I thank the Committee on Public Petitions for the invitation to meet with it to discuss the Owenacurra Mental Health Centre in Midleton. I am joined by my colleagues Dr. Sinead O’Brien, executive clinical director of Cork Mental Health Services and consultant psychiatrist, Mr. Jim Ryan, head of operations of HSE Mental Health Services and Mr. Alan O’Connell, assistant national director of HSE Estates. I take this opportunity to thank the committee for the invitation to address it and discuss Petition No. P00042/21 on saving the services of the Owenacurra Centre, Midleton, County Cork.
First, I acknowledge the moving testimony given to this committee by Dr. Orla Kelleher when it discussed the closure of the centre earlier this year. We understand that moving from the Owenacurra Centre to a new home is difficult for residents and we are working hard to ensure that every resident’s transition is as supported as much as possible. I hope that the details that we share today explain the reasons for the difficult but necessary decision to close the centre.
The Owenacurra Centre is a single-storey mental health facility that provides a continuing care service as approved centre unit with the Mental Health Commission in Midleton. The service is provided by Cork Kerry Community Healthcare mental health services and it is registered with the Mental Health Commission to deliver an inpatient service for up to 24 people for long-stay psychiatry of later life mental health rehabilitation and continuing mental healthcare rehabilitation.
I refer to the rationale for the closure. For the information of the committee, the original plan for the Owenacurra approved centre was to refurbish the day centre section of the building to address privacy concerns for residents of the centre. The current building simply did not allow for the kind of care and recovery that a modern service should provide. As a result of the Covid-19 pandemic, these works were delayed.
Notwithstanding the fact that there were no conditions attached to the registration, escalation or enforcement actions since the previous inspection in 2020, the Mental Health Commission completed an inspection between 16 and 19 February 2021, raising serious concerns with regard to persistent non-compliance with regulation 22, which refers to premises. On foot of this, Cork Kerry Community Healthcare committed to providing plans for the Owenacurra Centre to work to address the non-compliance. These concerns echoed the ongoing concerns of local management about the condition and unsuitability of the current building to serve the needs of the people using the service.
During quarter 2 of 2021, service planning and delivery started to recommence in a more normal way as Covid measures eased. Covid-19 also had the added effect of focusing additional attention on the standard of accommodation available in residential settings across the community healthcare organisation, CHO. Subsequently, the originally proposed works in Owenacurra were revisited and reviewed in both this context and in the context of other concerns evident in the centre, including fire risk assessment, asbestos survey, infrastructural deficiencies, etc.
Following a review by HSE Estates of the independent fire risk assessment, asbestos survey, mechanical and electrical infrastructure reports and taking account of the structural design of the Owenacurra Centre, all of which were undertaken to identify risks and potential solutions, the view was formed that the investment of significant capital did not represent the best use of public funds in providing the best solution for the service. Given the unacceptable deficiencies in the accommodation and the extensive level of investment required to provide a centre that would meet the resident’s needs, the decision became clear to close the centre and identify alternative appropriate options for the residents.
The following outlines the centre's further deficiencies and issues.
The findings of a fire risk assessment report survey that was undertaken detailed works required to address these deficiencies, which were significantly more than repair works. An asbestos survey detailed findings of a decorative coating throughout the ceilings in the centre that contains chrysotile asbestos, which would need to be removed when completing necessary fire risk works to a significant number of ceilings within the building. The presence of asbestos was also noted in the flooring. Essential systems such as heating, electrics and building fabric are beyond their end of useful life. HSE clients continue to live in 7.5 sq. m bedrooms with no en suite facilities, when the current best practice to achieve is 22 sq. m. including an en suite facility. There is a lack of social spaces, therapeutic spaces and essential staff support accommodation. The fact is that investment of significant funding into the building still would not bring the unit up to an acceptable accommodation standard for residents and other service users.
As has been outlined previously, the Owenacurra Centre is currently circa 1,050 sq. m. Based on existing standards of accommodation for the client profile in the centre, a new facility with the same number of bedrooms would need to be approximately twice the size of the current centre, that is, a facility in the order of 1,800 sq. m to 2,000 sq. m would be required. This does not include other essential requirements necessary on-site, such as secure, external recreational and therapeutic spaces, appropriate parking spaces, as well as creating an independent day centre. The age and type of construction of the building, a Roh-Fab building with a useful life span of approximately 40 years that has currently been in operation for circa 50 years, means the ability to comply with current building regulations and Government energy performance requirements would not be capable of being met.
