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Committee on Public Petitions debate -
Thursday, 15 Sep 2022

Consideration of Public Petition on Saving the Services of the Owenacurra Centre in Cork: Discussion (Resumed)

I want to wish everybody a good afternoon and welcome them to our public meeting. I see that we have some members present in committee room 4. Apologies have been received from Senators Craughwell, Buttimer and Warfield at this stage. We have substitutions. Deputy Quinlivan is substituting for Senator Warfield and Senator Maria Byrne is substituting for Senator Buttimer.

The Ceann Comhairle, Deputy Seán Ó Fearghaíl, and the Cathaoirleach, Senator Mark Daly, have published a Covid-19 code of conduct for the parliamentary community from March 2022. Face masks should continue to be worn when people are moving around the campus and during the meeting except when speaking. This will help to reduce the risk of Covid-19 spreading among the parliamentary community. We ask for full co-operation on this.

First on our agenda is to approve the minutes of the private and public meetings on 6, 7 and 13 July 2022. They have already been approved at a virtual private meeting, but we must do this for procedural reasons. Is that agreed? Agreed.

I remind members of the constitutional requirement that they must be physically present within the confines of the place in which Parliament has chosen to sit, namely, Leinster House, in order to participate in public meetings. I will not permit members to participate where they are not adhering to this constitutional requirement. Therefore, any member who attempts to participate from outside the precincts will be asked to leave the meeting.

Our next business is the engagement with the officials from the mental health services at Cork Kerry Community Healthcare, Cork Mental Health Services and Capital and Estates HSE South of the HSE board on Petition No. 00042/21 on saving the services of the Owenacurra Centre, Midleton, County Cork from Ms Joanna Curtis.

Before we start, I wish to explain some limitations to parliamentary privilege and the practice of the Houses regarding references to other persons or evidence. The evidence of witnesses physically present or who give evidence from within the parliamentary precincts is protected pursuant to both the Constitution and statute by absolute privilege. The witnesses are reminded of the long-standing parliamentary practice to the effect that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable, or otherwise engage in speech that might be regarded as damaging to the good name of the person or entity. Therefore, if any of their statements are potentially defamatory in relation to an identifiable person or entity, the witnesses will be directed to discontinue the remarks. It is imperative that the witnesses comply with such direction. Before we hear from our witnesses, I propose we publish their opening statement on the committee's website. Is that agreed? Agreed.

On a side note, we would like to remind members that we are here to tease out issues rather than individual cases at Owenacurra where the person is identifiable.

On behalf of the committee, I would like to extend a warm welcome to Mr. Jim Ryan, acting national director of community operations and assistant national director, head of operations of mental health services; Mr. Michael Fitzgerald, chief officer, Cork Kerry Community Healthcare; Dr. Sinead O’Brien, executive clinical director of Cork Mental Health Services; and Mr. Alan O’Connell, assistant national director of Capital and Estates HSE South. I understand that it is Mr. Michael Fitzgerald who will make the opening statement and I suggest he should make it for around ten minutes. We will then have questions and comments from members. We will give each member around ten minutes, which should allow members to come in more than once.

I now invite Mr. Fitzgerald to make his opening statement.

Mr. Michael Fitzgerald

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.

I thank Mr. Fitzgerald. Before I allow other members in, I have a few points myself. Can Mr. Fitzgerald give us a date on which the closing of Owenacurra was discussed? The Irish Examiner has given a date of 2019, while other reports have stated that it was 2021. Is it not strange that a development that would upend people's lives so much apparently took place during meetings for which no records were kept? We talk about best practice. Is it not strange that these types of meetings take place at which no one records the discussions that go on?

Mr. Michael Fitzgerald

There are two things. As the Chairman knows, it was not initially the intention to close the facility. It was the intention to look at it in the context of some refurbishment to be done. I took the decision to close it on the basis of the totality of the information.

It must also be looked at in the context of where we were with Covid and what we had learned around it. The decision was made by me but it certainly was based on the availability of the information, not just from a single source but from a perspective accounting for the capacity of the building, what we needed to do to it and what we needed to invest in it, as well as a serviced site.

I would suggest the HSE building issues in Owenacurra are replicated right across Cork and every other county. The buildings are so old that they all have the same problems. How was Owenacurra singled out?

Mr. Michael Fitzgerald

The Chairman is correct. While there has been significant investment in many centres – I can speak for the CHO area across Cork and Kerry – we have significant deficits in a number of centres. Some will need either significant refurbishment or replacement. We have developed an overall plan from a strategic perspective around those. There is a specific aspect to be considered concerning the information I provided in my opening statement on the fabric of this particular building, its nature and its lifespan. No more than with any of the other buildings in which we are investing, even by way of an interim arrangement until we have to replace them, the issue with the building in question was that once one started to work on it, all the other issues would come to the fore very quickly. That was the specific issue with regard to this particular building.

