Topical Issue Debate

Mental Health Awareness

Deputy Simon Harris

I welcome the opportunity afforded to me by this debate to highlight the need for stigma-reducing and mental health education in schools. As a country we must ensure that our children and young people leave schools with the tools they need to look after their mental health and the knowledge that there is no shame in discussing mental health or in looking for help from the various professionals best placed to provide it.

I welcome the commitment of the Government to continue to invest in our mental health services and to implement the recommendations of A Vision for Change. As we work to establish more community-based mental health services, a great deal has been made of the need to break down the stigma surrounding mental health issues in our society. We must work to prevent new stigmas from forming as well. Young people experiencing mental health problems are at exactly the same, if not a greater, risk of rejection, damage to self-esteem and a reluctance to seek support as their adult counterparts. It is vital that we do everything we can to introduce children in an age-appropriate fashion to positive mental health education and stigma-reducing programmes.

I have spoken in the House previously about the contrast between the way we teach children about their mental health and the way they learn about the basics of dental health. We teach our children from the youngest age in schools about the damage that sweets and fizzy drinks can do to their teeth. We teach them how to prevent dental problems. We discuss the tools they need and the importance of brushing their teeth morning and night. We discuss the need for regular visits and check-ups and the fact that there is no shame in a toothache. We should use our schools to teach children the fundamental tools they will need to look after their mental health using exactly the same method we use to teach them how to protect and mind aspects of their physical health.

We can learn from our international colleagues and neighbours on this issue. For example, in Scotland, following a successful two-year pilot programme, the positive mental health attitudes curriculum has been adopted by the education department. Children are given the opportunity to engage with mental health in the classroom and to discuss issues that may affect them with their teachers and peers. Since this is now a national curriculum, teachers have been provided with lesson suggestions, worksheets and a DVD of anecdotal scenarios to highlight mental health issues that young people and their friends and family members may be experiencing. At a basic level, the inclusion of this subject as part of a national curriculum would ensure that all children receive the same message on mental health from their school.

The answer I often receive from the Department of Education and Skills is that social, personal and health education is part of the junior cycle but this is not adequate. The subject touches on emotional well-being only in a broad sense. The reality is that one in four people in the country experience mental health difficulties at some stage in their lives. Their challenges have been kept behind closed doors for too long in this country and we have seen the negative consequences of this.

We must have a more specifically targeted programme to ensure young people leave school empowered with the tools required. This is nothing new and it is recommended in the Government's policy, A Vision for Change. It is also recommended and fleshed out in some detail by See Change, the national mental health stigma reduction partnership. There should be a willingness to recognise that this is about more than simply resources when we are discussing mental health. It is about a culture and how we can knit the promotion of positive mental health throughout the schools. We have a captive audience sitting in classrooms throughout the island on a daily basis and we must ensure that teaching time and the classrooms are used as the powerful tools they can be to reduce stigma and to give people the tools to promote positive mental health.

Minister of State at the Department of Education and Skills (Deputy Ciarán Cannon)

I take this topical issue debate on behalf of my colleague, the Minister for Education and Skills, Deputy Ruairí Quinn. I thank Deputy Harris for raising this important issue. Schools play a vital role in reducing the stigma surrounding mental health issues and mental health education features strongly in the curriculum.

The social, personal and health education, SPHE, programme has been a mandatory part of the curriculum in primary schools and in junior cycle since 2003 and is designed to promote positive mental health. It is supported by comprehensive teacher guidelines and curriculum support services which provide training and advice for schools and a resource directory. Its aim is to foster the personal development, health and well-being of children, to help them create and maintain supportive relationships and develop the skills and attitudes for responsible citizenship. It includes relationships and sexuality education. In addition, all schools are required to have an agreed school policy and a relationships and sexuality education, RSE, programme at senior cycle.

The curriculum at primary level includes such issues as self awareness; relationships and sexuality education, feelings and emotions, making decisions, relating to others, communications resolving conflict and dealing with bullying. These themes are continued at post primary level, where SPHE is presented in ten modules covering self management, communication skills, relationships and sexuality, belonging and integrating, emotional health and influences and decisions, physical health, substance use and personal safety.

