David Cullinane (Sinn Fein)
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I welcome the Minister of State to the House. I hope he is the bearer of good news for Waterford with regard to this matter. I seek an update from the Minister for Health - I am sure the Minister of State will give this on his behalf - about plans to build a 100-bed community nursing unit in the grounds of St. Patrick's Hospital in Waterford. I will provide an update of the situation and a brief history of the issue.

In 2008, HIQA carried out inspections in St. Patrick's Hospital and as a result of those inspections, it advocated that St. Brigid's ward in St. Patrick's Hospital should close, with the result that 19 beds were lost to the system. At the same time, the HSE carried out a review and the Prospectus report was published which dealt with bed capacity for geriatric care facilities in the State and for community nursing units.

The review was completed in 2012 and the Prospectus report examined bed capacity up to 2013. This informed the Minister's multi-annual capital plan which runs from 2014 to 2018. At the time when St. Brigid's ward was closed, the then Minister for Health promised that a replacement 50-bed unit would be built to replace those 19 beds but also to bring additional beds into the system. Like a number of capital funding promises, along came the crash and this project was put on hold. A further review was carried out and a new purpose-built 100-bed unit was promised. However, this does not provide any additional beds because this 100-bed unit is assigned to replace further wards and beds in the existing St. Patrick's campus.

The Minister will be aware that there are HIQA inspections of a range of community nursing units and geriatric care facilities across the State. What I want to achieve, and what I hope the Minister wants to achieve, is that this unit be built as quickly as possible, given that there are going to be further HIQA inspections. Notwithstanding my concern about bed capacity generally, and that this is the only geriatric care facility and community nursing facility in Waterford city, I welcome the commitment to build this 100-bed unit on the St. Patrick's campus grounds. Has the design team been appointed? Have the tender documents been completed? Has planning permission been sought? Is capital guaranteed for this project under the HSE's multi-annual capital plan, which runs up to 2018? The most important and direct question is, when will work on the ground start? When will we see work happening? There are a lot of capital projects promised for Waterford. A palliative care unit is another example of a facility that we were promised, and we are being told that there is commitment, that we are moving in the right direction, that it is a long process and that we are on the next stage. People want to know when they will see diggers on the ground and work happening to make this a reality.

Joe McHugh (Donegal North East, Fine Gael)
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I had a good conversation with the Minister, Deputy Varadkar, yesterday evening, and, as the Senator knows, I am taking this commencement matter on his behalf. Community hospitals are a critical and integral component of the overall health system. Even at the beginning of this month, when the conversations were focused very much on general hospitals and trolleys and blockages at accident and emergency departments, a key component was filtering and fluidity between the hospital and the primary community hospitals. For example, when I was in Letterkenny General Hospital last Friday we got a statistical breakdown of the demographics, which revealed that the vast majority of patients were over 75 years of age. It is important that we keep a firm focus on the critical need for community hospitals and that the Minister for Health is acutely aware of that.

I would like to thank Senator Cullinane for raising this issue, as it enables the Minister for Health to provide the House with an update on the plans for a new community nursing unit for Waterford. As Senators are aware, it is Government policy to support older people in living in dignity and independence in their own homes and communities for as long as possible. Where this is not feasible, the health service supports access to appropriate high-quality long-term residential care, including the provision of financial assistance under the nursing homes support scheme. Providing public residential care for older persons forms a significant and crucial part of the services. The overall objective is to protect the viability of as many units as possible within the funding and staffing resources available. Therefore, improving the supports available for older persons is a significant commitment in our programme for Government.

As we are aware, all developments must be addressed in light of the resources available and based on priority of need. HIQA has indicated that a number of units do not fully meet the standards one would expect to find in a modern nursing home. This is not surprising, given the age and structure of many of our public nursing homes. Currently, funding for the community nursing unit programme focuses on the upgrading and refurbishment of existing facilities to achieve HIQA compliance.

The Health Service Executive is responsible for the delivery of health and personal social services. This includes provision of the appropriate infrastructure to support service delivery, such as the facilities at St Patrick's Hospital. Given that demand for capital finance for the community nursing unit programme far exceeds the funding available, investment must be allocated as objectively as possible based on the HSE's assessment of priorities of needs.

The HSE has identified Waterford city as a priority location for a new community nursing home unit. The design team has been appointed. Currently it is projected that a planning application could be lodged with the local authority in the second quarter of 2015. Following the award of planning permission, it is expected that the project will progress to the tendering and construction phases in late 2015.

As with all capital projects, the community nursing unit infrastructure programme, which includes this project, must be considered within the overall capital envelope available to the health service. There will always be more projects than can be funded by the Exchequer. There is limited funding available for new projects over the next multi-annual period 2015-2019, given the level of commitments and the costs to completion already in place. Therefore, the reason capital funding is not ring-fenced by project is to ensure the HSE has the flexibility to manage within its voted capital allocation in the event that one or more of the hundreds of construction projects under way at any time do not progress as scheduled. Indenting rather than ring-fencing enables the HSE to leverage its capital allocation efficiently, so that it delivers the maximum number of priority projects for the funding available.

David Cullinane (Sinn Fein)
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I welcome the fact that the design team has been appointed, that a planning application will potentially be lodged in the second quarter of this year, and that towards the end of the year we could move to construction. At the same time, there is a caveat in the Minister's response, in that it is subject to capital funding which has not been ring-fenced. My understanding of what the Minister for Health is saying is that it is based on priority in terms of need, and that HIQA has identified a number of facilities which are not, as they see it, up to standard. The obvious question is whether Waterford is one of those areas. The Minister said that HIQA had identified a number of units that do not fully meet the standards one would expect to find in a modern nursing home. I would imagine from that, then, that the Minister is looking at those facilities to make sure we do not end up with a situation in which units are closed, leaving older people without facilities, because we did not build the new units that are needed.

While there seems to be good news in this, there is a strong caveat as well in that we cannot guarantee that the funding is there at this point in time, but the expectation is that towards the end of the year we will move to construction. It is my responsibility as an opposition Oireachtas Member in Waterford to push Waterford's case. Again, the question to the Minister is, in light of those HIQA inspections and with the Minister working on a priority basis, has HIQA identified Waterford and St. Patrick's Hospital as belonging to one of those areas where there are potential problems with the existing facilities?

Joe McHugh (Donegal North East, Fine Gael)
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I thank the Senator and will convey his question to the Minister for Health. The important thing that is stated in black and white here is that Waterford city, as the Senator has correctly pointed out, has been identified based on priority. That is the first important component. The Minister for Health has outlined the reasons why the voted allocation of capital funding does not happen at this stage but must go through a process. No doubt the Senator's own role as an Opposition spokesman on this issue and as a Waterford Senator means he will be keeping this on the agenda. No doubt his good colleagues in the Government will be heard loud and clear as well. The fact is that it has been identified and prioritised. I will pass on the question regarding whether HIQA has a hierarchy of priority nationally or where it fits into HIQA's schedule to the Minister for Health and will ask him to contact the Senator directly.