Closure of Owenacurra Centre: Engagement with HSE

I would like to welcome back representatives from the HSE to our meeting this morning to discuss the closure of Owenacurra Centre in Midleton, County Cork. I welcome from the HSE Mr. Michael Fitzgerald, chief officer, community health organisation, CHO, 4; Mr. Jim Ryan, head of operations, mental health services, HSE community operations; Mr. Mark Kane, HSE estates; Mr. Kevin Morrison, acting head of mental health services; and Dr. Sinead O'Brien, executive clinical director, Cork mental health services.

Before the opening statements, I must point out to our witnesses that there is uncertainty as to whether parliamentary privilege will apply to your evidence from a location outside of the parliamentary precincts of Leinster House. Therefore, if you are directed by me to cease giving evidence in relation to a particular matter, you must respect that direction.

I call Mr. Michael Fitzgerald to make his opening statement. You are very welcome.

Mr. Michael Fitzgerald

Before I read the opening statement, I would like to acknowledge the fact that we are with the committee again this week. We thank the committee for the opportunity to discuss Owenacurra with it. I apologise for last week. We were in the middle of a red alert in counties Cork and Kerry. Colleagues, including myself, were quite busy throughout that day, as members can imagine, ensuring that patients, residents, staff and our premises were intact and safe during the course of that spell. We apologies for that, but it was a weather piece that we obviously could not avoid. I wanted to mention that before I commenced.

As the Chairman outlined, I am joined by Mr. Jim Ryan, head of operations, mental health services; Dr. Sinead O'Brien, executive clinical director of Cork mental health services and consultant psychiatrist; Mr. Mark Kane, assistant national director of HSE estates; and Mr. Kevin Morrison, acting head of mental health services, Cork Kerry Community Healthcare.

The Owenacurra centre is a mental health services continuing care unit in Midleton, County Cork. It is registered with the Mental Health Commission to provide a service for 24 people for psychiatry of later life, continuing mental health care and mental health rehabilitation. There are currently 15 people resident in the centre. Cork Kerry Community Healthcare advised the mental health subcommittee in its hearing on 21 September 2021 of the difficult decision taken in June to begin the process of ceasing services at the Owenacurra centre.

The background to the decision was that it became clear following an assessment of the information available that the current building environment and layout did not allow for the needs of a modern residential centre. The centre had also been criticised by the regulator on a number of occasions. Initially, the plan was to refurbish the centre but, as we moved to the more detailed planning stage, serious concerns emerged that any level of such refurbishment could not bring the building to the standard required. Advice from external construction experts, along with HSE estates, which was shared with the committee previously, informed the HSE in its difficult but necessary decision to close the centre. This was not our original plan for the valuable services at the Owenacurra centre and, although it was a difficult decision, there was no other option open to us.

The immediate priority remains the welfare of the remaining residents of the centre. We have been working and continue to work with each resident individually and to consult their families to agree an appropriate alternative placement based on their assessed needs and will and preference. Residents will be moving on a phased basis and the planning on that work is ongoing. Discussions with residents and their families are led by a consultant psychiatrist and multidisciplinary team. Specific meetings with family members continue at this time as suitable placements are being identified. In order to keep residents and families informed throughout the process, a key contact lead is available to support and act as a facilitator between residents, their families and the project team.

A residential-type setting for several residents is being sought locally to provide a supported model of living which may, with some further rehabilitation, suit the needs of some residents in the medium term. It is important to state the emphasis is on supporting people with mental health needs to remain independently living, where possible, in their own homes and communities. There is an extensive community-based service operating in the local area, including a home-based treatment team and multiple specialist services. A possible location has been identified to restore the day service in the town and negotiations are under way in respect of specific premises.

When it has been vacated, the Owenacurra site will be used to build supported living accommodation for mental health service users. Discussions have commenced with the local authority to explore options in that regard. These discussions are at an early stage and we will proceed with developing proposals to this end in the coming months.

The closure of any centre, particularly one that provides residential care to service users, causes concern and uncertainty for residents and families. We understand that the Owenacurra centre has provided a valuable service to residents in a unique location for many years. The HSE, however, is committed to working closely with the residents to find appropriate alternatives suitable to their needs. The original timescale for the closure of the centre was six months. This has been extended to ensure additional time is provided for the transition of residents to the appropriate settings.

I thank Mr. Fitzgerald. The first questioners will have ten minutes each. Deputy Stanton has ten minutes for questions and answers.