SPHE is designed for implementation in the context of a caring whole-school approach, supported by the pastoral care structures in schools and good parental links. A report was published in 2009 based on inspection of SPHE in 40 primary schools. It showed many extremely positive findings, including high levels of satisfaction from parents that their children's social and personal development were being promoted in schools, that their confidence and self esteem was supported and that they were encouraged to behave well and take responsibility for their actions.

Inspectors found in most classrooms pupils were encouraged to voice their opinions and interact positively with others. They displayed a good understanding of the SPHE content they had covered and considered themselves to be thoughtful about the feelings of others. Very high proportions of students considered themselves to be happy in schools and the report found feelings and emotions were addressed regularly in SPHE lessons.

All post-primary schools provide a guidance and counselling service for their students. The service includes the provision of individual guidance and counselling for students at critical stages in their education or times of personal crisis. Psychologists from my Department's national educational psychological service, NEPS, are present in schools across the country and provide a range of supports. These include the promotion of positive mental health among the general student body and assistance in supporting pupils with particular social, emotional or behavioural difficulties. The NEPS also encourages the development of structures among teachers and schools care teams which link with the relevant local HSE mental health services. Schools are playing their part within the resources available to promote positive mental health among students.

Deputy Simon Harris

I thank the Minister of State for his response. While I welcome the provision of SPHE within our school system it is limited. We recognised that as a country when we brought together partners working in this area from the sea change initiative and the Government policy A Vision for Change.

One of the issues with SPHE, apart from the fact that it is a broad subject, is that we need to examine how to tackle the issue of stigma and stigma reduction at a much younger age. There is an opportunity to build on a programme called Zippy's Friends which is already delivered to primary school children in first and second class. We could consider rolling out scenarios in an age appropriate fashion. The problem is about stigma and culture.

It is not long ago, relative to others, since I was in primary and secondary school and it was not normal to see a child with special needs in school. As a country we have changed our attitude to special needs and disabilities. Mental health is the next big challenge for our education system and culture is a factor. I ask the Minister of Stage to revert to his officials and ask them to consider examining best practice in other places, particularly in regard to what I cited in Scotland.

It is clear that what we are doing is not working. While there might be positive steps we know as a country a huge body of work needs to be done in regard to mental health. I know the Government is committed and I am fully supportive of the measures it is taking in that regard but we have to think outside the box and realise that the days of giving the age old answer of SPHE as a solution is not enough. We have to go further than that.

The term "knitted" is important. The issue needs to be addressed across our curriculum and subjects. The language used by teachers and the environment of a school has to discuss on a regular basis the issues people are experiencing in their homes which for far too long were not discussed in this country. We have a huge opportunity to use our schools while educating students to tackle issues regarding culture and stigma. I urge the Minister of State to take the opportunity to do that.

Deputy Ciarán Cannon

I share many of the sentiments expressed by Deputy Harris. He is correct in saying that in the past a major stigma has been attached to mental health issues in this country and where better to address that than in our education system. In making our children more environmentally aware we have succeeded in making them the environmental wardens or lieutenants of our country through the green schools programme. We could achieve something similar in reducing the stigma associated with mental health problems.

The resource programme introduced in October 2010 entitled Working Things Out through SPHE was launched to support teachers in the delivery of the mental health promotion dimension of the SPHE programme. It demonstrates case studies of young people who have successfully managed a variety of difficulties, including bullying, bereavement, depression, easing problems, obsessive compulsive disorder and feelings of anger, fear and anxiety. Our response is beginning to happen, although I agree with Deputy Harris that one could never argue we have a perfect system in place.

It is always important to look to best practice in other jurisdictions. I will undertake to work with my officials and if the Deputy submits more detail of the Scottish programme I could undertake to consider it. He is correct to point out that we need to, as he described it, knit this sort of provision across the whole school programme.