I have just one more question before allowing others to contribute. Was Owenacurra chosen just on a financial basis? None of the recommendations we have seen states it should have been closed. The Mental Health Commission has consistently given the wards of St. Stephen's and St. Finbarr's hospitals lower compliance ratings than Owenacurra. Was Owenacurra chosen for closure on a financial basis rather than anything else?

Mr. Michael Fitzgerald

Absolutely not. It was not chosen from a financial perspective at all. Mr. O'Connell might talk about the fabric of the building itself. Certainly, the fabric is a significant issue.

Mr. Alan O'Connell

Mr. Fitzgerald is correct. Initially, before Covid, the plan was to refurbish a section of the building to provide a day centre whose entrance would be separate from that of the residents' living space. It was the case that the day centre had to be accessed through areas where residents were living. The provision of privacy at this level was regarded as involving interim works. After Covid, when the projects were being reviewed in the context of the fire risk assessment works that were required, part of those works involved the replacement of a significant number of ceilings, amounting to approximately 80% to 85% of the total throughout the centre. Because of the amount of refurbishment required, the building itself would have had to have been decanted of residents. The work required on the ceilings, considered in the context of the Mental Health Commission's observation that patients' bedrooms were too small, not en suite etc., would trigger a number of works that would have to be reviewed in order to provide a centre of the standard required by the building regulations. The knock-on effect of starting a chain of refurbishment works means the investment required quickly adds up in a building whose infrastructure is such that those works cannot be done in a cost-effective manner.

The HSE has taken up the very foundations of community care, that is, of people being looked after in their own community. They are being spread out among facilities that are in some cases questionable. It is not me but the Mental Health Commission that states they are not up to the standard of the Owenacurra Centre. There is no comparison between taking people out of single rooms and putting them into double rooms in addition to making no allowances for public transport for families who wish to visit.

I thank the representatives for attending. Where do I start? We are back here again. In the opening statement, Mr. Fitzgerald said his organisation is working very hard to ensure every resident's transition is supported as much as possible. We are not talking about individual cases here but about more than one. Mr. Fitzgerald will be aware that the engagement with the residents of Owenacurra Centre on the transition has not been very good. It has been worrying. Some of the family members have approached me on the possibility of coercion and on how there has been no engagement with them.

The HSE's submission refers to the rationale for closure. It states that as a result of the Covid-19 pandemic, the works were delayed. However, there were works prior to that. I have a record of works that were supposed to have been done in 2016. That is well before the onset of Covid. I have said before that the HSE is the landlord–proprietor of the buildings. We will talk specifically about Owenacurra. The spin seems to be that it is the Mental Health Commission's fault because it has said the place is not fit for purpose. It is telling the truth but my argument is that the HSE, as proprietor, should have been maintaining the buildings all along. This never happened. It is now handy for the HSE to say that, because the building is not fit for purpose, it will just close it and move the patients out. They are not patients; they are residents.

It is not just a question of the building and the area but of all the services that go with the centre. I include long- and short-term respite and chiropody services. The dentist is across the road. The centre is fully integrated. I met a resident of the centre in my own town last Thursday. He had the luxury of being able to go down the main street. He was sitting outside a shop having a cup of coffee and some chocolate cake. He will not be able to do that at St. Catherine's or Sarsfield Court. He would be better off in Fota than in Sarsfield Court because he is not going to meet anyone there.

The HSE is on about the best possible outcomes for these people. The HSE is moving them from the Owenacurra because of the compliance rating, yet the two premises it wants to put them into are less compliant. On top of that, the system seems to be working perfectly right now, despite the delegates' statement that the building is not fit for purpose. The staff have not been treated very fairly given the lack of information on what is going on. Members of the public have signed the petition. There is much public anger and in a petition several weeks ago, we collected over 600 signatures, of which I can give a sample.

Those were the points I wanted to make but I also want to refer to the size of the building and what is needed. The delegates know the location of Owenacurra Centre and that the community hospital is across the road. There are many acres across the road there are not built on. It is possible to do a new build there while the remaining residents stay in situ in Owenacurra Centre.

Let me outline the fear. I have not heard anything about the ten-bed unit the delegates are talking about, who is building it and whether planning permission has been sought or approved. It is pie in the sky. These things take a very long time. The demand for the services exists. There were 26 on a waiting list for the two short-term beds before Covid. I have had five cases in my office in the past three weeks looking for identical services in the area but we cannot get them in anywhere.

Between 2000 and 2002, there were 69 suicides in east Cork.

One can add more onto that, up to 2022. We have an ageing population. I am sure the HSE has data similar to what we have with constituency dashboards on demographics to show what is going on. One can predict, more or less, what will happen.

The biggest fear here is that the 600 people plus who signed those petitions and I do not believe that we will get the same level of care in Midleton and east Cork, specifically on respite and mental health services and the additional day mental health services. The fear is that once the service is gone, it is gone. It looks like this is being replicated in other parts of the country. I watched a while ago on the news about the scaling down of services in Bantry. We have the community health centre out the road in Castlemartyr being scaled down because it is not fit for purpose. There seems to be a tsunami in this regard.

