Ned O'Sullivan (Fianna Fail)
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Cuirim fáilte roimh an Aire Stáit.

Seán Kyne (Fine Gael)
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I thank the Cathaoirleach’s office for choosing this Commencement matter. My colleague, Councillor Eileen Mannion, and I arranged a community meeting in Clifden on Sunday. It was attended by hundreds of people – there was standing room only with people out the door - concerned about the future of Clifden District Hospital, which is used for respite convalescence and has been used for palliative and end-of-life care as well. There is concern because individuals in the community were told by the HSE to take their loved ones out of the facility by 3 p.m. on Sunday or 3 p.m. on Monday. This causes huge concern in the community.

Issues regarding rostering and difficulties between unions and management on the amalgamation of practices between St. Anne’s nursing unit and Clifden District Hospital have had an impact. It is now clear that there is more to this. Issues with recruitment and the availability of nurses and physiotherapists seem to be at the heart of the problem. This is reducing the number of referrals from Galway University Hospital, GUH, which is impacting on the ability to have convalescent and step-down facilities.

I ask that the Government intervene with the community healthcare organisation, CHO, to ensure that it has an appropriate recruitment programme in place for Clifden District Hospital, that it engages with local doctors regarding palliative and end-of-life care and that it ensures there are referrals from GUH for local people who wish to be cared for and visited by their families in the local community.That was certainly always the case in Clifden District Hospital pre-Covid. Covid changed issues and there is a concern in the community that issues are now at play to downgrade Clifden District Hospital with a view to closing it. We had a commitment - I apologise, I will hand over to my colleague.

Pauline O'Reilly (Green Party)
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I thank the Minister of State for joining us. I attended the meeting in Clifden on Sunday and it was heartbreaking to hear the stories of people, especially family members of older people or those close to the end of their lives, who were phoned on Friday and asked to remove their loved ones from Clifden District Hospital. We also heard from doctors who said they were given no notice. One doctor said he was asked not to make any more referrals for palliative care. There seems to be a real problem around communication in the hospital with the HSE. I joined with my colleagues, Senators Kyne and Crowe, and some of the Deputies for Galway West to meet with the HSE for two hours on Monday but we still do not seem to be able to get to the bottom of the problem.

Ollie Crowe (Fianna Fail)
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There is a unity of purpose between my colleagues and I on this very serious issue for Clifden. As has been stated, I certainly got the impression at the meeting that it was a case of death by a thousand cuts. As Senators Kyne and O'Reilly outlined, there is a considerable issue with the increasing population in Clifden and the surrounding areas. We ask the Minister of State for her full support and for an update for the people of Connemara.

Mary Butler (Waterford, Fianna Fail)
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I thank the three Senators for raising this important matter. It is great to have a collaborative approach. It is very effective. I am acutely aware of the significant healthcare role that Clifden District Hospital plays and the excellent level of care and support which it provides to patients and their families in the local community and surrounding areas. Just after the meeting the Senators organised on Sunday evening, Deputy Ó Cuív contacted me at approximately 6.10 p.m. to explain the issue to me, exactly as the Senators have done. I asked that evening for a briefing note from the HSE for first thing the following morning in order that I would know exactly what was happening.

As the Senators have said, in recent years, Clifden District Hospital has been primarily designated to provide convalescence care to patients stepping down from acute hospital. However, with the evolution of Sláintecare and the transition of care from acute to community settings, the need for step-down beds has reduced. In fact, the demand for step-down care is currently an average of less than one patient per day.

Clifden District Hospital also provides respite beds to allow family carers in the community a welcome break. Following a meeting with local politicians and residents in July, Community Healthcare West repurposed some of the convalescence beds to accommodate those requiring respite. I have been advised by the HSE that the average respite demand and occupancy is approximately three beds per night. This brings the total average occupancy of Clifden District Hospital to 3.2 beds per night.

In the Clifden area, St. Anne's community nursing unit is a designated centre registered with HIQA to provide a home for older people. My understanding is that it is approximately 1.5 km from Clifden. Unfortunately, St. Anne's has faced significant challenges over many years to secure sufficient nursing staff, despite national, international and local recruitment drives.