In this country we are providing literacy solutions to resolve literacy problems among our adult learners by incorporating literacy solutions into all of the further education provisions across a number of different courses and training provisions. We need to engender a cultural change which will bring the issue of mental health and the stigma associated with it in the past to the fore. If Deputy Harris wants to liaise directly with me, we could examine best practice abroad and determine how we can incorporate some aspects into a provision in the future.

National Drugs Strategy

Deputy Aengus Ó Snodaigh

Amidst the discourse on the economic crisis the drugs crisis has been forgotten. It would be wrong for that to happen given the new report from the European Monitoring Centre for Drugs and Drug Addiction. It is a stark reminder of how serious Ireland's drug problem is and the horrific consequences of the failures of successive Governments to make sufficient funding available. The report should serve as a wake-up call to the Government and all Members of this House of this crisis.

Comparative research by the European centre found Ireland has the worst heroin problem, the second worst ecstasy problem and the third worst cocaine problem in the whole of Europe. We also have the second highest rate of drug induced deaths. At 70 deaths per million the figure is more than three times the EU average.

That amounts to almost one death per day. Moreover, it is most likely an underestimation.

These statistics clearly demonstrate the need to afford greater resources to drug prevention, treatment and rehabilitation projects rather than reducing them. Chronic underfunding has historically been a feature of the State's response to the drugs crisis. Despite this, drugs services have already been subject to disproportionate cuts since the beginning of the recession. It is not just the Fianna Fáil Government which is responsible for these disproportionate cuts; the current Government is also introducing cuts in these areas. Health Service Executive funding for numerous drugs projects in Dublin has been reduced by 5% for the final quarter of this year, with a promise of further reductions next year. I understand the Minister of State, Deputy Róisín Shortall, has made a complaint to the HSE in this regard. That is not good enough.

The Government must take ownership of and drive forward the State's response to the drugs crisis. The former Minister of State, Deputy Willie Penrose, resigned his office because of the closure of a local Army barracks. I am talking about the avoidable deaths of more than 300 people per year. Does the Minister stand over the 5% cut already imposed by the HSE this year? What action will he take to ensure there are no further cuts? Schemes which have experienced cutbacks include the Inchicore needle exchange, which was shut down last year, and the Rialto early morning methadone clinic. Services such as these save lives and aid rehabilitation by facilitating participation in education and work. By doing so, they also save the Government money.

Reductions in these services will lead to higher rates of drug abuse and a higher incidence of mortality. The Government is putting great effort into convincing the public that cuts to essential services are necessary and that there is no alternative. That is not the case. I urge the Minister to examine the alternative set out in Sinn Féin's pre-budget submission, which we presented to Government yesterday. It clearly shows that front line services can be protected and that there is an alternative. There must be a greater urgency in addressing the drugs crisis.

Minister for Health (Deputy James Reilly)

It is important to note that the European Monitoring Centre for Drugs and Drug Addiction, EMCDDA, depends on individual countries to supply it with figures on drug use. Two issues arise in this regard, namely, the quality of information supplied and the timeliness of such information. The EMCDDA report is historic rather than current. The Irish content on prevalence in the 2011 report is based on the 2006-2007 drugs prevalence survey. This was an all-island survey prepared by the national advisory committee on drugs and was carried out to the highest standards. Not all contributors to the EMCDDA would have similar comprehensive prevalence surveys on which to base their figures. The drugs prevalence survey is carried out on a four-year cycle and the 2010-2011 report will be launched next week.

I acknowledge that we have had a problem of heroin use in Ireland, particularly in Dublin, for some years. Significant steps are being taken through the implementation of the National Drugs Strategy 2009-2016 to address this issue. An Garda Síochána and the Revenue's customs service continue to prioritise their efforts to reduce the supply of drugs into Ireland and the production of drugs within the country. The further development of prevention measures aimed primarily at those deemed to be most at risk of becoming involved in illegal drug use, and at the younger population generally, is a critical element of the national drugs strategy.

