Seanad Éireann debate -
Wednesday, 7 Nov 2012

Vol. 218 No. 5

Adjournment Matters

Nursing Home Services

Senator John Whelan

I welcome the opportunity to raise this matter on the Adjournment and I am glad the Minister of State at the Department of Health, Deputy Kathleen Lynch, is in the Chamber to respond to it. I do not doubt her commitment, passion and common-sense approach to care of the elderly. Many groups such as Older and Bolder share my opinion of her, even though they are concerned and fearful about what is happening in the sector.

One year ago this week the HSE unilaterally announced the immediate closure of dozens of community nursing homes. It also circulated a list of 64 nursing homes earmarked for closure or drastic rationalisation, which put the fear of God into many communities.

Abbeyleix community nursing home and Shaen community nursing home in Portlaoise - two of the three remaining community nursing homes in County Laois - were on the list. Before the Minister of State took up her post, her predecessor had presided over the closure of 20 beds in St. Joseph's Ward in Mountmellick. The beds in question remain closed. If the HSE decision had been implemented unchecked - the Minister of State played a key role in intervening and having it referred back for review and policy consideration - we would have been left with just one community nursing home in County Laois. One of the biggest wards in the nursing home in Mountmellick has been closed and mothballed. Like the patients, families, staff who have been affected by the closures, I am most grateful to the Minister of State for taking the time to visit Shaen community nursing home in Portlaoise and Abbeyleix community nursing home. I know she was impressed with the quality of care she saw at first hand when she called unannounced to the homes in question. It was a genuine visit. There were no airs and graces following her arrival.

I am sorry to report to the House the sad news that two of the three elderly ladies who had showed great courage and guts by taking a High Court action against the HSE this time last year, Mrs. Maureen Delaney and Mrs. Catherine Kelly, passed away in recent weeks. This has caused no shortage of distress in the community. The third lady, Mrs. Bridget O'Neill, remains hale and hearty. She is a strong and robust woman. Does the Department of Health intend to smoke out the entire community and wait until there is no one left? One year on, we do not know what the outcome of the review is and we are not clear on the policy the Department is pursuing because it seems to be at odds with Government policy as set out in the programme for Government. In the last week I was shocked to learn in response to a parliamentary question in the Dáil that the HSE had presided over the closure of 1,200 further nursing home beds around the country. Essentially, it is closing hospitals down by stealth. If it has its way, it will leave us totally at the mercy of private nursing homes. I have no ideological problem with private nursing homes. Many of them are very good. However, those involved in such homes will admit that they are unable to, incapable of and unwilling to care for high dependency patients such as those with severe Alzheimer's disease and dementia who are cared for in Shaen community nursing home.

I hope the Minister of State can shed some light on what exactly is happening in this sector. What is the policy of the Government on this matter? What is the future of Abbeyleix community nursing home and Shaen community nursing home?

Minister of State at the Department of Health (Deputy Kathleen Lynch)

I thank the Senator for raising this issue and giving me an opportunity to update him and others who have an interest in this matter.

The 2012 national service plan of the HSE which was published in January anticipated that between 555 and 898 beds would close during the course of the year. Some 492 beds had been closed by the end of September. It is not expected that the minimum projection of 555 will be reached before the end of year. Around the time of publication of the service plan, the Minister for Health asked the HSE to draw up a viability plan for its residential units for older people. The aim of the plan is to identify the maximum number of beds and public community nursing units which can be retained in each region within existing available financial and staffing resources. This will give a clear indication of the viability of all community nursing units across the country and the composition of public bed provision in the future. The HSE is finalising the plan which will form the basis for discussions between the Department and HSE with a view to submitting a final set of proposals to the Minister.

I wish to speak about the provision of services in the midlands region. The Senator will be aware that in 2011 the HSE considered a proposal to close Abbeyleix community nursing unit and St. Brigid’s Hospital in Shaen. My colleague, the Minister for Health, and I met local action groups and elected representatives to discuss these proposals. Both of us have visited each of the units in the last year. I was sad to hear the news the Senator gave to the House about two of the Abbeyleix residents who had instigated court proceedings in 2011 to challenge the proposed closure. Our sympathy should go out to the families of the ladies in question. When I met the women who were taking the case, it struck me that they were incredibly strong, forthright and clear in their thinking, despite their advanced years. On 7 December 2011 the HSE agreed to set aside its decision to close the Abbeyleix facility. Following the court proceedings, the HSE confirmed that it intended to carry out a comprehensive consultation process before making any recommendation to the Minister on the future of the Abbeyleix and St. Brigid’s Hospital units.

