Terry Leyden (Fianna Fail)
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I welcome the Minister, Deputy Leo Varadkar, to the House. I thank him for engaging in this Commencement debate on the future of the Sacred Heart Hospital in Roscommon.I wish to share my time with Senator John Kelly.

The Minister is probably aware of the situation regarding the HIQA report into the future of the Sacred Heart Hospital in Roscommon. In the report of 2 March when an inspection took place, HIQA highlighted many issues the director of nursing, Ms Silke, was well aware of but for which no funding had been forthcoming from the HSE. I have a long association with the Sacred Heart Hospital, having been there at the opening of the new unit in the 1970s, as a former Minister of State in the Department of Health and as a Deputy and former chairman of the western health board. I have always fully supported this fabulous institution in Roscommon.

I was also anxious to have the facility called the Sacred Heart Hospital, as opposed to Sacred Heart home, because it carries out the work of a step-down hospital and is a tremendous support to the work of the acute county hospital in Roscommon with which it works closely. The Minister will be aware of the facilities there. The hospital cares for 95 residents and has 35 full-time nursing staff, 48 health care assistants, 11 interns, cooks, kitchen staff, laundry staff, clerical staff, maintenance staff and two physiotherapists. All of this is provided at the Sacred Heart Hospital. The overall medical care is under Dr. Gerry O'Meara, consultant geriatrician and registrar, and staff. All temporal and religious needs are cared for, with mass every day in the beautiful church on the site.

The immediate crisis is that from 7 September 2015, no new admissions are purported to be allowed. However, I got an update on the situation this morning and have been informed by the management of the hospital that there is no block on admissions and it is still admitting patients. The licence has not been renewed and they have been told it is in the process of being renewed. The immediate challenge is the provision of approximately €170,000 for remedial works - partitions, doors, toilets, etc. - which will ensure registration will continue, pending the allocation of a major capital injection from the Department.

I understand that in the past few days a proposal has been made to provide approximately €400 million over the next five years for the upgrade of State institutions like the Sacred Heart Hospital, Roscommon. Knowing the background situation in Roscommon, the Minister is aware that his predecessor, Deputy James Reilly, gave a commitment to maintaining the 24-hour accident and emergency facility, but that was closed despite the commitments given by the Taoiseach and Deputy Gilmore. The people of Roscommon will not stand idly by and allow lightning strike twice. If the new 50-bed single occupancy rooms with full ancillary services and facilities are not provided, at an estimated cost of up to €13 million, the future of the Sacred Heart Hospital is in jeopardy.

The people of Roscommon have attended meetings in large numbers and have highlighted the issues on the Vincent Browne show. I am confident the money will be forthcoming. I have pressed my party's shadow spokepersons to ensure there is provision in the Fianna Fáil manifesto for major capital investment. This will be provided, but we must see this as an issue of putting people before politics. I ask the Minister for an indication of the allocation and ask him to approve that allocation in the budget to secure the future of the Sacred Heart Hospital in Roscommon.

John Kelly (Labour)
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I welcome the Minister to the House. I support Senator Leyden's matter. Roscommon has the highest number of people over 65per capita in the country. We have an excellent facility. If funding is provided, the project is shovel ready and the HSE knows that. It does not need to acquire land to build these extra units. It is amazing that the project is under threat and that the hospital faces downsizing because of its four-bedded units. There are four-bedded units in every hospital in the country, but will the same apply to them down the road? If the investment is not put in place, there will be no more admissions, which will eventually bring about the closure of the Sacred Heart Hospital.

No complaints were made by patients about the facility. On the contrary, patients were delighted to be in four-bedded units where they could talk to one another. This is good for their mental health.Now their proposals will isolate them, which will not be good for their mental health. As Senator Terry Leyden said, health services in County Roscommon have suffered in the past four years, particularly following the closure of the accident and emergency department in Roscommon County Hospital and because of the underfunding of mental health services, which are in crisis. We also have a problem with the ambulance service and cannot open the new ambulance centre in Loughglynn because we do not have the required staff. It would be an endorsement of the Government if it gave something back to the people of County Roscommon. Sadly, if it does not, it will be viewed as another means of privatising older people's services.

Leo Varadkar (Dublin West, Fine Gael)
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I thank Senators Terry Leyden and John Kelly for raising this matter. I am taking the debate this on behalf of the Minister of State, Deputy Kathleen Lynch, who is abroad on Government business.

The policy of the Government is to support older people to live in dignity and independence in their own homes and communities for as long as possible. If it becomes necessary for an older person to move to a nursing home, appropriate accommodation must be available that meets his or her care needs and matches his or her wishes and preferences.

The Health Service Executive, HSE, is responsible for the delivery of health and personal social services, including those at the Sacred Heart Hospital in County Roscommon.