There are approximately 14,500 known opiate users in Ireland, of whom 9,300 are in receipt of methadone treatment. In total, more than 12,500 people are in receipt of drug treatment. Clients can usually access methadone provision in Dublin within one month of assessment. The major focus recently has been on increasing the availability of services outside Dublin. In the past 18 months, for example, additional services have been put in place in Limerick, Tralee, Cork, Waterford, Kilkenny, Wexford and Dundalk. Increased detoxification facilities have also come on stream recently in counties Carlow, Kilkenny, Cork and Limerick. The roll-out of needle exchange services in approximately 65 community pharmacies at various locations outside Dublin began in October. Needle exchange services in Dublin are provided through HSE clinics and voluntary sector providers. This initiative will facilitate broad national coverage.

I am particularly focused on ensuring there is an increased emphasis on moving people on from drug treatment to a drug-free life, where that is achievable. Apart from the obvious benefits to those concerned, this will open up more treatment opportunities, allowing us to encourage more people into treatment. The EMCDDA notes that we have adopted "imaginative responses" in addressing the problem of new psychoactive substances and have had greater impact in dealing with this aspect of drug use. As a result of the prompt actions taken, the number of headshops has reduced from 102 to 12 and psychoactive substances are not for sale in any of these outlets.

On drug mortality, Ireland reports the third highest rate after Estonia and Norway and is just ahead of the UK figure. However, it is acknowledged that the figures from Ireland, compiled through the Health Research Board's national drugs-related deaths index, are very accurate. This index combines information from four sources, namely, coroners' records, the hospital inpatient inquiry scheme, the central treatment list and the general mortality register. Drug death figures in most European countries are based on general mortality register records only. Nevertheless, the number of deaths arising from drugs misuse is of great concern and underlines the importance of tackling the drugs problem in a comprehensive way.

Deputy Aengus Ó Snodaigh

I am surprised by the Minister's response. Is he denying that cuts are being imposed which are affecting people in the communities worst affected by the drugs scourge? Is he denying the death rate? As I said, that figure is most likely an underestimation. For instance, it tends only to include those who die of overdoses, while excluding deaths arising more indirectly from drug misuse, such as in road accidents. Is the Minister claiming that the level of drug abuse is not as bad as indicated in this report? The reality is that in many communities — not only in Dublin but throughout the State, in Portlaoise, Cork, Waterford and elsewhere — the drugs problem is getting much worse. Consequently, there is a need for greater resources, not fewer.

It is not too late to address the problem. Will the Minister offer a renewed commitment to the national drugs strategy? Will he undertake to reverse cuts that have been made and to protect the sector from further cuts in budget 2012? In particular, will he renew the commitment to drugs taskforces — the infrastructure upon which the drugs strategy is based — throughout the country? Some Government Deputies have been less than supportive of their local taskforces, which serves to undermine the network of support they offer. The Department of Education and Skills has abandoned the taskforces in many areas. If that is allowed to happen, what is to stop other statutory agencies withdrawing from the taskforces?

The drugs strategy mechanisms which bring together the relevant stakeholders and actors, including the community, service providers and State bodies, are regarded as an example of best practice in this area. Will the Minister reaffirm the Government's commitment to this multifaceted system? Will he take concrete steps to guarantee funding for schemes such as the Rialto early morning methadone clinic and the Inchicore needle exchange which have been closed as a consequence of HSE cutbacks?

Deputy James Reilly

I have acknowledged the number of deaths and that it is of great concern to us. I am underscoring the accuracy of our figures as we take them from four different sources whereas as other jurisdictions only use one, the general mortality register. I mentioned that the information is from 2006-07. There has been a reduction of €74,000 to community drugs projects supported by the HSE in the Dublin and mid-Leinster region arising form the implementation of cost-saving measures across hospitals and community services. No such reductions are envisaged in the other HSE regions and no reduction is being made in the funding provided through the Department of Health in the current year.

The Government is committed to dealing with the scourge of drugs in our community. I have highlighted how the legislation on head shops has been updated to make a further list of psychoactive substances illegal and how successful the legislation has been in reducing the number of head shops. I assure the House from the notes handed to me that no psychoactive substances are available in those that are open.