Mr. Fitzgerald stated in his statement: "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." The only medical expert is the person himself or herself who is living in the Owenacurra Centre. They call that their home. We spoke to them repeatedly. Their preference is to stay at home and their home is the Owenacurra Centre. They have told me St. Catherine's is not their home and Sarsfield Court is certainly not their home. There is a rights-based issue here as well. The HSE is saying the building is not fit for purpose. The HSE should leave those people there - it has the facilities across the road to expand - and replace it with what the HSE wants, that is, a modern up-to-date proper service, but do it in tandem.

The public trust has been lost. That is sad to say. We are dealing with some of the most vulnerable people in society who most of the time do not have the capacity for decision-making. It is a pity that the decision support services are not up and running because I would be reporting the HSE on this as a human rights issue, not as an aesthetic issue. They are all talking about a building and a service. I do not care about that. That is the HSE's problem because that is where it failed at the start. The HSE did not maintain it. The HSE cannot blame Brexit for it. It cannot blame Covid for it because we have the documents here. There were repairs to be carried out, in 2016 and 2017. Therefore, we are not buying that.

I do not think Mr. Fitzgerald is able to give a commitment on what I am looking and hoping for here. What the people of Midleton and east Cork want is to maintain all the existing services, not to break any of them. If that building cannot be rebuilt or refurbished, the HSE should build a new, proper one with the same number of beds in Midleton and keep it integrated within the town and community-led.

Mr. Fitzgerald stated that, "A suitable property, located within Midleton, is being purchased...". Has a property been bought in Midleton or not? We need to know.

This "ten-bed ... focused residential unit in Midleton ... [with] 24-hour staffing ...". That "24-hour staffing" seems to be a new one. Are St. Catherine's and the other one outlined above staffed on a 24-hour basis?

Mr. Fitzgerald also stated: "Our plan for residential mental health services in the east Cork area will ultimately deliver a modern service into the future in line with Government policy." That, "into the future", is the problem. This could take ten or 20 years. What happens to all those people who need services? It will be gone.

I have a lot to say on this. This is not a personal attack on the HSE officials. It is an attack on the system which is not working but on which, we hope, with the HSE officials' support, we could work together.

We have received responses from the Oireachtas Joint Committee on Public Petitions. We also have a response from the Joint Committee on Health. It states that the Joint Committee on Public Petitions fully supports the Joint Committee on Health in expressing its dissatisfaction and concern with the Minister of State at the Department of Health with responsibility for older people and mental health, Deputy Mary Butler, on the decision that the Owenacurra Centre is to be closed and also calls on the Minister of State to reverse the decision urgently. It states that it is enclosing for my own information the text of the petition as provided by the petitioner in addition to a link to the meeting of the Joint Committee on Public Petitions on 7 July 2022. It also states that they did not buy the HSE's original submission on why the building was not fit for purpose. We are still not buying it. We do not want to be dragging them in here every day, every week or every month, but the biggest problem here is we have been going over a year, we have been told the same story over and over again, yet we have seen zero concrete evidence that anything is moving forward.

All that is moving in Midleton, in that Owenacurra Centre at present, is residents being moved out. I am being honest here. It is not of their free will. How can one push people out of a residential unit that they class as their home? Surely there is a constitutional requirement, as a human being never mind as a professional, to give those residents the best level of care possible and also respect their rights and wishes to remain in that centre.

In summary, and I thank the Chair's indulgence and patience on this, I would like to know if the HSE has bought any premises in Midleton. I would like to know if the HSE has looked at building a new centre across the road. I would like to know why we are going from 22 beds down to a ten-bed unit when we have a growing population. Cork city, Cork county and the east Cork populations are predicted to grow by over 12% in the next couple of years. Can we get clarity on why this is happening in this day and age? When I talk to the layperson in the street, he or she says the worst of this is that they are moving the residents from a centre because of compliancy issues but they are putting them into other centres that are less compliant than the one they are in. It is like saying we will take them out of the hotel room and put them into the mobile home. I ask Mr. Fitzgerald to explain how that is rights-based best decision-making and a rights-based place to put people, and how it will be for their betterment. I cannot understand how that can be.

I thank the Chair. I know there is a lot in that.

Mr. Michael Fitzgerald

I will start the response to Deputy Buckley. There are a couple of things to pick up on.

I would be concerned that early on in his statement Deputy Buckley mentioned the word "coercion". I would be concerned that that phrase is out there with regards to coercion. Certainly, in the process and in the methodology that is supplied to discuss the movement, I would be very concerned if there was anything remotely like coercion. I would have to say, if there was, we would certainly want to hear the detail of that because that would certainly be totally inappropriate and it certainly is not part of the ongoing process as far as any of us here is concerned.

On that coercion, I have been told by family members of residential patients who were taken from the Owenacurra Centre and brought to other places to have a look without any of the family members being informed of that until it happened. Mr. Fitzgerald can change the word from "coercion", but it is still wrong. If it is an issue, we can always go with the family members down the protected disclosure route. We are not here to make accusations. We are here to ask whether the HSE officials are aware of this and to state that it is neither the proper procedure nor the rights-based approach to the matter. That is why I used the word. Also, the family members used that word.

