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Dáil Éireann debate -
Wednesday, 10 Nov 2004

Vol. 592 No. 2

Adjournment Debate.

Health Board Services.

I am glad to have the opportunity to raise on the Adjournment a serious matter that is developing in Clifden in my constituency. The community residence was built in Clifden at the initiative of the Clifden Mental Health Association after a long fundraising campaign over ten years. The group acknowledges the grant aid support from the Department of the Environment, Heritage and Local Government in the building of the facility. This modern facility has lain idle for the past year and a half because the Department of Health and Children has not provided the necessary funds for the Western Health Board to staff the facility and allow it to be opened. Some young people are using it as an area of congregation. A certain amount of vandalism has taken place and some windows have been broken. Clifden Mental Health Association has replaced the windows and is trying to keep the building in its original perfect state.

The facility is fully equipped with a capacity of ten beds, eight residential beds and two respite care beds. Eight people from the Clifden area are waiting to be admitted to the facility. Some of those people are unable to live an independent life and live at home with elderly parents who are no longer able to cater for them in the family home. They are very worried as to what will happen to their children when they die. The situation is deplorable. Some people from the Clifden area are also in the long-stay unit in Merlin Park hospital and if they were transferred to Clifden, it would allow the redistribution of beds in the long-stay unit in Merlin Park hospital.

Apparently the obstacle preventing the Department of Health and Children giving funding and allowing the health board to open this facility is the embargo on the recruitment of staff in the Western Health Board area. The Minister of State might tell me in his reply, as I was recently advised in the reply to a parliamentary question, that there is no embargo on the recruitment of nurses. This is not true because the reply to that parliamentary question continued to say that there is no embargo subject to the employment levels remaining within the authorised ceilings. If a health board is at the authorised ceiling it cannot employ anybody else. As the health board needs 14 people to run this facility, unless 14 people leave the employment of the Western Health Board, as a result of the Government embargo, it cannot recruit the people to run the facility.

While I welcome the Minister of State, Deputy Brian Lenihan, I regret that the Tánaiste and Minister for Health and Children is not here. The Tánaiste is not in any way concerned at the plight of aged parents at their wits end minding a loved one in their own home. This matter is very urgent. A year ago one of the members of the Clifden Mental Health Association, an aged lady in her 80s, met representatives of the Western Health Board and on several occasions in the past year and a half I have written to the former Minister asking him for the funds to open the facility. This elderly lady is so serious about the way the opening of the facility is being delayed that almost a year ago she threatened to go on hunger strike within a year if the building is not opened. That very sad event will take place in December as this lady is determined. Even though she is 80 years of age and has nothing personally to gain for herself, for the good of the community in her area she will go on hunger strike if the facility is not opened. There is no use in the Minister of State fobbing me off with a prepared speech. I want him to address the problem.

This week the Western Health Board applied for the necessary funds and the go-ahead to appoint the staff to the facility in Clifden, as it did in December 2002 and mid-2003. Will the Minister respond to the Western Health Board's request to provide the finance and go-ahead for the appointment of the 14 staff to open this facility for the good of the people in the area, especially the aged lady in Clifden who will be on hunger strike outside the building if it is not open within a month?

I thank the Deputy for raising this matter on the Adjournment of the House.

Major changes in the delivery of mental health services have taken place in Ireland over recent years. Enormous strides have been and continue to be made in developing a service that is comprehensive, community-based and integrated with other health services. This shift in the delivery of services from predominantly hospital-based care has been a success and the quality of care for persons with a mental illness has been enhanced as a result.

Significant capital is being provided over the lifetime of the national development plan for mental health services. A significant part of this funding is going towards the development of acute psychiatric units linked to general hospitals as a replacement for services previously provided in psychiatric hospitals. In addition to the 22 acute units already in place, a number of units are at various stages of planning. Funding provided under the national development plan will also provide for more community facilities, such as mental health centres and community residences, which will accelerate the phasing out of the old psychiatric institutions.

There has also been a decline in the number of inpatients from 5,192 in 1997 to 3,701 in 2003, with a corresponding increase in the provision of a range of care facilities based in the community to complement inpatient services. In 2003, there were 418 community psychiatric residences in the country providing 3,210 places compared to 391 residences providing 2,878 places in 1997.

Deputy McCormack raised a specific matter related to the Western Health Board and the community residence in Clifden. This was constructed by the Connemara Sheltered Housing Association with funds provided by the Department of the Environment, Heritage and Local Government and the Western Health Board. The fit-out of the building was completed by December 2003 following expenditure by the health board in the amount of €100,000.

In 2003, my Department allocated €300,000 towards the opening of this service but difficulties subsequently arose with the staffing of the residence. Representatives from the health board and the Psychiatric Nurses Association met the Labour Relations Commission on several occasions. This week, however, the Western Health Board has submitted an agreed proposal to my Department on the staffing of the community residence in Clifden. This submission, which would require additional revenue funding and an increase in staff numbers, will be considered in the context of the Estimates for mental health services in 2005.

Will it be done in 2005 or will it just be considered?