Of course, the war on drugs will continue, with the involvement of law-enforcement and customs officers. We will endeavour to have more effective treatments. I am not happy with the numbers of people who come off methadone and I am reviewing that situation. I certainly want it reflected in any new contracts given to doctors who are treating people currently on methadone.

Care of the Elderly

An Ceann Comhairle

The three Deputies should have a total of four minutes. I will be as liberal as possible and I ask them to limit their remarks to two minutes each. We will make up the time as we go along.

Deputy Brian Stanley

I thank the Ceann Comhairle for taking this issue so promptly. The closure of the facility at Shaen is a double whammy for County Laois. It is a devastating blow, coming as it does less than two weeks after the announcement of the closure of a similar facility at Abbeyleix, only 14 or 15 miles down the road. It is a black day for the health services in County Laois and the midlands in general. The only public nursing home in the county that is not under threat, in Mountmellick, already has closed wards. The proposed closure of the facilities at Abbeyleix and Shaen removes 70 out of the 200 public nursing home beds in the county at a time when there is an increasing demand.

In the past week I have tried to access services for someone in need of such a bed. This is happening under the Minister's watch. I heard him say that that he would grab the reins of the health services and would not allow the HSE to continue to flounder along. In the eight months since coming to power, the Minister has set about the destruction of public nursing home facilities in the county in which I live. During previous recessions these fine facilities in Shaen and Abbeyleix were kept open. However, the difference now is that the two parties in government are continuing with the disastrous policies of the previous Government——

An Ceann Comhairle

Thank you, Deputy.

Deputy Brian Stanley

—— which used taxpayers' money to bail out banks instead of providing services and jobs.

An Ceann Comhairle

Thank you.

Deputy Brian Stanley

The other major difference is that we are going down the road of a privatisation agenda here. Just to conclude——

An Ceann Comhairle

The Deputy is taking other people's time now.

Deputy Brian Stanley

The overspend is just €7 million for the entire midlands area. I ask the Minister to consider how efficiencies can be obtained within this figure. As a representative of the area, I ask him to reverse this proposal.

Deputy Charles Flanagan

There is a crisis in the provision of long-term care in County Laois as evidenced by the second closure of a long-established unit in as many weeks. I must comment on the antics of Deputy Seán Fleming yesterday. He knows that his party contributed to the crisis in the county by dint of years of underinvestment in facilities when we had money. The hypocrisy of Fianna Fáil is breathtaking.

That said, I want this issue resolved. How does the HSE propose to reduce the number of beds from almost 300 five years ago to a mere 130 today? It is a crisis and we cannot expect the county to be denuded of institutional care for the elderly when at least 4% of the community have a requirement for such services. Why is County Laois being targeted for repeated closures? If these closures proceed, I ask the Minister to commit to reopening the closed wards at the sole remaining long-term residential care facility in the county at Mountmellick, where, as Deputy Stanley has said, scores of beds have been taken out of commission under Fianna Fáil. I want the Minister to commit to reinstating these beds, opening up that hospital and more than anything else providing quality long-term care for elderly people in County Laois.

Deputy Billy Kelleher

If the Deputy wants to witness hypocrisy, he should go out to Merrion Square and see 40,000 students protesting. If he goes to Roscommon, he will see hypocrisy at its best.

Deputy Charles Flanagan

The Deputy is a disgrace and so is Deputy Seán Fleming.

Deputy Billy Kelleher

Deputy Seán Fleming was obviously very passionate in raising this issue yesterday and has conveyed to me the depth of feeling and very strong anger in County Laois at the closure of Abbeyleix Community Nursing Home and now St. Brigid's Hospital in Shaen. The programme for Government clearly states that there will be annual increased funding for community care and home care. The projections for future funding indicate there will be a sustained attack by the Government on public nursing homes.

Deputy Charles Flanagan

The Deputy is a hypocrite. The Deputy sat on this for a year.