I thank our guests for being present and I thank Deputy Colm Burke for allowing me to substitute for him. As the Chairman is aware, this centre is in my town. I have been familiar with it for a very long time. I personally knew many residents who lived there, some of whom are no longer with us. I have been to the centre on many occasions, so I know it quite well.

I am on record as stating that this situation could have been handled far better. The fact that it was to close in October and, obviously, there was no plan for the residents, as has now been evidenced, led to a lot of angst, disquiet, worry and so on among families and residents.

I think that is acknowledged by everybody involved. It could have been handled much better.

I wish to ask Dr. O'Brien a question about the kind of service that is currently being provided in the centre. It is a 24-hour staffed service. If the centre were not to close, would the service continue? Are there many other places in Cork or elsewhere in the country where such a service is currently being provided?

Dr. Sinead O'Brien

I thank the Deputy. The continuing care service that is operating in the Owenacurra centre would have continued for a period because, obviously, we were not aware of the scale of the premises issues. However, it is fair to say that we have seen that, over time, there has been a decrease in the requirement for continuing care facilities as more people who have severe and enduring mental illness have the benefits of services such as early intervention in psychosis and rehabilitation psychiatry teams and, therefore, more people are able to live their lives in the community with support. As outlined in A Vision for Change, the number of people requiring continuing care residences is expected to decline over time. We also have high-support hostels in the county and these provide a model of 24-7 supportive care.

I thank Dr. O'Brien. I ask her to elaborate on the difference between the high-support hostels and what is being provided at the moment in Owenacurra.

Dr. Sinead O'Brien

The first key difference is the level of staffing in a continuing care unit. For example, in the Owenacurra centre there are four staff on duty. That staffing level was increased due to concern relating to the premises. In a high-support hostel, however, there are two nurses by day and one nurse by night with a health care assistant. The level of staffing reflects the degree of support individuals need. Although we focus on the great work our nursing colleagues provide, I must emphasise the importance of a full multidisciplinary team because individuals need to benefit from other disciplines such as social work, occupational therapy and clinical psychology. We have the advantage of a new rehabilitation psychiatry team being introduced for Cork, which is most welcome and will, no doubt, benefit individuals in both the continuing care units and the high-support hostels.

I thank Dr. O'Brien. All present would agree with her that the best practice is for people to be looked after in their communities and homes for as long as possible. These are settings with which they are familiar. What is the level of need for a centre such as that in Owenacurra in a large area such as east Cork which covers, as she knows as well as I do, the towns of Youghal, Midleton and Cobh, right up as far as Glenville? It is an area the size of some small counties and has a similar population. Will there be a need for a centre such as Owenacurra providing the kind of service it is providing in east Cork and keeping people close to their own communities with which they are familiar?

Dr. Sinead O'Brien

It is really important that all people in Cork have access to facilities such as continuing care and high-support hostels. We need access to be within a reasonable distance. As regards where our current continuing care facilities are located, we have the St. Stephen's campus and St. Catherine's, which is located at St. Finbarr's Hospital, and then we have high-support hostels throughout the county. I think it-----

May I interrupt briefly? I wish to focus on east Cork. Am I right in saying that if the centre at Owenacurra closes, the nearest facility will be St. Stephen's Hospital? As Dr. O'Brien is aware, St. Stephen's is in a rural area far from any town centre. At the Owenacurra centre, the residents are familiar with the town centre.

They can walk up and down the street. I have met and know many of them. They engage me on the street regularly. They are there with their friends, neighbours and so on. It is familiar to them. I ask the witnesses to comment on the difference between what is happening in Owenacurra at the moment and what might happen in St. Stephen's. Is there any plan, or any need, to have a centre such as Owenacurra in east Cork, covering areas such as Youghal? It is a long distance from Youghal to St. Stephen's for families and others.

Dr. Sinead O'Brien

It is important to point out that we have high-support hostels in a number of areas within 20 to 30 minutes of the east Cork area. It is important that all the people of Cork have access to services in a timely manner and that all our facilities are available to everyone. It is important to focus on community integration. The Deputy quite rightly pointed out that the St. Stephen's campus is on the outskirts of Glanmire. However, we have a therapy programme which includes our own transport to allow people to integrate within the Glanmire area and further afield for outings. That would be-----

My time is short. I am concerned about east Cork and large towns such as Midleton, Youghal and Cobh, as well as all the small towns in between that will not have a service. What Dr. O'Brien is saying, if I heard her correctly, is that the service will be moved to Glanmire. That is not acceptable to the people or the taxpayers of east Cork who I represent. We want a service like the one being provided in Owenacurra at the moment and envisaged for St. Stephen's to be provided in east Cork. In other words, we must keep services like Owenacurra going. Dr. O'Brien said that the numbers and the need will be reduced but the need will still be there.

