Denis Landy (Labour)
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I welcome the Minister of State to the House and thank him for taking this debate on Our Lady's Hospital, Cashel. In 1996, an agreement was signed with the South Eastern Health Board by those concerned at the hospitals in Cashel and Clonmel to move services from the former to the latter. In return, the three-storey Cashel hospital would be upgraded through the provision of 25 specialist and geriatric beds, 15 nursing home and convalescent beds, 20 beds for general practitioner, GP, assessment and rehabilitation and five palliative care beds, a total of 65.This was in 1996. One of the people involved at the time, Councillor Tom Wood, from Cashel, is still trying to get beds into the hospital in Cashel. We will roll the clock forward to the last Government's term of office. Two phases of refurbishment of the building of Our Lady's Hospital were undertaken. One was a new reconstruction at a total cost of €10.15 million and the second phase was the main building, which I am discussing now, on which €12.6 million was spent. The final services were transferred to Clonmel in 2007. These were the acute services and at that time the commitments were reinforced again. However, in January 2015 there were still no step-down beds opened in Cashel by the HSE.

This issue has been raised regularly. In 2015, the then Minister of State at the Department of Agriculture, Food and the Marine, former Deputy Tom Hayes, announced 21 step-down beds to relieve the chronic overcrowding in Clonmel, which has been ongoing for the last number of years. It is now 5 July 2016 and there are still no step-down beds in Cashel, after a total of almost €23 million of taxpayers' money being spent on Cashel hospital for what is operating there and on the main building. There is no return by way of beds for the public and those who are distressed by overcrowding and family situations in Clonmel. It is time to raise this question again and seek a response from the Minister which, I hope, will stand.

This matter was brought to the attention of the new Minister for Health by Tipperary County Council in the months since his appointment to office. The Minister was invited to attend the hospital but the reply the council received, on 20 June 2016, was that the Minister was currently too busy to visit the hospital. However, he has been visiting other hospitals across the country so I cannot understand why some representative at ministerial level would not visit the hospital to see the great job that was done for the amount of money spent, yet the hospital remaining without the beds despite the chronic situation continuing in Clonmel.

Finian McGrath (Dublin Bay North, Independent)
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I thank Senator Landy for raising this matter. I also congratulate him on his election to the Seanad. I am aware of his background of dealing with major concerns over the last number of years, particularly with regard to health and disability issues.

With regard to South Tipperary General Hospital, Clonmel, I understand that the increasing demand on the emergency department and the increasing numbers of patients requiring admission have resulted in delays for patients accessing inpatient beds within the current available capacity. There have been persistent monthly increases in emergency department attendances at the hospital this year compared to the same period in 2015. Such increases are broadly in line with the national experience. The Department of Health has been assured, however, that, with a view to improving the current situation, the south-south west hospital group and South Tipperary General Hospital are strengthening the management structures in the hospital, expanding capacity, improving infrastructure, reviewing processes and intensifying relationships with their community and primary care colleagues. We must focus on these issues for a start. Management at the general hospital has advised that it does not require transitional care beds at Our Lady's Hospital, Cashel.

As the Senator is aware, a wide range of HSE services is currently provided across the campus at Our Lady's Hospital. These include the minor injury unit, primary care services, leg ulcer wound clinic, radiology and ultrasound. Additional services provided on the hospital campus are services for older people, disability and intellectual disability services and mental health services.A proposal to reorganise the provision of services from St. Patrick's Hospital, also in Cashel, to Our Lady's Hospital was included in the HSE 2013 service plan in order to address the environmental and infrastructural issues at St. Patrick's Hospital. A unit on the Our Lady's Hospital campus has been upgraded to meet national standards and it is the HSE's intention to transfer residents from St. Patrick's Hospital to the new St. Clare's ward. This will accommodate 11 elderly mentally infirm residents.

The HSE's six-year capital plan for the period 2016 to 2021 includes plans to replace the current St. Patrick's Hospital with a new 100-bed community nursing unit. It is envisaged at this time that Our Lady's Hospital will be utilised to provide interim accommodation pending the construction of the replacement for St. Patrick's Hospital. It is important that we recognise that overcrowding is not just a problem for emergency departments alone to solve. The response has to be multifaceted and health system-wide. For that reason, A Programme for a Partnership Government has prioritised a number of initiatives which will reduce the numbers of patient attendances at emergency departments by developing alternative services, including primary care; increasing hospital capacity; supporting timely patient discharge from hospital; and improving the ability of the health system to respond to surges in demand for emergency care.

The Minister, Deputy Simon Harris, recently announced funding of €40 million for a new winter initiative, to plan for the next two winters. This is a key provision in any health strategy. The initiative will seek to support actions to improve patient flow through hospitals and optimum discharge planning. South Tipperary General Hospital will be considered in the context of the winter initiative. It will also be included in the national bed capacity review which was committed to in A Programme for a Partnership Government.

With respect to the Senator's frustration at the fact that the provision of 65 beds was mentioned in 1996, I will raise that matter also with the senior Minister. The current position is unacceptable. The Senator said the matter had been mentioned again in January 2015. He also highlighted the fact that €23 million had already been spent. I will convey his strong message on the issues raised to the Minister.

Denis Landy (Labour)
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The Minister of State's response was very well crafted by whoever wrote it. I compliment the person concerned, but most of the response dealt with St. Patrick's Hospital in Cashel. I visited that hospital every Sunday for a long time when my grandfather was in it and during that time it was known as the Old County Home. However, it is Our Lady's Hospital, not St. Patrick's Hospital, that we discussing. I cannot understand how €23 million was spent at Our Lady's Hospital, €12 million of it on a new main building, and how it was then left standing idle. South Tipperary General Hospital in Clonmel is not and has not been able to cope. On checking the Official Report I found part of this structured response to parliamentary questions tabled on this issue in recent years. There is not enough capacity in South Tipperary General Hospital. Another hospital is waiting to be filled. Somebody needs to get the finger out and put patients into it, given that there is overcrowding in Clonmel. I thank the Minister of State for coming into the House to take this matter.

Finian McGrath (Dublin Bay North, Independent)
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I accept the Senator point and agree with him that the real issue does not concern St. Patrick's Hospital but Our Lady's Hospital. It is a key priority for me. I also accept the Senator's point that there is not enough capacity in the hospital in Clonmel. We have to deal with that issue. During the talks that took place in agreeing to A Programme for a Partnership government we constantly discussed the urgent need to provide more beds in the health system. The Senator will have noted that an extra €500 million will be provided for health services this year, but we need to deliver services to local communities in local hospitals such as Our Lady's. I will convey all of the Senator's concerns and views to the Minister, Deputy Simon Harris, and give a commitment to push these matters.