Deputy Billy Kelleher

It is evident that this is the case.

Deputy Charles Flanagan

Hypocrite.

Deputy Billy Kelleher

We have put forward policies supporting public long-term care and private residential care working in unison. So far all we have had are reports from HIQA recommending closure in some cases and in cases where HIQA has not recommended a closure, budgetary constraints are being used as a reason. Clearly there is a crisis in public long-term nursing home care throughout the country. However, closing two facilities in County Laois in a few weeks rips the heart from the community. The Deputies in the House along with Deputy Seán Fleming have conveyed that adequately without me needing to add more to it.

Deputy James Reilly

I thank the Deputies for raising the issue, which provides me with the opportunity to update the House on the matter. I point out to Deputy Stanley that there are 28 clients in Abbeyleix and 29 in Shaen. I do not know how he makes 70 out of that.

Deputy Brian Stanley

There are 70 beds.

Deputy James Reilly

Suggesting that they are fine facilities when one is a 1932-built sanatorium beggars belief. Fine people are working there and fine people are being cared for there. However, to describe the facility as fine is stretching imagination and HIQA would take a very different view. In answer to Deputy Kelleher, I say that we all know why we have the crisis we have. Abbeyleix Community Nursing Home provides continuing care, day care and respite services to people in Laois, Offaly and bordering areas of Kilkenny, Carlow, Tipperary and Kildare. While it might suit the purposes of the Deputies opposite to say it is closing, it is not closing. The long-term residential bed element is moving, but the day-care services are staying and will indeed be expanded.

St. Brigid's Hospital, Shaen, Portlaoise, is a two-storey building that was originally opened as a TB sanatorium in 1932 and is now a 28-bed residential community nursing unit with two respite beds.

The Health Service Executive is facing major challenges across all services owing to a reduction in funding allocation. This, together with staff losses as a result of the public sector moratorium and the anticipated loss of staff between now and the end of the year make it essential that it move to consolidate the overall provision of long stay care within the Dublin and mid-Leinster region.

The HSE has also advised that the physical infrastructures of both facilities are totally unsuitable for a modern service. It believes that without a rebuild it would not be possible to provide adequate care for the residents at these locations.

Taking all these factors together, the HSE took the decision to proceed with closure of both facilities. The HSE is committed to a full and meaningful consultation process with the residents and families through this difficult time. It will also consult and communicate with staff, public representatives and key people in the wider community. Staff will be transferred to reopen beds and-or prevent the closure of other public beds resulting from moratorium losses in the area. The HSE will ensure this transition process is managed professionally for the residents. Every effort will be made to minimise disruption to them and to ensure that long term relationships with fellow residents and staff will be maintained to the greatest extent possible. In addition, liaison persons have been appointed to support the residents through the process.

I would like to assure the Deputies that no service users will be placed in a more costly financial position in terms of their care. In regard to the other services provided at Abbeyleix CNU, I can confirm that the day care service will continue to cater for the needs of the 90 clients, approximately 24 per day, who use the service and there are plans to further enhance this service in the future. Respite service for the current eight clients at Abbeyleix will continue. However, it is intended that this service will transfer to a private provider following consultation with the families concerned.

I can also assure the House that the primary care centre located on the grounds of the Abbeyleix facility will also continue in line with the HSE primary care strategy. The changes to service I have outlined will help to ensure that the HSE achieves the highest standards of care for all residents affected.

An Ceann Comhairle

I will allow Deputies Stanley, Charles Flanagan and Kelleher one minute each for a supplementary question. I ask Deputies to be brief as we are way over time.

Deputy Brian Stanley

I thank the Minister for his reply. With regard to the age of the Abbeyleix facility, the Mater Hospital is hundreds of years old and remains a fine facility. The Minister may not be aware that in recent weeks renovations have been carried out to the facility at Abbeyleix. I stand over what I said. These are fine facilities, both of which have been providing good care for people. I ask the Minister to meet with Members from the area and representatives of the staff to discuss the reasons for closure and how we can rescue this situation. Also, I want him to overturn this appalling decision until such time as this issue has been worked out, thus ensuring these facilities remain open.