Dr. Sinead O'Brien

I accept that the need will be there. There will be many different sites, not just St. Stephen's campus, where services will be available and where rehabilitation will be focused on enabling people to move on with support, depending on individual needs, to the community.

When does Mr. Fitzgerald expect the day service to open? How many people are involved in that?

Mr. Michael Fitzgerald

As we said in our opening statement, we are actively pursuing a specific premises at this point in time. There is ongoing negotiation with regard to the arrangements around that centre. We hope to close off that arrangement, all going well, over the coming weeks. If we are in that position, we would hope to open in the first quarter of next year. We would obviously have to open it in the context of the current Covid restrictions but that is the case for all services, as we well know.

How many residents are now left in the Owenacurra centre in Midleton?

Mr. Michael Fitzgerald

There are 15 residents left in the Owenacurra centre at the moment.

Therefore, four people have moved out since we last spoke on this matter.

Mr. Michael Fitzgerald

That is correct.

What is the current state of play of the discussions with families and residents, where appropriate, regarding other people moving on?

Mr. Michael Fitzgerald

It is very much ongoing. That series of discussions is ongoing with consultant psychiatrists and the multidisciplinary team. It is a very important and sensitive time for the residents and their needs.

Is it true to say that no resident will be moved out against his or her will?

Mr. Michael Fitzgerald

Of course. We are working with each of the residents to find the most suitable location for their needs and that discussion is very much ongoing. We are certainly not in a place, and do not need to be, where we are forcing people to do anything against their will. We would not be doing that. That is a given on our side.

In other words, if people want to stay in the centre they can do so. They might not be able to do so indefinitely but there is no major pressure on people to move. The HSE is having discussions and there are reduced numbers in the centre now. In Mr. Fitzgerald's view, is the centre safe at the moment? That is an issue that has come up time and again.

Mr. Michael Fitzgerald

In order to mitigate any concerns, we have increased staffing. As the number of residents has dwindled, that has made the centre safer. Those are the actions we have taken with regard to the safety of the centre.

Regarding the long-term plans for the site, Mr. Fitzgerald stated that the HSE is in negotiations with the county council to build supported housing there.

Would those be own-door state-of-the-art modern facilities?

Mr. Michael Fitzgerald

Very much so. That discussion with the local authority has only just opened but it has welcomed the ongoing discussion with us and any approved housing body in order for the redevelopment to happen. That is in line with the policy that we will provide opportunities for people to live as independently as possible. Going back to an earlier question the Deputy asked of Dr. O'Brien, that is the view of the model and type of service we want to provide in east Cork. We will not be leaving people to their own ways-----

I have one final question because my time is up. I am sorry about this. Is planning permission needed for the day service provision that is being put in place?

Mr. Michael Fitzgerald

That is part and parcel of our discussions with the provider. If we need planning permission, we will have to apply for it. That is something we are working through at the moment.

I have listened to the first speaker and will get straight to the point because I do not mince words. Dr. O'Brien mentioned the reasonable distance for services. There is St. Catherine's ward in Cork city and St. Stephen's Hospital, Glanmire, is very rural. There are also services in Kanturk, Mallow, Fermoy, Macroom, the Western Road, Cork, Blackrock, Cork, and two places in Skibbereen. It is farcical that we will have no services in east Cork. I have a basic question for whoever can answer it. Has the HSE bought a premises in Carrigaline that is being refurbished at the moment? That is a "Yes" or "No" question. Why the HSE has not invested in a premises in Midleton is beyond me. Dr. O'Brien mentioned that there is a decrease in demand for services. There will never be a decrease in any area. In our current Covid pandemic, the demand for mental health services has gone off the Richter scale. People will get sick no matter what you do. The services are not being fully resourced. It is very timely that the Minister of State, Deputy Butler, announced €500,000 for mental health day services in east Cork this morning. That is pretty good timing. What will that be spent on? The HSE does not have a plan. It is a secret when it comes to the day services and what building it is going for. The people watching this meeting this morning need to know whether that centre is closing. If it is, will there be 24-7 respite care services in east Cork and the Midleton area, serving from Youghal up towards the city, including Cobh and Carrigtohill? Is that going to happen? If not, the HSE should let us know now because this will end up a talking shop and I do not want that. My biggest fear is that when the services are gone, they are gone. I submitted nine parliamentary questions on this issue. Luckily, I got the replies yesterday. Each one of these questions was different but six of those nine have an identical response and the other three are also identical to one another. In other words, the answers are being copied and pasted. Even we as public representatives are not getting replies to the questions we are asking on behalf of the families and residents in that centre or the people we represent in east Cork. It is very disappointing. Did the HSE buy a premises in Carrigaline and is it refurbishing it?

