and injuries and endoscopy units, things in the hospital have been left in abeyance.

As I have pointed out, the outpatients department is not fit for purpose. It was built in 1947. The endoscopy unit cannot expand to ENT and neurological endoscopy for want of a decontamination unit. The injuries unit cannot expand its service because of a shortage of advanced nurse practitioners. In addition, elderly and frail people are going to memory and frailty clinics but cannot park on the grounds of Roscommon hospital. They have to walk from the local GAA grounds, which are about 500 m away, in spite of there being adequate space around Roscommon University Hospital.

The people of Roscommon need to be reassured that in the deal proposed to them after the reconfiguration of the hospital, which deeply disappointed people in the area, the State will not forget investment in what is a critical piece of infrastructure in the delivery of healthcare in the west. I am happy the Minister of State has confirmed that the rehabilitation unit has not been removed from the planning of health services in Roscommon.

Kieran O'Donnell (Limerick City, Fine Gael)
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Once again, I thank the Deputy for raising this issue, which is very important to the people of Roscommon. Roscommon University Hospital is a model 2 hospital in the HSE west and north-west region which provides vital services to the local population. There are robust systems and procedures to appraise management of and deliver health infrastructure projects to ensure delivery of the right care in the right place at the right time.

As I have stated, a review of the spatial plan at Roscommon hospital has been concluded and a clinical planning consultant is being engaged to verify service brief requirements, including the updated version of the spatial plan as well as an alignment with other hospitals in the catchment and national programmes. The rehabilitation unit at Roscommon University Hospital is a project currently included in the updated version of the spatial plan 2024-25.

The development of new or refurbished healthcare facilities anywhere in the country cannot be seen in isolation or separate from the delivery of related healthcare services. The capital plan is an annual document that sets out the planned health infrastructure investment in a given year. Capital investment plays a critical role in enabling and enhancing health service provision. The capital plan 2025 will outline the planned investment in health infrastructure throughout the country. As I have stated, it is expected the capital plan will be published in the coming weeks, in line with established procedures.