Hospitals Building Programme.

This is a crucial issue for thousands of my constituents, especially those living in the Dingle peninsula. I have for years asked various Ministers for Health and Children about the development of a new hospital in Dingle and I have received the same tired old answer from the Government. I remember it being an issue during the 1997 general election. I remember calling to the hospital during the local and European elections in 1999 when the Government again made promises. The issue had not been resolved by the general election in 2002 and even when I was canvassing during this year's local elections, the people of the Dingle area were still wondering why there is such a delay in this project.

The condition of the existing district hospital in Dingle is appalling. The occupants are mainly geriatric patients who are not being allowed to live out their days in appropriate and comfortable circumstances. The matron and the staff of the hospital do a wonderful job with the limited resources from the health board and the Government but the old hospital is like something from the age of Florence Nightingale. The Minister should visit it. It spans two floors and some of the wards are huge. There is an 11-bed ward, a ten-bed ward, a nine-bed ward, a six-bed ward and three wards with two beds. The hospital was originally built as a workhouse in 1852 in the aftermath of the famine and the existing building is far from adequate, having outlived its use.

A site has been acquired for the new hospital on the outskirts of Dingle town but the health board is waiting for the Department to allow the project to proceed to tender. It is the number one priority primary care project for the Southern Health Board but it is being held up by the Department of Health and Children. The staff of the hospital were under the impression that the project was to go to tender in February this year. What has happened since?

We must consider how necessary this new hospital is for the people of Corca Dhuibhne. There are 10,000 people living in the Dingle Peninsula and 25% of them are over 65. At any time, 20 patients from the west Kerry area are resident in the St. Columbanus home in Killarney. I made a round trip of 90 miles from Killarney to a meeting last night in Dingle. There is no direct bus service and some of the elderly cannot drive that distance to see their relatives. A local group campaigning on this issue, Comhar Dhuibhne, has pointed out that when patients are discharged from the Kerry General Hospital in Tralee, they are often sent to convalescent homes in other parts of the county because there is no nursing home in the Dingle area. This causes immense hardship for relatives who do not have a car, especially when there is no direct public transport and they must go through Tralee.

The new hospital will provide essential services such as day centre for physiotherapy, occupation therapy and X-ray facilities. There will also be a mental health centre that will be welcomed by the psychiatric services in Kerry but the Minister has stalled on funding and permitting the project to move on to the next stage. Elderly patients should be able to avail of geriatric care in their own locality as close as possible to their friends and relatives. There are only 33 beds in the old hospital while the new hospital will have 72 beds, many of which will hopefully be used to allow elderly patients from the Dingle area to avail of their local hospital.

The Government and its representatives in my constituency have been announcing the opening of this hospital year after year but the patients, staff and people of the Dingle Peninsula are still waiting and still being denied this vital facility. The cost involved is only €12 million. The Government squandered €52 million on electronic voting and at the end of year the Government is millions of euro ahead of target in tax receipts. The Minister of State should ensure that €12 million is spent on this essential health care facility in the west Kerry Gaeltacht. When will this new hospital be built and open for use? When will the project be allowed to proceed to tender?

I am pleased to deal with the matter raised by the Deputy. It falls easily off the lips of Opposition Deputies that there was a substantial waste of funds on electronic voting but there has been a sizeable increase in the amount local authorities had to spend as a result of the decision not to proceed with it. Electronic voting would have led to substantial savings in local authority funding because it did away with the need to pay staff to count votes at the conclusion of any election or referendum.

The Government has made services for older persons a priority and is fully committed to the development of a comprehensive health service capable of responding quickly, fully and effectively to the health service needs of older persons. In recent years health and social services for older persons have improved both in hospitals and the community and the Government has substantially increased the level of funding, both capital and in respect of services, for older persons, with €280 million in additional funding allocated on the current spending side to these services since 1997. In the health sector, capital funding over the years 2000-03 was approximately €1.7 billion. Progress has been made in addressing some of the historical deficits in health infrastructure and in improving the standards of facilities required for quality modern patient care. Considerable capital funding has been provided to services for older people which will enable a comprehensive infrastructure of community nursing units and day care facilities to be put in place as well as the refurbishment of existing extended-care facilities and the replacement of old workhouse-type accommodation such as that to which the Deputy referred. I agree with the Deputy that older people deserve first class facilities and we intend to provide such facilities in appropriate locations.

In regard to Dingle Community Hospital, the Southern Health Board, which is responsible in the first instance for the provision of health services in County Kerry, took a decision to build a new 72 bed community hospital to replace the existing hospital. This new hospital will comprise a mix of beds for continuing care, rehabilitation-convalescent, respite, palliative care beds and beds which will be used for direct admissions by the local general practitioner-primary care team. In addition, there will be a central module, a day care unit, a mental health day care unit and an ambulance base.

The next step in the progressing of the Dingle project to construction is to arrange for submission of tenders. Any decision in regard to progressing this project will be considered by my Department in the context of the significant additional revenue funding and staff which will be required by the board to operate the new hospital and having regard to the board's employment ceiling and funding available in the Department.

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