Mr. Michael Fitzgerald

We have acquired a premises in Carrigaline and we are refurbishing it.

Why could it not buy one in Midleton?

Mr. Michael Fitzgerald

Our intention is to use it for mental health needs.

I am sorry for cutting across Mr. Fitzgerald but I am conscious of the time. The HSE's opening statement mentioned A Vision for Change. We have a catchment area of over 94,000 people in east Cork. The HSE is obliged to provide a service when areas reach around 100,000 people. We are fairly close to that and yet it is moving services back into the city, even to the far side of the city, and there is no mention of east Cork or Midleton. I cannot fathom that. Mr. Fitzgerald also mentioned discussions with families. One person - I will obviously not mention names - told me that they were due to have their third meeting with the HSE today. They asked in advance who would be present and again they got no information. There is something happening there. I have also been informed that there is no cohesion between family members and residents in the centre.

They are not being met together. I do not know what is happening with the communication there.

There is another thing I want to find out. Mr. Fitzgerald said the building was not fit for purpose in July, yet did he say there are 15 residents there? We now have July, August, September, October, November and December and it seems it is still fit for purpose and the HSE can magically cure the building defects by putting in extra staff. I do not accept that. That is why I am very angry. I cannot understand why everything seems to be moving away from east Cork. I cannot believe it. I refer to Kanturk and public transport. Many of these people are elderly. The HSE is taking away these people's freedom. No matter what the HSE says, it just keeps coming up with excuses to the effect that it is doing X, Y and Z, everything will be great and it will put in more of this, that and the other but it is not putting it into the pot in east Cork. That is what I am trying to say. It is going from Cork city all the way over to north Cork. The east Cork catchment area all the way down to the Waterford border is huge and we will be left with no services.

I will ask three simple questions. First, because I want the people outside of the committee to listen and to hear what the witnesses' answer is, will the Owenacurra centre close indefinitely with the loss of all the respite beds? Second, when will the HSE replace those respite beds in Midleton to serve the people of east Cork? If it will not do so, why not? Third, I appeal to the other Deputies here because there are Deputies at this meeting who are part of the Government and I am blue in the face from raising this with the Minister of State, Deputy Butler, and the Minister for Health, Deputy Donnelly. I ask those Deputies to go back to their party representatives and to appeal on behalf of the people of east Cork to keep the services there open. It is not the building; it is the service itself. We all know - let us be honest and call a spade a spade - that if those long-term respite beds are gone, they are gone. The witnesses should not tell us that fewer people are getting sick and that there will be less demand on services. That is an absolute crapshow. My God, if we could predict this, we would have a lot of things cured, whether dental services or GP services, so the witnesses should not spin that to people.

Finally, I cannot figure out how the HSE can go and find the money for a building, purchase it and start refurbishing it on the north side of the city, again miles away from east Cork, yet it could not find a suitable site in Midleton or even carry out works on the same site. It could have probably put in temporary respite beds in Youghal and Fermoy because the demand for these services will always remain but it just chose to say, "No, we will close it." I mean no disrespect to the previous speaker. Yes, putting in community living for the elderly is a brilliant idea but if the HSE cannot find the money to refurbish a place, I do not know where it will find the money to start building houses for these people.

I ask the witnesses to answer my questions honestly if they can. Are these services in Midleton to go? Are they coming back? Will they be replaced? I do not think they will be. I do not want the people in east Cork or Midleton or those people with residents in that centre to waste their good energy asking for it to be kept open if the HSE has made up its mind to shut it.

I know I have three minutes left. I might come back in.

Who wishes to reply?