On 24 May last the HSE launched a public consultation process on the planning and provision of services for older people in the midland counties of Laois, Longford, Offaly and Westmeath with a view to ensuring the most efficient and effective delivery of its services within available resources. Part of this process involved a review of the HSE's current long-stay residential units, including the potential closure of Abbeyleix community nursing unit and St. Brigid's Hospital in Shaen. The consultation process has been completed. I understand all of the relevant documentation was presented to the HSE designated officer for consideration on 16 August and that the officer’s recommendation is expected presently. In accordance with the HSE protocol consultation document, this recommendation will be conveyed to the national director of integrated care and the chief executive. If the HSE concludes that full closure of any unit is necessary, a recommendation to this effect must be made to the Minister. I can confirm that both facilities are registered with the Health Information and Quality Authority as designated centres for older people. Service providers are legally required to provide six months notice for the regulator before a designated centre can close.

Senator John Whelan

I am grateful for the Minister of State's informative response which includes some good and interesting detail. She has pointed out that the review was concluded on 16 August. Her suggestion that a recommendation is expected "presently" is a little vague for people from where I come. What does "presently" mean? How long is a piece of string? I would like to receive some indication of what is meant by "presently". It is causing undue distress and anxiety for elderly people, including some who are in their 90s, in the run-up to Christmas. A year has passed since the original proposal was made. As the Minister of State said, the Abbeyleix unit is registered with the Health Information and Quality Authority. It is able to cater for and cope with 33 clients, but it has just 22. It is not being utilised to its full advantage, which is not serving anyone well. Perhaps those beds might be used to care for people who are in acute beds in hospitals but do not need to be. If these resources are not being used properly, they are costing the Department of Health more money than is necessary. The unit is not operating at maximum capacity. I am glad to hear that the buck will stop with the Minister who will have the final say on the matter after the recommendation is made. It would not make sense to leave the region without sufficient community nursing home beds. The people of the area would be totally at the behest of the private sector. I reiterate that the private sector does not want to cater for high dependency patients and does not have the capacity to meet the growing demand for geriatric beds, of which I have strong evidence.

Deputy Kathleen Lynch

We have had long discussions about the Abbeyleix and Shaen facilities for many months. I am sure the Senator will be aware that it is not strictly a question of the level of care provided. As he has rightly pointed out, the level of care provided is excellent. Other factors have to be taken into consideration. When I said a recommendation "is expected presently", I meant the report would be on the Minister's desk shortly. It will have to be discussed. I am sure the Minister will not take an arbitrary decision on it.

Air Services Provision

Senator Trevor Ó Clochartaigh

Cuirim fáilte roimh an Aire Stáit. Is cuairteoir rialta í ar an Teach seo. Tá míle fáilte roimpi. Tá mé ag ardú ceiste a bhaineann le Roinn na Gaeltachta go bunúsach - an tseirbhís eitleoireachta a fhreastalaíonn ar na trí oileán Árann. Tá a fhios aici go bhfuil seirbhís aeir go dtí na hoileáin - i dtosach ó Ghaillimh agus níos déanaí ó Aerfort na Minna i gConamara - le níos mó ná 40 bliain anois. Is cuid fíor-bhunúsach agus fíor-thábhachtach d'infreastruchtúr na hoileáin í an tseirbhís seo. Bhí dlúth-bhaint ag an aerstráice agus an seirbhís aeir leis na roghanna a rinne daoine chun fanacht ar na hoileáin, dul amach le cónaí ar na hoileáin nó gairm a dhéanamh ar na hoileáin.

Má táimid chun na huimhreacha a choinneáil suas sna scoileanna, má tá daoine chun gnóthaí a bhunú ar na hoileáin agus má tá sé le bheith níos fusa do dhaoine cóir leighis, srl., a fháil, tá an tseirbhís aer riachtanach. Ag cruinniú leis an Aire Stáit, an Teachta McGinley, le déanaí, tugadh le fios go bhfuil an fordheontas a chuireann an Roinn ar fáil don tseirbhís aer i mbaol. Bhí ráfla ann go mb'fhéidir go bhfuil an fordheontas le gearradh. Tá an-imní ar phobal Inis Mór, Inis Meáin aguis Inis Oírr go dtarlóidh sé sin. Mar a dúirt duine amháin, dá ndéarfaí le duine i mBaile Átha Cliath a bhraitheann ar an Luas go bhfuil an tseirbhís sin le n-imeacht, bheadh an cairpéad bainte faoi chosa an duine sin. Is féidir an rud céanna a rá faoin tseirbhís bus i gceantair tuaithe. Cé go dtéann seirbhís farantóireachta maith go leor amach go dtí Oileáin Árann chomh maith céanna, tá an tseirbhís aer riachtanach do phobal na n-oileán. Labhair an dochtúir a oibríonn ar Inis Mór, Marion Broderick, go poiblí faoin gceist seo an tseachtain seo caite. Dúirt sí go bhfuil an tseirbhís aer fíor-thábhachtach i gcás aire a thabhairt d'othair a bhíonn orthu taisteal isteach go rialta go Gaillimh. Níl sé feiliúnach do chuid mhaith acu taisteal ar an mbád mar tá an t-aistear ró-fhada agus déanann sé dochar dóibh. Cabhraíonn an tseirbhís aer le gach éinne go dteastaíonn uathu aistear i bhfad níos tapúla a dhéanamh ó am go ham.