I ask Deputy Buckley to withdraw the word "coercion" or reword it.

If I can use an alternative wording, "residents were removed under duress." Would that do?

Mr. Michael Fitzgerald

I am sorry I could not accept that. Nobody has moved.

We could not accept that anyone would say that people were moved with duress. If there was, we would want to immediately look at that.

Maybe pressurised into making a decision.

Mr. Michael Fitzgerald

Again, I would be concerned about using any of those words, like "pressurised". We completely accept and understand that this is very difficult for people. There is no question-----

I will rephrase and say that some family members and residents felt pressured into going to look at alternative accommodation. That is what I am hearing back from the family members. I am only reiterating what the family members are telling me.

Mr. Michael Fitzgerald

I do not want to get lost in a word but I could not accept "coercion", "pressurised" or something of an inappropriate nature like that. It might be helpful to say in this context that we understand this is a very difficult process. It is a change for residents and particularly people who were long-term residents there. It is a change. Any change for any of us is an adjustment for people. Of course, it will bring its own issues for people. We understand that. We also understand that it is not an easy thing to go through for families. People going to see other centres, in my head space anyway, is appropriate. As we said it is about will and choice. People also need to see what they are moving to, what it is like for them, what the feel of it is like and would they be comfortable there and with the services that are provided there. Those also are all important pieces.

If there are issues of that nature which are concerning to the Deputy, we would be quite happy for him to bring them forward to us and we will investigate them and come back in case there is anything untoward.

On that basis, I will certainly withdraw it.

Mr. Michael Fitzgerald


Moving on, the Deputy asked a few specific questions around a property in Midleton. Yes, we are in significant negotiation on a particular property. As I said in my opening statement, there is a process within the HSE around proposing that for purchase. The property is being considered through that process. Mr. O'Connell might fill in details around that process. We have not purchased a property but we have one in mind that is going through our approval process to purchase. We are very hopeful that it will emerge on the other side, which would be helpful in this regard. Part of the plan for the future is that it would be there as another stepping stone for people to live as independently as possible in Midleton and the general area.

The opening statement also outlined where we are on the ten-bed rehabilitation-style residential centre that we intend to build there. We have to do an options appraisal on that because we have to say what the best location is, whether it is possible and whether it is the appropriate place to build on the site. Is it appropriate to build on the site across the road, on the community hospital, as the Deputy said, or should it be on another site given the requirements for doing it? There is an approval process around how we go around that Mr. O'Connell might talk about too.

The other important thing I want to reiterate is that we completely understand that this is not easy. If we had the perfect accommodation somewhere else and quite close to it which would be more or fully compliant with the commission that would be helpful particularly for those people who require a level of specialist service around them to meet their particular needs. We do not have that. We are not suggesting that all of our residential services are all modern and appropriate in the context of fully complying with regulation. They are not. It is certainly our intention and our plan that a significant refurbishment and replacement programme will be required right across Cork for many of the centres in question. I do not think that we ever said that we were able to find places that were better but we do need to make sure that the people's needs are met. It might be an appropriate location to meet those particular clinical needs and that balance has to be there as well.

I hear the Deputy's concern, particularly that the service could be taken away and how you could have no service there. What we are striving to do, in accordance with Government policy and with what we know is the right thing to do, is to make it very much a community-based service for Midleton, east Cork and the greater area right across the CHO. In the development of a ten-bed unit or in the development of a house or a type of residence, and along with the other services such as our home-based treatment team, with a focus on rehabilitation, our view is that in accordance with policy, you maintain more people at home, well and independent for as long as possible. Unfortunately we still live with an institutional mindedness, perhaps, which surrounds us and we are only coming away from that with the closure of significant large centres that were not the appropriate place for people to live out their lives and where they did not have the opportunity of living their life as independently as possible. That is what I recognise as a rights-based service into the future.

The Deputy said it was into the future and I think that is the reasonable thing to say as you have not got it in your hand at the moment. But there are certainly aspects of that service in place already through the home-based treatment team and the supports that are there in the community. I think that we need to start talking in a positive way about the future service that can and will be achieved in Midleton and the area. We have to embrace that. It might be different. Like change, it might be different to what we felt before but it has the capacity to support people and to support people to support themselves to maintain wellness as long as possible. Mr. O'Connell might speak on the processes around the two developments that we talked about.

Mr. Alan O'Connell

On the residential property, a property has been identified and a price has been agreed subject to approval. There is an approval process for purchasing the property which means that a property business case is submitted to the national property review group. That business case has been submitted and we are waiting on a final decision on that which is expected imminently. Once that approval is received then we can proceed to purchase the property.

On two points-----

A quick one, Deputy.

I suspect that is how rumours grow. It is not too far from the town in walking distance.

Mr. Fitzgerald mentioned the ten-bed unit and the specialist care. He is right on the specialist care but these people cannot live independently at home. They need this specialist respite. Even the short-term respite is there to give families relief. That is the kind of care that we still need in the town. I understand where Mr. Fitzgerald is coming from but if we lose those services, families are going to struggle.