Mr. Michael Fitzgerald

I will start anyway. The Deputy raised a couple of issues. The service that has been provided in the Owenacurra centre and that was registered with the Mental Health Commission was for continuing care and rehabilitation purposes. Our intention is that we will re-provide the day services in the town and, as I said earlier, we are actively pursuing that at this point in time.

It was a 24-bed service-----

Hold on, Deputy Buckley. Let the man respond, will you? You have asked a number of questions. Give Mr. Fitzgerald the courtesy of allowing him to respond.

Mr. Michael Fitzgerald

Our intention is not to re-provide the 24 beds in continuing care and rehabilitation as they have been in Midleton.

What we intend to do is ensure that our support to people who live in that broad community the Deputy talked about is maintained and increased in line with Government policy and that on the site itself we work with the local authority to build a new building that will provide for support and independent living, which is the journey we are asked to go on from a policy perspective nationally. I hear the Deputy's concern, though, about continuing care and rehabilitation required for inpatients. We hear that very clearly. The reality is that we need development in the greater Cork area for good centres and good, appropriate beds in order that we can deliver that to what will be a decreasing number of people who will need that level of specialist service. We have already developed our thoughts as to how and where we have to do that. Going back to what Dr. O'Brien said earlier, we have to take the broader Cork area into account. We have to look at the specialist-led services we are providing. We have very much a community model to provide to the broad community. It is also important to say that that is in line not just with mental health services but with other areas. The east Cork areas the Deputy has talked about form a community healthcare network area where we are providing additional services in primary care, chronic disease and older persons' services in general. Again, the model is one whereby we bring the service locally, there are specialised teams and it is supported and provided or led by consultants. That is the model with which mental health services fit exactly.

I thank Mr. Fitzgerald for his honesty. Chair, may I ask just one more question?

Go ahead.

I will be brief. Thank you, Chair, and I thank Mr. Fitzgerald again for his reply. My fear is that while everything looks very well in plans and on paper, Mr. Fitzgerald said the services are consultant-led. We have problems with recruitment of consultants and so on at the moment. My biggest fear, therefore, is that east Cork will lose its vital services and that the HSE is trying to fix something that is not broken. Now we realise we will not even have something to fix and the people of east Cork will be left behind. I understand the role and the model the HSE must follow but my point is that we have lost that vital service in Midleton and it is not coming back. Anyone who wants to access those services in the east Cork area will now have to go into the city or north Cork. If that is a good model and practice, we are in trouble and we will be in trouble in the future. I am disappointed. You do not get everything you want every day but I thank Mr. Fitzgerald for his honesty and the reply to my contribution. The people in Midleton and east Cork need to know that that centre will close and that that respite care is gone.

Thank you, Chair, for your patience.

I will move on to Deputy James O'Connor, who is replacing Deputy Lahart this morning. Deputy O'Connor, you are very welcome.

I thank Deputy Lahart for allowing me to have his slot and thank you, Chairman, for your co-operation.

This issue needs no introduction. It is extraordinarily serious. Mr. Fitzgerald and the representatives here with him from the HSE are very aware of just how concerned all of us in the constituency of Cork East are by what the HSE is trying to do in Midleton. I wish once again to express here today, as I have done both internally at our recent Oireachtas Members' health forum held in Ballincollig and previously at the committee, my extraordinary concern at the loss of this service in the Midleton area. The Owenacurra centre is an incredibly important supervised centre for residential mental healthcare. It is a facility that is deeply important to the availability of immediate mental healthcare services in the Midleton area, and I would be very concerned if the HSE were to withdraw it from the area for a number of reasons but particularly given the information that has come to light in recent days. We are told on the one hand that the HSE is moving away from this model yet, on the other, when you go down to Cork South-Central and look at what is happening in Carrigaline, there are other residential centres being financed by the HSE. I have a problem with that.

I have a problem with an area the size of east Cork being left with no residential mental healthcare service. It is unacceptable. I have outlined this to the HSE previously. A number of suggestions I have made to it include purchasing residential houses to provide care in the community. However, my understanding is it will only be getting one house, which will provide nowhere near the number of beds required given the existing level of demand in the Midleton area. This is a concern.

Another concern is communication with the families. I am hearing about many mixed messages from those with whom I am engaging. That is not good enough. The announcement was originally made just before the Dáil went into recess, and it is not fair on the residents of the Owenacurra centre that the situation has been playing out in this way for the past six months. Even if the HSE presented a plan for closure, the style in which the situation has been managed is unacceptable. That is wrong given the circumstances of the service users involved.