Notwithstanding the above, a further significant factor regarding any potential refurbishment options is that the existing structural design is not capable of facilitating such major renovation works without requiring a complex and extremely costly engineering solution to maintain its integrity while any works would advance. In addition, it would be impractical and inappropriate to undertake works of such significance on a phased basis, with residents in place, due to issues including health and safety, the overall welfare of residents and staff, fire control, asbestos and aspergillosis risks due to the nature of the works involved. As there was no way to bring the centre to a standard where it would be fit for purpose at a realistic cost, HSE Cork Kerry community healthcare was left with no choice but to close the centre. The replacement of the building is now proposed as the most effective way of ensuring a facility that meets with residents' needs, meets with best practice guidelines for such accommodation, meets current building standards and will meet the Government's energy target requirements for public buildings in a cost-effective manner.
The difficult decision to cease services at the Owenacurra Centre was taken by me as chief officer, having considered the information pertaining to the condition of the building, its requirement to comply with regulations and its future appropriateness to provide specialist residential services. The decision was supported by the mental health head of service, the area director of nursing for mental health and the executive clinical director for mental health. There has been significant public debate on whether it would be possible to refurbish the existing Owenacurra Centre, with residents remaining on-site during the works. The position is that this would not be safe and would not be in the best interests of residents. The expert reports outlined and taken into account in the decision make it clear that investment in the current building would not deliver the quality of accommodation that residents deserve, in line with modern requirements and regulatory standards within a realistic budget.
On consultations with families and residents, the assessed needs and will and preference of residents have always been to the fore in the context of their relocation to other appropriate settings. The HSE has been very conscious of the need for engagement with residents during this difficult period and has extended the closure period of the centre while the services and residential requirements of residents are being identified and sourced. This assessment consists of individual care plan multidisciplinary reviews with the residents, consultant psychiatric reviews, formal family meetings and informal family contacts. At all times, residents have been given the option to approach named members of staff to provide supports and information relating to their assessed needs and will and preference. There is an ongoing advocacy service available and in place to discuss and support residents’ concerns.
Mental health services in Cork Kerry community healthcare are working in close collaboration with the affected service users and their families to find more appropriate accommodation. This process is being handled with sensitivity with regard to the wishes and preferences of each individual resident and is aligned to his or her current needs, including his or her health and safety and provision of appropriate treatment and care. Residents are moving on a phased basis and engagement with each resident is ongoing. Eleven residents have moved to a variety of new settings and our staff remain in contact with them. Their new homes include nursing homes and community residences, and these new placements fit each person’s individual assessed needs. Residents are settling into their new homes and continue to receive support in a more appropriate environment.
For the remaining residents, the supports being provided as they move through what is a difficult process for them will continue, as will the engagement with them and their families. Our priority now is to work with the remaining residents to identity new homes for them, which will meet their needs as assessed by medical experts, as well as their own will and preference. This work by our clinical experts will continue to be a support to the remaining residents in the Owenacurra Centre.
As regards commitments in Midleton, we remain committed to providing quality mental health services for the population of east Cork and the wider region. We strive to support the principle of maintaining people in their own homes and communities where possible, and bringing the specialist services required as close to homes and communities as possible. We have provided assurances that we will explore options to relocate and reinstate the day centre in the town as soon as possible. The day centre has moved to a new location and is operating there successfully. The longer-term plan is to provide this service at the redeveloped Midleton Community Hospital site.
I wish to advise that we will provide a new ten-bed rehabilitative focused residential unit in Midleton town. This service will have 24-hour staffing, and will have a focus on supporting people to return to their homes and communities. We will appoint a development team, which will conduct an options appraisal and engage with people using mental health services in the area. The Owenacurra site will be among the possible locations considered. A capital submission initiation document for this proposed development has been submitted for the approval of the national capital and property steering committee of the HSE. A meeting of this committee is scheduled for the end of September when this proposed development will be discussed.
In addition to the above, we will also provide at least one community residence in Midleton town for three or four residents. The model for this service will also be rehabilitation focused, with healthcare professional staff supporting the residents and with 24-hour staffing in place. A suitable property, located within Midleton, is being pursued for this purpose and a property transaction approval form for the purchase of this property has also been submitted for the approval of the national property review group. Our plan for residential mental health services in the east Cork area will ultimately deliver a modern service into the future and in line with Government policy.
I hope that this detailed account of the rationale for the closure of the current Owenacurra Centre, and the future transition of the services with a rehabilitation centre and community residence service for Midleton and its environs, will see the further transition of service to a much more community-based recovery approach. The supports being provided to current residents as they move through what is a difficult process for them will continue, as will the engagement with them and their families. The recent restoration of day services is also a key component of the transition. Cork Kerry community healthcare acknowledges the challenge it faces to implement the transition and the fact that many of its mental health residential centres in Cork, in particular, require replacement or refurbishment. The mental health management team of the CHO are committed to work through these issues to ensure a modern and proactive service is achieved to meet the needs of the community.