I thank Mr. Fitzgerald and Mr. O'Connell for being here today and outlining the rationale behind the decision. The committee has discussed Owenacurra a lot. Throughout I have been reminded of a healthcare facility in my constituency. It gave incredible care, had amazing staff and undying community support but it simply did not have a building fit for purpose. It failed HIQA assessment after assessment as a result and ultimately it closed and residents were relocated. I share that to demonstrate I fully understand how emotive an issue this is. In some ways, the situation in Owenacurra is similar. It is the building that is not fit for purpose. The committee has heard testimony about the incredible care, amazing staff and community support. Deputies in the local area have spoken about how ingrained the facility is as part of the local community, how it is so central to other facilities and amenities nearby and how that it makes it a really valuable space.

We have policies and regulations in place to govern facilities such as this. Residents and their protection are at the heart of those policies and regulations. I am minded to ask if this opens questions for a wider discussion about the practical repercussions of policies on congregated settings. Peamount Healthcare in my constituency, for example, includes purpose-built cottages in which people with intellectual disabilities live together. That model which works so well in practice is out of date in the context of the policy to decongregate settings. The fire safety works are absolutely necessary and must happen. The structural defects need to be addressed and the ceilings need to be replaced. I would welcome any estimates that Mr. Fitzgerald has for the cost of that level of repair. If those things were addressed, are congregated settings the next hurdle? Is that where the main challenge will arise? If those things were invested in, will it be the case that the facility still will not meet the criteria?

Everybody values the incredible care that has been provided at this facility. We have heard from many people with family members who have benefited from that care. That is where this resistance is coming from. It is a good thing in that people are fighting for an amenity in their area. We need to ensure the service is provided in an appropriate setting and in as best a way as possible, with the patient at the heart of it. It would be helpful if Mr. Fitzgerald could give me an estimate for that remedial work. Perhaps he or Mr. O'Connell could provide some input on congregated settings and whether that policy is having an impact.

Mr. Michael Fitzgerald

I will make a broad point about congregated settings. Rather than in mental health services, they are more often used in the context of disability services. The Deputy is correct about the policy which intends to move forward with smaller, individual units. What might have once been a very large residential facility in disability services may be decongregated and reduced to a population of four or five people, who would take up a new residence together. The best way to look at that is to go and visit such a setting one, two or three years after its decongregation and compare it with the model that was there previously. In my time, I have seen centres decongregated. I have compared the services that were available before decongregation and after it. People's lived experience in the smaller setting is very different. A person-centred model of service is available in a smaller unit compared with a larger unit. That is a specific thing in the disability services in particular. It is unquestionably the correct approach in that area. It is a difficult thing to do because there is an impact from a housing perspective and on the provision of services. However, it is certainly a good model.

In older person services, we still have larger settings such as nursing homes etc. Through HIQA regulation, there is a push towards fewer multi-occupancy bedrooms and that type of thing. Over the coming years, as we replace units and services, there will be more smaller units. There will be more space for privacy and dignity for people who reside in such settings. That is a common trend across all of those particular services. People are, in general, happier to live in those circumstance when they have the experience of doing so. Services in places such as those can maintain the privacy and dignity of people in those settings much more easily. That is always the challenge of regulation. We are probably always going to be following regulation as opposed to being ahead of it. There is a financial challenge involved, both from a revenue perspective and a capital perspective. They should go hand-in-hand but these are very large models to move away from and towards a model of smaller facilities. Mr. O'Connell might be able to answer the Deputy's question about costs.

Mr. Alan O'Connell

I do not have the specific estimates for the ceiling repair. The ceilings will be replaced in their entirety. Because of that, there is a requirement for the building to comply with the current building regulations. The building was designed and built in the 1970s. Bringing that particular building up to current regulation standards would include adhering to the Government's climate action plan in respect of the energy performance of the building. It will be an extremely expensive exercise to bring that particular building up to the standard required to meet current building regulations. If that were to be taken in isolation and no other works were done to the building, we would have to justify spending a considerable sum of money to meet current energy standards and building regulations while also having residents' bedrooms and spaces that were not up to the level of the best practice guidelines for layouts. Taking all of that into account will require an investment of a significant amount of money. It would be difficult because of the ro-fab nature of the building. The cost of doing all of that means it would be better for the building to be replaced rather than refurbished.

Am I right in saying that because a brand new roof is being provided, a new facility is effectively being provided and must comply with current regulations?

Mr. Alan O'Connell

It must comply with current building regulations. That is correct.

It must comply with current building regulations and fire safety requirements.

Mr. Alan O'Connell

It must also comply with requirements around energy performance etc.

It must comply with the energy performance requirements. That will then have an internal impact on the requirements in respect of bedroom size and en suites.

Mr. Alan O'Connell

Such a level of investment in a building to bring it up to standard cannot happen without looking at the internal layouts. To do one without the other does not seem to provide value for money. The building would meet its energy performance requirements but the layout of the building would not be in line with best practice.