I have heard, as I am sure all here have, many concerns from residents' family members about where people will be relocated to. I wish to ask for a couple of points of clarification about the statistics. I will revert with a further round of questions later. How many service users' families has the HSE some degree of agreement with about relocating their family members? How many residents are in the centre today?

Dr. Sinead O'Brien

I thank the Deputy for his questions. As of today, there are 15 residents in Owenacurra. Two individuals are expected to move within the next week. I have been part of some of the family meetings with the core multidisciplinary team, including consultants and psychiatrists, responsible for the centre, and Dr. Ruth Collins, the clinical director of the north Lee mental health services, has been present at others. We have had open and honest discussions with families and have met families and the residents when the residents wanted that to be the format. In terms of each individual, we have discussed the clinical recommendations and personal preferences, and we have agreed with the family the type of service that would best meet that individual's needs. Of the original 19 residents, six will be moving towards nursing home care, nine will require high-support hostel-type care and a further four individuals are expected-----

Will Dr. O'Brien run me through the difference between the level of care provided in high-support hostel accommodation compared with the service level received by someone in the Owenacurra centre? Is there round-the-clock supervision, which is the requirement in many cases?

Dr. Sinead O'Brien

The key difference between a continuing care unit and a high-support hostel has to do with the number of staff available to attend to individuals' needs. On a continuing care ward, there would be four staff on duty. In a high-support hostel, there would be two nursing staff by day and one nursing staff-----

Where are those hostels?

Dr. Sinead O'Brien

We have in excess of 120 high-support hostel beds in County Cork. We have three residents in north Cork. We have residents in the city. We have residents in Macroom. We also have residents in Bantry and Skibbereen.

I wish to ask about an issue that has been well discussed but must be raised again, that being, the HSE's position on the Owenacurra site. We heard at the Oireachtas forum that the HSE was willing to utilise the site for future mental health services. Six months on, surely someone at this meeting will clarify whether rebuilding a fit-for-purpose Owenacurra Centre with full-time residential care and the same level of assistance that is provided at the current centre is a possibility. If it is not, will one of the witnesses explain why that is so?

Dr. Sinead O'Brien

Regarding the current site, I will defer to Mr. Kane. He can advise the committee on the site and the practicalities associated with it.

Mr. Mark Kane

I will point out something that might answer some of the Deputy's questions. We have examined the deficiencies on the site, which have been well documented in a number of Mental Health Commission inspections. We have a premises that is approximately 1,050 sq. m. If we wanted to bring that building in line with appropriate standards for a residential care setting, it would effectively have to double in size. We will not be able to develop that type of facility, though, given the current site constraints. This presents us with a-----

Mr. Kane is telling me the HSE cannot rebuild on the existing site because of its current constraints.

Mr. Mark Kane

That is correct. We were-----

That is ridiculous.

Mr. Mark Kane

Apologies, but if we were to redevelop the site, we would have to do so in line with the appropriate standards.

There are acres of room at the facility. Do not try to sell me or any other public representative that line.

Will Deputy O'Connor allow the witness to respond, please?

With all due respect, that was one of the most outrageous answers I have heard since walking into the Oireachtas. I have to say that.

Will the Deputy try to confine himself to the questions? He has asked a question, so will he let the witness respond, please?

Mr. Mark Kane

I appreciate why the Deputy would want this to be documented or evidence based in a reasonable manner. We have rooms at that facility that are 7.5 sq. m, but we all know the current standards would require something like rooms of 22 sq. m. There is a gulf between the existing accommodation and the accommodation that is needed. This is why there is such a significant uplift to be done. No one at this meeting would want us to reinvest in a building that would afterwards still fall far short of what was needed from a standards perspective. Under the current standards, we would have to go from 1,050 sq. m to 2,000 sq. m, and that 2,000 sq. m would still not include elements like the day unit, external therapy spaces or the external support accommodation that was required. We also have to provide elements like public and staff parking spaces, etc. When we consider the matter in the round and given the size and appropriateness of the building that is needed, site constraints would prohibit such a building on that campus. We have reviewed the matter and this is the strong conclusion to which we have come.

