Colm Burke (Fine Gael)
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I welcome the Minister of State to the House. Teach Mhuire in Cork is a facility purchased in 2007, at cost of €2.1 million, by the group headed by Sr. Consilio. At the time there were negotiations with Cork City Council and the HSE whereby Sr. Consilio's group would purchase the house and the annual cost of running it would be borne jointly by Cork City Council and the HSE. We are now 11 years on and the facility is still vacant.

I visited this centre recently and it is a state-of-the-art facility with full central heating and double-glazed windows. It has been totally refurbished and it has been in that state for eight or nine years. It can accommodate 16 people. My understanding is the original intention was for it to be a step-down facility and there is a disagreement between the HSE and the group on what the centre should be used for. The group has more than 90 beds in various units throughout the country providing step-down facilities, and the funding is normally split, with 40% from the local authority and 60% from the HSE.

I am very concerned that at a time when we need to free places in facilities around the country, this centre was designed to help people who would have come through rehabilitation either for drug or alcohol abuse and are now moving on with their lives. This is a stable environment in which they could live. This facility is in Cork and it is available. The doors could be opened tomorrow morning if funding could be provided jointly by the city council and the HSE. I have discussed this with members of the city council and the Minister for Housing, Planning and Local Government, Deputy Eoghan Murphy. My understanding is they are prepared to come on board once there is agreement between this group and the HSE. I ask that this should not drag on for another 12 months, with 16 beds left vacant, when we badly need them. I ask that we now have a commitment for funding for 2019.

Finian McGrath (Dublin Bay North, Independent)
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I thank Senator Colm Burke for raising the matter of people who are homeless in Cork city and for giving me the opportunity on behalf of my colleague, the Minister of State, Deputy Catherine Byrne, to update the Seanad on improvements in health services for this population.

Implementing the national drugs strategy, Reducing Harm, Supporting Recovery 2017-2025, is a Government priority. The strategy identifies people who are homeless as having a higher risk of problem drug use. Their difficult and chaotic life experiences expose them to many health and social risks, including mental health issues. The Minister of State, Deputy Byrne, is aware of the recent study published by Cork Simon on the quality of life of the homeless population in Cork city. The study identifies the routes into homelessness and highlights the many vulnerabilities of homeless people and their challenges in finding a place to call home. The study indicates the high levels of addiction among the Cork homeless population. At same time, there is good engagement with addiction services and other services, with many people either abstinent or in treatment. That is positive. However, the lack of independent housing is minimising the opportunity for improvements in mental and physical health and for reduction in alcohol and drug use.

In the first instance, the social determinants of the health needs of people who are homeless must be addressed. These are underpinned by income inequality and poverty, lack of material resources, limited access to employment and, of course, homelessness.These are whole of government issues and involve a range of stakeholders.

The Department of Health is supporting the national implementation of Housing First, including in Cork city. Under Housing First, the priority is to support a person who has experienced homelessness into permanent housing as quickly as possible without any preconditions. In line with the Sláintecare report, the Department and the HSE are developing new models of care that deliver more effective and integrated care to people with multiple, complex needs who are homeless. The Department has invested an additional €6 million to improve health services for homeless people since 2016, bringing the total health expenditure on homelessness to €36 million. Earlier this year, for example, the Department funded a new step-up, step-down intermediate care facility run by the Simon Community in Dublin. This facility will provide person-centred care for people who are homeless and who require nursing and related care prior to hospital admission and after discharge from hospital.

The Minister of State is aware that the HSE is developing a number of initiatives to improve health services for people who are homeless in Cork. There have been ongoing discussions with Cuan Mhuire on the development of a step-down facility for people who exit its detoxification and rehabilitation services. The Minister of State has been advised by the HSE that it is very supportive of Cuan Mhuire proceeding with this facility. I understand the HSE will discuss this option with Cuan Mhuire as part of a review of its local service level agreement and the Minister of State looks forward to a positive outcome from that review.

Colm Burke (Fine Gael)
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This is exactly the same reply as the one I have been getting for the past few years. It is not setting anything new out for me. Cuan Mhuire needs 60% of its funding to come from the HSE. It is a simple matter of the HSE committing that funding so that the facility can open on 1 January 2019. If we accept this answer, we will not get anywhere for at least three to four months. In the meantime, we will not get a commitment from Cork City Council because it does not understand the internal issues between Cuan Mhuire and the HSE. This facility has been fully furnished and ready to open for eight years. It is a turnkey facility that has been idle for eight years. In fact, it has been idle for 11 years but it was fully equipped eight years ago with up-to-date facilities including fire alarms.

The answer from the Department today does not give me anything concrete. I cannot go back to Cuan Mhuire or to Cork City Council with this reply. I cannot tell them that this is going to progress because this answer does not tell me that. Surely the HSE is able to give us a "Yes" or "No" answer at this stage. It has been given its budget for 2019, amounting to €17 billion. I am talking here about 60% funding for a facility that costs €300,000 per annum. We want the HSE to commit to providing 60% of the funding. As I understand it, the issue is that the HSE wants Teach Mhuire to be used as a step-up facility whereas Cuan Mhuire wants it to be used as a step-down facility. I am not sure what the difference is but for God's sake, can we not get on with this? The sum in question is 60% of €300,000. That is what we are looking for and we should have a commitment in writing before 1 January 2019.

Finian McGrath (Dublin Bay North, Independent)
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I take on board the strongly held views of Senator Colm Burke, particularly with regard to 60% funding from the HSE. Obviously there are internal issues going on between Cuan Mhuire and the HSE but I will relay the Senator's concerns to the Minister of State. As I said earlier, the HSE is discussing this option with Cuan Mhuire as part of a wider review and the Minister of State is optimistic that the outcome of that review will be positive.

As Senator Colm Burke knows, addiction is a particular problem for people who are homeless. They face additional challenges in accessing health services and the lack of appropriate accommodation can undermine the effectiveness of healthcare interventions. Implementing the national drugs strategy continues to be a priority for this Government and within the envelope of resources available in budget 2019 for health services, the Minister of State is committed to prioritising services for homeless people who are facing addiction issues.

I will relay the Senator's concerns to the Minister of State and hopefully there will be some movement on the issue soon.

Paul Coghlan (Fine Gael)
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I thank the Minister of State. Before calling on the next speaker I would like to welcome Deputy Eamon Scanlon and his delegation to the House.