Okay. I understand.

Mr. Alan O'Connell

In order to justify that level of investment, it is better to go that extra step to provide a building that is in compliance with modern standards for that level of care.

Okay. I thank our guests.

Additional money was set aside for mental health services in two tranches, one of which amounted to €16 million. I am thinking outside the box. I have been talking to family members who have requests. Would it be possible to move the existing residents across the road into the Midleton Community Hospital section? If the building is not fit for purpose, is it possible, as our guests have suggested, to knock it down and replace it? Can that be done? There are things I would include on a wish list that are not going to happen. I know this is based on trust, belief and whatever else. Is there a guarantee that the existing services and associated services will be protected, will not be reduced and will be improved? Is there any way the HSE can give that commitment to the committee?

Mr. Michael Fitzgerald

I will ask Dr. O'Brien to comment on the first part of the Deputy's question. He asked is it possible to move the remaining residents of the centre across the road. The Deputy suggested moving them to the community hospital setting.

Dr. Sinead O'Brien

As for being able to move people across the road, there is at present no facility there that would be able to meet their needs.

As for Deputy Buckley's second question, we are fully committed to enhancing the services in east Cork and all of Cork. What we need is to develop services that recognise that a variety of services and a variety of supports will be needed. Absolutely, we will need services for people who will need a higher level of support on a 24-hour basis. We also need, however, to embrace the fact that people can gain and regain skills and can have, therefore, a better quality of life and, as we have seen from the international evidence and evidence here, can move after having periods of rehabilitation. We have already appointed a consultant in rehabilitation psychiatry, and there are a number of other multidisciplinary team members in the process of being appointed. We are therefore already putting in place additional resources to assist people in their recovery journeys. That, coupled with a facility such as a residence, where people can have more independence and practise more of their everyday activities, the same way we do, will allow people to have a step-up, step-down model of support. That will be very positive. It will then be coupled with people moving on to the community, where they can have the east Cork home treatment team and a seven-day service. All of that together will be the hallmarks of a very modern service that will benefit everybody. I can therefore certainly tell the Deputy that we are absolutely committed to further developing the services in east Cork and Cork as a whole.

I thank Dr. O'Brien. What she says about the variety of services and so on is very much welcome. I just do not want the point lost that, while people can recover, progress and so on, there will always be a demand for what specific beds we have there already. What I have tried to do here is get clarity so the people of east Cork will know that those services will be protected and complemented by the variety of additional services as time goes by.

I wish to come back to 2019 and the possible sale of Owenacurra Centre reported in the newspapers. The response from the HSE at the time was that it was being looked at because it is a stand-alone building. Three other buildings, Carraig Mór in Cork, Mount Alvernia Hospital in north Cork and old Caherina House in Tralee, are also stand-alone buildings, yet for some reason they were not mentioned as being for sale. Why was the same investment not talked about in 2019? As Deputy Buckley said, this was before Covid. Why was that kind of investment not looked at for Owenacurra Centre instead of looking for the sale? It was mentioned twice to go for sale in 2019.

Mr. Michael Fitzgerald

I am aware of that information. No more than with any meeting, the view was out there. If we do some development, we have to look to see, when it comes to the value for money and what will be spent on something, whether it will continue and, if something else has to be done, whether the value of what was first invested in is lost. There was never any further movement on the sale of Owenacurra Centre. It was never tabled or even up for discussion as a decision. We did not even get it valued or anything of that nature. No more than with any other building, however, we would ask what its value is; whether we can replace it; whether we can refurbish it; and whether, if we were to build it somewhere else or to buy something somewhere else, it could present as a sale opportunity for us in the future in order that its value would be realised. That is as far as any question about it went. It was certainly discussed, but not in any serious way such that it moved on as a determined factor of our getting it valued or putting it forward through our own approval system, because we would have to get approval for that in the context of selling any type of building. It did not proceed any further than that.

I hope you do not mind my saying, Mr. Fitzgerald, that I find it very hard to believe that the sale of Owenacurra Centre came up for discussion twice and no one decided to find out how much money could be raised by its sale. If I am selling or buying something at home, I go on DoneDeal and start looking for different prices. Mr. Fitzgerald is trying to tell me that a meeting took place about selling Owenacurra Centre, or it came up for mention twice in 2019, and no one decided to try to find out how much money Owenacurra Centre could make for us.

Mr. Michael Fitzgerald

There was no meeting to talk about the sale of Owenacurra-----

The sale of Owenacurra Centre came up twice in meetings, though, in 2019.

Mr. Michael Fitzgerald

Absolutely, as a discussion point, but it did not proceed in any way. I presume that it did not proceed because it was seen as a service that we were providing at the time. The ability to realise its sale was not discussed further at the time.

The HSE has a policy document on services for people with severe and enduring mental illness that includes this sentence: "To successfully live in their chosen community, it is recognised that a small cohort of service users will need the on-going support and structure of a community residence which is geared towards continuing care." Under the HSE's plans for east Cork, continuing care needs will now be in St. Stephen's Hospital. How does the HSE justify a situation whereby people with the highest level of mental health need in the east Cork area will now not be able to live in their own community?