In recognition of service needs in the Clifden area and in order to seek to redress the nurse staffing shortage, HSE Community Healthcare West commenced a process two years ago under the Croke Park public service agreement. In August 2022, under the auspices of the Workplace Relations Commission conciliation services, Community Healthcare West informed the Irish Nursing and Midwives Organisation and SIPTU that it would be issuing a common roster, which commenced on 26 September, covering both Clifden District Hospital and St. Anne's community nursing unit sites in order that staff could be assigned across both sites, based on service needs. The change in rosters involves a change in shift start or finish times of a maximum of 30 minutes and working in one of two locations less than 1.3 km apart.

I have been advised by the HSE that one of the staff representative bodies communicated with the HSE on Friday, 23 September to suggest that it had instructed its members not to co-operate with the revised rosters. Community Healthcare West is committed to ensuring the safety of its residents and patients and, accordingly, put contingency arrangements in place in light of any potential action by staff from 26 September onwards.

Unfortunately, over last weekend, the HSE was unable to secure cover to fill the rosters due to gaps in St. Anne's community nursing unit which the HSE required to fill to ensure the safe care of residents and patients. Community Healthcare West therefore started to develop contingency arrangements for the patients in Clifden District Hospital. Patients and their families were contacted by HSE nurse management and all patients were offered the alternative option of Merlin Park University Hospital should they wish to avail of respite this week. I understand it is approximately 80 km away, which is a long distance. Day care services will continue as normal.

I will clarify that Community Healthcare West has not advised that respite services will end in Clifden District Hospital but simply took contingency measures following advice it received that staff may not co-operate with the new roster. The contingency measures will be implemented only if there are insufficient staff available. In these instances, alternate respite slots can be sought at a later date or patients can be accommodated with a respite bed in Merlin Park. There are no plans to cease respite services in Clifden District Hospital at this time. I have asked the HSE to keep me updated on any developments. I will come back with a further reply.

Seán Kyne (Fine Gael)
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The Minister of State's reply is similar to what we have received in communication over a long time. There are no plans to cease services but it is happening. Services are being reduced and it is not possible to get palliative care. There is no physiotherapy and therefore there are no referrals. Of course the referrals from GUH have dropped because physiotherapy is not available for those who need convalescence and step-down care. This is the crux of the problem. There is a problem with recruitment that needs to be addressed by the community healthcare organisation, CHO. I ask that the Minister of State intervenes with the CHO to ensure there is adequate recruitment to the facility.

Pauline O'Reilly (Green Party)
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We appreciate the Minister of State coming here. It is an urgent issue. While we have heard this response before, there is a lack of clarity, otherwise we would not have had a two-hour-long meeting with the HSE and still not have got any further on Monday. It needs to be addressed. As the Minister of State said, the nearest facility is 80 km away. It is not acceptable for the people of Connemara to not have their district hospital operational.

Ollie Crowe (Fianna Fail)
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The major issue here is referrals. As Senators Kyne and O'Reilly outlined, the issue is that the hospital is not getting the referrals in, which creates uncertainty. The Minister of State alluded to the cost of travelling 80 km on a two-hour journey to Merlin Park. It is not feasible or possible. I ask the Minister of State to do all within her remit to support us on this vital cause.

Mary Butler (Waterford, Fianna Fail)
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I assure the Senators that I will treat this with the utmost importance. Unfortunately, short-stay capacity in public hospitals and community nursing units can be impacted for a number of reasons including HIQA standards, infection prevention and control requirements and staffing challenges. The new rostering system was put in place and contingency measures were implemented to ensure respite services will continue.

Having listened to the Senators and spoken to some of their colleagues in the past day or two, I think there are two issues here. The first is staffing. There has to be a dedicated approach to try to find staff in the short term to continue these services. The second is that we need to get a bit of urgency around the new community nursing unit proposed for that area in which Clifden District Hospital and St. Anne's community nursing unit will amalgamate. My focus will be there.

I have every intention of speaking with the chief officer in Community Healthcare West to see exactly what is happening on the ground. It is very frustrating when there is no communication on rosters because, at the end of the day, vulnerable people are affected the most.

I was here last week answering a question from Senator Lombard on challenges with regard to beds in Bantry hospital for people with enduring mental health conditions. It strikes me that these are two very rural areas which nonetheless have considerable catchment areas. Asking an elderly person who requires respite to travel to Merlin Park, which is 80 km away, is very difficult and is not fair. The Senators have my support in trying to find a resolution.