Nuair a labhair mé le fear gnó - Tarlach de Blácam - a bhfuil gnó idirnáisiúnta atá ag plé le cúrsaí cniotála bunaithe aige ar Inis Meáin, dúirt sé liom gur ionann deireadh a chur leis an tseirbhís eitleoireachta agus deireadh a chur leis an ghnó atá ar bun aige. Tá 16 duine fostaithe aige sa chomhlacht, a dhéanann a gcuid gnó go hidirnáisiúnta, go háirithe leis an tSeapáin. Bíonn orthu earraí agus samplaí dá gcuid oibre a chur thar lear go rialta. Bíonn custaiméirí an chomhlachta ag súil le seirbhís tapaidh. Ní thagann an bád isteach sách rialta ionas gur féidir é sin a dhéanamh. Tá an comhlacht ag brath go hiomlán ar leithéidí DHL, a phiocann na hearraí seo suas nuair a thuirlingíonn an t-eitleán. Nuair a bhriseann píosa innealra sa mhonarchan, mar a tharlaíonn ó am go chéile, caithfidh an comhlacht píosa nua a fháil isteach go tapaidh. Muna bhfuil an tseirbhís seo ar fáil chun a leithéid a dhéanamh, is féidir leis an 16 duine atá fostaithe san ionad seo bheith díomhaoin ar feadh roinnt laethanta.

Caithfear glacadh leis go bhfuil an tseirbhís eitleoireachta go dtí Oileáin Árann mar bhunchuid d'infreastruchtúr, córas iompair agus córas sóisialta na trí oileán. Tá sé mar sin le 40 bliain. Is mar gheall ar sin gur éirigh leis an daonra fanacht ar na hoileáin, go bhfuil na scoileanna faoi bhláth agus go bhfuil seirbhísí sóisialta ann, srl. Tá mé ag impí ar an Aire Stáit deimhniú dom nach bhfuil sé i gceist ag an Rialtas drannadh leis an fhordheontas seo. Sa bhuiséad atá ag teacht, ní cheart aon ghearradh siar a dhéanamh ar an airgead a íoctar le chinntiú gur féidir seirbhís eitleoireachta amach go dtí na trí oileán a chur ar fáil. Tá an tseirbhís ríthábhachtach do na hoileánaigh. Tá siad trína chéile le seachtain anuas. Tá cruinnithe poiblí eagraithe acu ar na hoileáin éagsúla. Beidh cruinniú acu le hionadaithe tofa i nGaillimh Dé Luain seo chugainn. Bheadh sé tráthúil dá bhféadfadh an tAire Stáit leid a thabhairt dúinn nach bhfuil sé i gceist drannadh leis an tseirbhís seo. Ba ionann sin agus na seirbhísí bus nó Luas a bhaint as ceantair eile.

Deputy Kathleen Lynch

The Senator will appreciate that my Irish is not as proficient as his, which is very nice to listen to.

The Government recognises that our islands have a precious built and natural history and a rich cultural and linguistic tradition. These are valuable assets for the island communities and the country in general. The maintenance and development of sustainable communities on the islands have been the goals of the Department of Arts, Heritage and the Gaeltacht for many years and substantial investment has been made to this end. The 2007-13 National Development Plan identified measures aimed at promoting the future development of the islands, including the development of the piers on the three Oileáin Árann as a flagship project. This work has been completed. Over €100 million has been spent on island infrastructure in the past ten years. This includes the cost of the redevelopment of Cill Rónáin Harbour on Inis Mór at a cost in excess of €40 million.