Dr. Sinead O'Brien

I will take that. We are committed to developing the services in Midleton. The Chairman is absolutely correct that what we are looking for are different levels of support to allow different people to be able to live to their best quality of life. Therefore, we are looking at allowing people to get more support when they need it and to get multidisciplinary rehabilitation. Then people can move to other levels of support and, indeed, on to wherever they choose to live and to independence if that is suitable at the time. In essence, we are aiming to provide a wide variety of services that will allow a much bigger number of people to benefit from this service and then to move on and, ultimately, to have the best quality of life they can have.

I will read the first couple of words again - "ro successfully live in their chosen community". The HSE is not giving them that option at Owenacurra Centre - and not just at Owenacurra Centre, because we have been involved with St. Brigid's Hospital, in Carrick-on-Suir. How many other centres like Owenacurra Centre and St. Brigid's Hospital has the HSE earmarked to close down? It just seems that bit by bit they are being closed down. I remember being at a meeting with the Minister of State, Deputy Butler, and she threw out a figure of 350 more beds. Will we see ten at Owenacurra Centre, 12 at St. Brigid's Hospital and so on in other places? That directly goes away from what the HSE states in its own policy document, "To successfully live in their chosen community".

Dr. Sinead O'Brien

In this case, as Mr. O'Connell has described, there were structural reasons we had to make this decision. However, we are clearly looking to invest not only in the continuing care aspect but also in other levels that will support more people to avail of this service in the Midleton and east Cork area.

I am not sure.

I will come back to one of the first things I asked the witnesses about, the meetings of which there were no reports. None of the witnesses answered that. Do they consider it best practice to have meetings that affect people's lives and communities all across this State at which no one takes minutes? I am involved in a residents' association. If we talk about putting down a flower bed, we take minutes at the meeting. The witnesses are talking about stuff that really affects patients, families and communities.

We have been told that these meetings take place with no one taking minutes. Is that best practice?

Mr. Michael Fitzgerald

I will answer that question in a second. To go back to the Chairman's question asking what are our plans to close other centres or whatever, I have no view in terms of the HSE having a masterplan to close lots of centres around there. I do not believe that is the case and certainly, speaking for the Cork-Kerry CHO, we do not have such plans in place.

We do have challenges, as I said earlier, to meet the requirements of regulators in a broad sense. I do not blame the regulators. Having regulation and a regulator to ensure that we provide services which are fit for purpose is very appropriate. We very much welcome that but it takes investment and adherence to Government policy. A very significant investment is required for us to put all of our centres in Cork right in the context of regulation and will take time. Such an investment across a range of centres where we have issues, which must be put right from the perspective of the environment, is going to be a costly set of plans and in the environment in which we find ourselves it will take a period to do so. We are in that space where that is happening. Thankfully, we have some investment already under way and planned in some of our centres. That is ongoing at the Carrig Mór and Mercy centres where funding is available for a very significant refurbishment of both. I do not think that it can all be achieved in a day and certainly it cannot all be achieved without significant resources. It is our intention to redevelop the two centres so that we have a modern service with supporting infrastructure.

Sometimes we do not take stock of the things that happen. Therefore, I wish to note that there has been a very significant development of primary care centres in Cork and Kerry. Mental health teams have been provided accommodation in an integrated way with primary care centres right across the system. A few years ago that would not have been the case as they would have been very much based in old psychiatric hospitals, etc. Now many of our teams across Cork and Kerry provide services in those centres and to people in their own homes. One might not see that service as it is not the same as seeing a centre with a name on its door. That is a hugely powerful level of service that is being provided to people right now and that is important to state.

The Chairman asked a question about the decision-making. While we do not have a specific note on the specific decision that was made, it was I who made it in consultation with the mental health team and in consultation with my colleagues in estates. I viewed the documentation that was available to me at that particular point in time and weighed up very strongly the requirement for a service provision for the people in residence at that particular point in time versus the challenges. That was provided through the view from my colleagues in estates and with the reports that were available to them as to whether we were to move forward with that or not, or were we actually to let people stay in what at the end of the day was a building that was not fit for purpose. I have to say that I made the decision that we should not keep people in a place that was not fit for purpose nor was it possible, in any kind of a financially viable way, to continue to do so.

I appreciate that Mr. Fitzgerald made decisions. Can he give a ballpark figure for how much it cost to close down the Owenacurra Centre and move its residents elsewhere? Did it cost €1 million or €2 million?

Mr. Michael Fitzgerald

In what context?

Mr. Fitzgerald has said that he made the decision but I still cannot comprehend that no records were kept at meetings of decisions concerning large sums of public moneys. We know that these decisions were made at meetings and no records were kept but I find it strange that decisions were not recorded. We are all involved with different committees and the first thing one does is hand someone a biro and a piece of paper to take minutes.