The HSE is in the process of trying to obtain an existing day care centre. I believe it has actually identified a location. As Mr. Kane knows well, I am talking about a residential mental healthcare service that has 24-hour staffing and supervision. If the square footage of the site is an issue, no one would be disappointed or upset at reducing the current number of beds by a fraction to accommodate the construction there of a new, purpose-built residential facility. How many rooms are in the Owenacurra centre? Dr. O'Brien has the answer.

Dr. Sinead O'Brien

Essentially, we are looking at 19 rooms. We did have some-----

There are 19 residents to be-----

Hold on, Deputy.

There are probably rooms available in the facility.

Deputy, please.

This is an important question.

I understand how passionate you-----

I think I am being misled at this committee.

-----and every other member is going to be about it this morning. Will you let me chair the meeting?

You have asked the question. Will you please let the person respond? You are out of time, by the way, but I am allowing you-----

They are not giving accurate answers, Chairperson.

I am allowing you to ask the question. You have gone beyond your time. I ask that you please give respect to the witnesses and let them respond. Does Dr. O'Brien wish to respond?

Dr. Sinead O'Brien

We have 19 bedrooms so each of the residents had their own rooms during Covid-19. It is registered for 24 people so we did reduce the occupancy in light of infection prevention and control, IPC, guidance.

There are 19 bedrooms in total in the Owenacurra centre.

Dr. Sinead O'Brien

As Mr. Kane has outlined, some of the bedrooms are extremely small-----

I asked a question and I want an answer to that. How many bedrooms are in the Owenacurra centre? The question is not how many residents were in there. How many bedrooms are in the Owenacurra centre?

Dr. Sinead O'Brien

I answered that we have 19 bedrooms.

There are 19 bedrooms. If the HSE reduced the number of bedrooms in that facility to bring it up to the current guidelines that are needed by it to provide an acceptable level of care, is there then the availability or option of reconstructing a new residential mental healthcare service in Midleton?

Dr. Sinead O'Brien

I will defer to Mr. Kane as to how many bedrooms could be facilitated on the current site.

Mr. Mark Kane

I would estimate that probably no more than eight or maybe ten rooms are built to an appropriate standard that could be accommodated on the site. Again, I will stress that this does not look at things like external therapy spaces. It certainly does not look at anything by way of the day service that is currently on that campus as well. Specifically, with regard to residential accommodation to an appropriate standard, it is circa eight to ten bedrooms.

Okay. I need to move on to Deputy Shortall.

I welcome the witnesses. It is very hard to figure out what exactly the motivation is for this change in service and what would seem to be a significant reduction in services at a time there is generally a greater recognition of the need for improving rather than disimproving them.

What families want and are looking for in the main is a building that will be brought up to a good enough standard. They are not looking for state-of-the-art facilities. Very often, when organisations are trying to change things to suit themselves, we see that the best is the enemy of the good. We are told that something is not perfect and not state of the art so we must change it. We are not looking for state of the art. We are, however, looking for a decent service and improvements to be introduced to the existing services. I find it very hard to understand why exactly the HSE is closing down this service.

The point has been made about the 15 existing residents. We are told that six are moving towards nursing home care. What does moving towards nursing home care mean? We are told that nine are going into high-support hostels. That is not what the people themselves or their families want. There is an obvious saving in staff. One cannot help but think this is part of the motivation and that rather than meeting the needs of people with significant dependencies in the mental health area within east Cork, the HSE is forcing people to fit into its requirements. I cannot help but think that is what is motivating this.

I want to address a couple of questions to Mr. Morrison. In June, when he was announcing the closure, he said, "the centre must close because the building is not suitable and cannot be brought to the standard needed and that you deserve." He went on to say that "as we started planning for a refurbishment, it also became clear the work would not be enough to bring the building to the standard quite rightly required by the Mental Health Commission." In a letter to the Taoiseach's office in July, he stated, "... no matter what refurbishment takes place, the building could not meet either building standards or the high standards set by the Mental Health Commission ..."

A strong impression is being given to residents and their families and to public representatives that the commission's concerns played a large part in the closure decision.

It is also implied that other facilities are of a better standard yet some alternative facilities can involve dormitory-style accommodation in ward-based settings, for example, St. Stephen's Hospital and St. Catherine's ward. How does Mr. Morrison reconcile those communications with the reality of those alternative placements where the HSE is proposing to move people from what are essentially single and, in some cases, small rooms to dormitory-style accommodations in St. Stephen's Hospital and St. Catherine's ward?