The facility provides services for 80 residents in ongoing care. Many of the residents have complex and challenging conditions and almost half have had a diagnosis of dementia, psychiatric conditions or other complex medical needs. There are 15 beds used for rehabilitation, respite or palliative care. The rehabilitation service is led by a consultant. This service makes an important contribution to facilitating patients to move from acute hospitals to a more appropriate care centre when they no longer need acute care.

The Health Information and Quality Authority, HIQA, is the independent authority established under the Health Act 2007 to drive continuous improvement and monitor safety and quality in Ireland's health and personal social care services. Since 2009 all nursing homes - public, private and voluntary - have been registered and inspected by HIQA. The most recent HIQA report on the hospital was published last July. Inspectors found that the centre was well managed. Residents and family members told inspectors that they were very happy with the services provided. While HIQA praised the care provided, inspectors expressed concern about environmental standards and staffing levels at night. The issue of staffing levels has been addressed and is being progressed. During August the HSE received a notice of proposal from HIQA to restrict admissions. The HSE has responded to this notice and is in ongoing contact with HIQA regarding the registration. This, of course, is a process that inevitably ends up in court. It is not one in respect of which I can make any ministerial direction, nor do I have the power to do so.

As is in the case of the Sacred Heart Hospital, residents in public facilities and their families are generally very happy with the standard of care provided. They frequently choose such facilities, even when other alternatives are available. However, a number of buildings are very old and it can be difficult or very costly to fully adapt them in line with modern practice. Demands on public capital funding generally exceed what can realistically be provided. Only a finite amount of funding can be provided for public capital investment and there are many competing demands across government for the funds available. However, the Minister of State and I have made the strongest possible case for investment in community nursing units. My Department will work with the HSE to direct what does become available in the most effective way possible, with the safety and welfare of residents always being our top priority.

Terry Leyden (Fianna Fail)
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I acknowledge that the Minister has acknowledged the excellent work of the staff at the Sacred Heart Hospital which is a very popular location for patients. I am concerned, however, that he has not confirmed that there is a capital allocation of over €400 million to be spread over the next five years. Obviously, it has not been signed off on yet. I note that the Minister for Public Expenditure and Reform provided €23 million for the accident and emergency department at Wexford General Hospital but closed the accident and emergency department in Roscommon. I understand the Taoiseach provided €10 million for a similar 50-bed unit in Castlebar. There should be fair play. I hope that, being very fair, the Minister will come to Roscommon to see the facility with Senator John Kelly, Deputy Frank Feighan and other colleagues and what is happening on the ground. The people feel badly let down. We provided two seats for Fine Gael in the last general election. It will be lucky to win one the next time, but we will see what happens.

Leo Varadkar (Dublin West, Fine Gael)
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I wish to mention, in particular, that many of my party colleagues are very concerned about and have been in touch with me about this issue. Of course, Deputy Frank Feighan is the local Deputy. Others involved include councillors Maura Hopkins and Michael Creaton.On foot of that, I spoke to the national director of social care in the HSE, Mr. Pat Healy, in the past couple of days. He has informed me that remedial works worth €170,000 would not be sufficient to satisfy the HIQA requirements and that what is required is either a total replacement of the facility or major refurbishment. I cannot give any commitment at this stage on that, and I would not be honest if I did so. The simple reason for that is that I do not know what is available for health in the capital budget yet. That has not been signed off by the Government. It is intended that it will be signed off next week, at which stage I will know what capital is available for the health sector for the period between 2016 and 2021. I will have to sit down with Minister of State, Deputy Kathleen Lynch, the HSE and everyone else to prioritise and decide what aspects might be addressed by direct Exchequer funding and what aspects could be addressed by public–private partnership. However, I am not willing to make a commitment I cannot stand over. I cannot make one at this stage.

Senator Kelly mentioned that there are people in four-bed rooms. He asked whether this is happening throughout the country. It is. There are two facilities in my constituency in a similar position. Neither has funding to be replaced at this stage. Therefore, it is an issue that applies across the country. It is deemed no longer appropriate to have people in long-term care in four, six or 12-bed wards. People may have their own opinions on that but the general view is that it may be acceptable for somebody in hospital for a week or two but not for an individual for whom hospital has become home. In the latter case, the view is that one should have a private en suiteroom or certainly a room with no more than two beds. That is the current standard. However, as Senators will appreciate, many of these facilities date back hundreds of years. People have been in four-bed and six-bed units for-----

Terry Leyden (Fianna Fail)
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There is confusion. This is a new unit that was built in 1973.

Paddy Burke (Fine Gael)
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We are way over time.

Leo Varadkar (Dublin West, Fine Gael)
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I said "many". The standards now are very high and it will not be possible to replace 200 years' worth of health infrastructure in the course of five or six years. However, we need a multi-annual programme that will allow us to make a good start on that. In the meantime, while we are doing that, admission should continue to those facilities that are a few decades old or much older.