Mr. Michael Fitzgerald

I viewed and saw all of the information that was available beforehand, I discussed it with key people both in terms of the service provision and the estates perspective, and I viewed the available documentation. The documentation is in the public domain with regard to the expert reports that were made available by the estates division and, indeed, by the estates division to me. There was no disagreement on the unfortunate decision we had to make.

Many times people like me are challenged because we do not make or cannot make decisions or whatever, and when a decision is made then it can be a difficult one. I can say that this was a very difficult decision to make but nonetheless I stand over my decision because of the following considerations. First, were we to continue by putting money into a centre that still was not going to be fit for purpose and where the escalation of the issues that would be there with regard to the regulator were going to continue? We did not need the regulator to tell us that because we knew it from the actual reports that we got. Second, were we to continue to provide services in a building that was not fit for purpose without a plan of how we were going to do something different for them?

I have no doubt that the decision was hard. I have no issue with Mr. Fitzgerald making his decision but find it strange that these decisions were not recorded.

We invited representatives of the Mental Health Commission to attend this meeting and they informed us that they could not. Did the HSE inform the commission when it was moving residents and had the commission concerns about any of the placements to which residents were being moved to by the HSE?

Dr. Sinead O'Brien

Yes. We informed the Mental Health Commission of all moves in advance. We met on a weekly basis as a multidisciplinary team and the Mental Health Commission would be notified of all possibilities. Obviously it would be common practice that people would consider particular options and then some of those would have materialised. Yes, we would have told them.

Did the commission object to any of the placements?

Dr. Sinead O'Brien


Let us say the Minister instructed the HSE to reverse the decision to close the Owenacurra Centre and gave a commitment to do whatever had to be done to retain those services and put in a restructuring package. Could that be done if there is support and a will to do so?

Mr. Michael Fitzgerald

There is no getting away from the fact that the building is not fit for purpose.

I accept that. Mr. Fitzgerald has said that the HSE is investing in property. We do not care about that because the HSE, as an entity, is obliged to invest in people and look after them to the best of its ability. That obligation has got lost and, therefore, the residents and their families have suffered the most from the HSE's inability to maintain these buildings.

What if there was political will whereby the HSE was asked to get a cost, knew how much it would cost to build a new centre in Midleton while locating it somewhere temporarily? As Mr. Fitzgerald and I know, once a centre is up and running there will be a demand for its services. I have approached the Minister of State many times about the centre. If there was the political will could the HSE replace the services in Midleton and maybe even with half of them in the Owenacurra Centre and the remaining half across the road?

Mr. Michael Fitzgerald

There is a deeper level of complexity than that outlined. The issue is that the two services are very different in terms of their components and people's needs in a broad sense.

To be honest, resolving it in the way outlined by the Deputy would not be possible.

However, I do take his point. For the likes of the Owenacurra Centre and other centres - I speak from a Cork-Kerry perspective - significant investment is required and, in fairness, it has been an issue for some time. Has sufficient funding not been available to us to refurbish buildings over the years? Yes, absolutely. Were there occasions in which we tried to refurbish buildings that were not fit for purpose in the long term? Yes, that is also true. Would we rather be in a different place with a better environmental structure in respect of our services? Absolutely, but we are not there. That is going back many decades. We must remember and put it into the context that some centres, like the Owenacurra Centre, were built as the next move on from what were the psychiatric hospitals of old. They moved wards out from those hospitals according to what the State was able to afford or what was seen as the appropriate thing then.

I have to keep coming back to this point. For the likes of myself and my colleagues here, we have to keep our eye on the current and future model of service going forward. I believe there is a bright and appropriate future for services in Midleton and the greater east Cork area, as well as across Cork. However, we will have to stay steady about it because if we keep saying that we will go back to a residential model of service, that is what will happen but I do not think that is an appropriate thing. Over the many decades I have been working in the services, that type of a residential institutional model was detrimental to people. It is much better for people to be maintained in their community, as the Deputy said, where they lived their lives, as best as they possibly could be with the supports we provide to them. I honestly believe that.

No other members have indicated. I thank Mr. Fitzgerald, Dr. O'Brien, Mr. Ryan, and Mr. O'Connell. Would Mr. Fitzgerald like to make any closing comments?

Mr. Michael Fitzgerald

I thank the committee for having us in. It was a good and appropriate engagement. I want to reach out to the petitioner on behalf of the families; their concern is not lost on us, high up or low down. We completely understand their concern. We would like to engage with them around any remaining concerns they may have now. We would also like to have an engagement with the Deputy and his colleagues locally in order that, across the community, we can talk about a new, modern model of service. That would be an important thing for the community. If you were peripheral to the service, you would get the sense that everything is being lost in the area. In fact, what we are talking about is the future. We need the community support to make that happen. We will reach out to the friends, the broader political spectrum and the community to talk about that going into the future. That is all I wanted to say.

Thank you Mr. Fitzgerald. It has been very informative for the committee. We thank the witnesses for coming in. We will suspend the sitting to allow our guests to leave.

Sitting suspended at 3.04 p.m. and resumed at 3.08 p.m.