Deputy Charles Flanagan

I have three brief questions for the Minister. Can the Minister confirm if the HSE is a provider of beds or a commissioner of beds in constituencies such as Laois-Offaly and beyond? What is the position regarding the 110 bed community care long term residential unit in Portlaoise? Also, will he reaffirm his intention to reopen wards and beds in the Mountmellick unit which have been closed for some time?

Deputy Billy Kelleher

I urge the Minister to reconsider this matter in the context of his statement that he is ultimately responsible for the health services. This is an attack on the heart of the community in County Laois. Patients and families continually say these facilities are providing excellent care. With a small capital investment these facilities could remain open and provide care for those most in need in their immediate vicinity and community.

Deputy Charles Flanagan

Fianna Fáil had 14 years to do this when in Government but it did nothing.

Deputy Billy Kelleher

The Deputy should look at what Fine Gael in Government has done in eight months.

An Ceann Comhairle

I call on the Minister to reply.

Deputy Charles Flanagan

I am not a hypocrite.

An Ceann Comhairle

The Minister has two minutes to reply.

Deputy Finian McGrath

Fine Gael is in power now.

Deputy Billy Kelleher

By the time this Government has been in office one year the whole country will be closed.

Deputy Finian McGrath

It will not be closing the Army barracks in Kilkenny.

Deputy Phil Hogan

No.

Deputy James Reilly

Excellent care is being provided in both facilities, of that there is no question. However, the facilities are not up to the standard described by Deputies. On Deputy Stanley's remarks in regard to the Mater Hospital, some €200 million is currently being spent on refurbishing the core of the old hospital. The facilities of which we are speaking, which were built during the 1930s as sanatoria, were not built to last the duration of time they have been in use. The Health Information and Quality Authority, HIQA, has strong views in this regard, which will come to the fore in due course.

Given the cost of refurbishing these facilities, it would be more cost effective to knock them down and rebuild them. I have been assured by the HSE — it is important the families are aware of this — that all patients in the Abbeyleix facility who wish to do so will be able to stay together and retain their community relationships. I acknowledge and accept that this facility has been home to people for a long time, that relationships have grown and that moving is stressful. We aim to minimise that stress. The facilities to which these people will be moved will be modern and well run. People wishing to stay together will be able to do so. They will have a choice. There will be consultation with them and their relatives.

Similar options will be made available to people residing in the facility at Shaen. We want to give people plenty of time to come to terms with this. As I have stated nothing can happen within six months and people can move within that time if they so choose. However, there will be plenty of time for people to consider this. The reality is that once a communication is made with patients or staff the information is out in the public arena, following which public representatives from the Opposition try to make as much hay as they can of it. That may suit their purpose but it does not help——

Deputy Brian Stanley

I am trying to save beds.

Deputy Billy Kelleher

The Minister is the master of it. We learned it from him.

Deputy James Reilly

——the people in this situation. It upsets them more than needs be.

On Deputy Flanagan's questions, the HSE is a provider and commissioner of services. On the long term care issue, I will look into the position in regard to the unit in Portlaoise. As I understand it, beds in the Mountmellick unit will be staffed by the staff freed up as a result of the closure of the other facilities.

There appears to be some misinformation about. Using the 2006 census, the requirement in terms of the number of beds recommended for over 65s is 4.5%. This means there needs to be 45 beds per thousand for people aged over 65. This means there should be 744 long term care beds in the Laois-Offaly area. There are currently approximately 790 beds, public and private, excluding Shaen Hospital and the Abbeyleix Community Nursing Home in the area.

We will use all the facilities open to us. We want people to be cared for in modern conditions of a standard of which we can be proud while equally respecting people's right to stay together based on the relationships they have formed. Staff at Shaen Hospital will also have the option of moving so that there will be minimal disruption to patients.

Dáil Éireann debate - Wednesday, 16 Nov 2011