The Department of Arts, Heritage and the Gaeltacht has agreed contracts for 20 islands to which passenger ferry, connecting bus, cargo and air services are provided by 24 contracted operators. School transport links are provided for students from Inishbofin, Inishturk and Clare Island who attend mainland schools. In awarding the contracts, priority is given to the needs of island communities. The timetables for these services that have been agreed with island representatives allow inhabitants a great deal of flexibility when going about their daily lives. Passenger and cargo fares have been significantly reduced for islanders as a result of these subsidised services. The standard of the vessels involved in the provision of these services and the overall comfort of passengers have improved considerably, mainly as a result of the subsidies provided. Expenditure of €5.93 million was incurred in 2011 to provide passenger and cargo ferry, air and connecting bus transport services for offshore islands under contracts administered by the Department of Arts, Heritage and the Gaeltacht. These contracts ensure the provision of regular access for island communities to the mainland at an affordable cost to island residents. Owing to improved access to the islands, visitors have greater options than ever before when choosing to visit particular islands, as a result of which economic benefits accrue to the local and national economy.

The Department of Arts, Heritage and the Gaeltacht has a public service obligation contract with Aer Arann Islands for the provision of air services for the three Oileáin Árann. This contract will expire on 31 August 2013. The total cost of the public service obligation contract with Aer Arann Islands for the period from 1 September 2009 to 31 August 2013 is over €6 million. The exact figure is provided in the reply circulated. The contract provides for three daily return flights to Inis Mór and two daily return flights to Inis Meáin and Inis Oírr on weekdays, with four return flights at weekends. Additional flights are also provided, depending on demand. A separate contract is in place with Bainistíocht Aerfoirt Teoranta, a subsidiary of Aer Arann Islands, to manage the three aerodromes on Oileáin Árann and two airstrips at Inishbofin and Clifden in County Galway. The cost of the contract for the period from 1 March 2012 to 31 August 2013 is €540,580.

The Department of Arts, Heritage and the Gaeltacht appreciates the importance of this service for the residents of the three islands. However, account must be taken of the overall funding available to the Department for offshore islands. Approximately 60% of this funding is being spent on passenger and freight services to the three Oileáin Árann. According to the 2011 census of population, some 1,251 people live permanently on the three islands. This represents approximately 43% of the total population of the offshore islands. The Department will make every effort to ensure the funding available for offshore islands in 2013 is used to provide safe, regular and high quality access. It recently agreed a five year ferry contract for the provision of a scheduled ferry service from Ros a' Mhíl to Inis Meáin and Inis Oírr at a cost of €800,000 per annum. In addition, the tendering process has begun to renew the ferry contract from Ros a' Mhíl to Inis Mór which will expire on 31 January 2013. The Senator will appreciate that the 2013 Estimates process is ongoing. The Department has not yet been informed of its allocation for 2013. Therefore, no decision has been made on the renewal of the air service to and from the three Oileáin Aránn. We are very conscious of the preciousness of the islands' only means of transport.

Senator Trevor Ó Clochartaigh

I did not mean to offend by speaking completely as Gaeilge and I am sorry if that was the case.

Deputy Kathleen Lynch

The Senator did not offend me at all.

Senator Trevor Ó Clochartaigh

I am surprised the Department of Arts, Heritage and Gaeltacht has supplied an answer in English only, which is not like it because it has given us both on every other occasion. I appreciate that the Minister of State will read as Béarla but, at the least, an Irish language copy should have been provided.

The provision of safe, regular, high quality access is key. The case made by the islanders is that businesses and medical and tourism services on the island are dependent on the air service, which is at the core of delivery. I am disappointed the Minister of State has not been able to say the company will continue the service for sure, although I can appreciate that a budgetary process is ongoing.

I ask that the Minister of State, Deputy Lynch, would ask the Minister, Deputy Deenihan, or the Minister of State, Deputy McGinley, whether they would be willing to sit down with the stakeholders given it is important there would be representatives from the co-ops and the islander community as well as representatives from Aer Arann Teoranta, which runs the service, from the airports and from the Department. The islanders have suggested ways in which this could be averted and money saved while still providing an air service and operating within the parameters required by the Department, which is crucial.

Deputy Kathleen Lynch

I was not in the least offended as I love listening to the Irish language. I very much hear what the Senator is saying in terms of the medical service, in particular the emergency element that may be necessary from time to time, although thankfully not very often. When this is the only means of transport, it is essential, and I know people get very worried about it. The Minster of State, Deputy McGinley, would have been present but, while he is unfortunately not available, I will convey the Senator's request and ask him to refer to the Senator directly.

The Seanad adjourned at 8.15 p.m. until 10.30 a.m. on Thursday, 8 November 2012.