Mr. Kevin Morrison

I thank the Deputy very much for her question. We came into this from the perspective of looking to see whether we could refurbish the building. I will defer to my colleague in a second with regard to the detail of that. We did exercises and looked to see if we could refurbish the building.

Could Mr. Morrison respond to those questions, please?

Mr. Kevin Morrison

Which question would the Deputy like me to respond to first? I was responding to the overall situation, which was the first question she asked.

I asked how Mr. Morrison can reconcile the comments he made at the time to the fact that the proposal is that some of the residents would move to dormitory-style accommodation in St. Stephen's Hospital and St. Catherine's ward?

Mr. Kevin Morrison

First, the current process with regard to the interaction with the families and the residents themselves would have resulted in three separate meetings at this stage with the multidisciplinary team, that is, the consultant psychiatrist involved, the clinical director and the executive clinical director, ECD. That consultation process is based on two things. It is based on the set needs of the individual and the-----

I am sorry. My time is very limited. I asked Mr. Morrison about how the justification given for the move is that the current premises does not meet standards, yet he is saying that the residents will be moving to St. Stephen's Hospital and St. Catherine's ward, which both have dormitory-style accommodation that are not high standard. How, therefore, can he reconcile that as the motivation put forward for the change?

Mr. Kevin Morrison

I will first say that all our premises in County Cork have problems from an infrastructural perspective. We have infrastructural issues in probably all our centres in Cork with the exception of our new centre in-----

I really would appreciate if Mr. Morrison would answer that question. How does he reconcile the excuse that he gave with the fact that residents will be moving into dormitory-style accommodation?

Mr. Kevin Morrison

With respect, I am trying to explain to the Deputy rather than giving her an excuse. That is the first thing to say. The situation is that the Owenacurra centre is closing because of the very serious infrastructural issues that we have.

I am sorry; I am going to move on to the next question because I have asked that question three times. How can Mr. Morrison reconcile the excuse he gave for the closure with the fact that residents will be moving to dormitory-style accommodation that is not high standard?

I will move on to my next question. He has given the impression to everybody concerned that the Mental Health Commission's concerns contributed in large part to the closure decision yet the compliance ratings for the Owenacurra centre have been consistently higher than some of the alternative facilities, such as St. Stephen's Hospital and St. Catherine's ward. Can he comment on this, please?

Mr. Michael Fitzgerald

I might take that question. Of course, we are always very cognisant of the Mental Health Commission's reports because they are a guidance to us in terms of meeting the correct regulatory requirements.

My question was addressed to Mr. Morrison.

Mr. Michael Fitzgerald

Can I respond though?

Mr. Kevin Morrison

I would like Mr. Morrison to respond, please. The question is addressed to him.

Mr. Kevin Morrison

As the chief officer indicated, we always take into account what the commission says to us on the approved centres. This is an approved centre. It has been criticised and that is a matter of public record in the context of the Mental Health Commission's reports. The Deputy will have noted that in the last of the Mental Health Commission's reports, the size of the bedrooms was specifically mentioned and a number of other criticisms were made of this particular facility. In briefings and in answers to parliamentary questions, the criticisms of the Mental Health Commission were taken into account. However, the most important piece, as I outlined to the Deputy in my answer to the last question, was the fact that we had independent assessments in respect of the building. These indicated that no matter what we did with the building, it could not be brought up to an appropriate standard to deliver the service that we wanted to provide there.

Mr. Morrison used the excuse of the Mental Health Commission. We know that the commission has been more critical of the facilities to which the HSE is proposing to send the current residents. There is no justification there and this was certainly used as an excuse.

There is a significant population of approximately 92,000 to 94,000 people in east Cork. What is Mr. Morrison’s assessment of need for high-dependency mental health residential facilities is that area?

Mr. Kevin Morrison

Is the Deputy addressing that question to me again?

It may be taken by whoever is responsible for ensuring assessment of need.

Dr. Sinead O'Brien

I will take that question. As to the mental health need, we are absolutely committed to providing a comprehensive service in east Cork. For that reason, in addition to the two community mental health teams, we have a fully staffed home-based treatment team, we have a psychiatry of later life team-----

Yes, I appreciate that. I ask that Dr. O’Brien just answer the question asked, please. What is the assessment of need for high dependency residential facilities to serve the population of east Cork?

Dr. Sinead O'Brien

We are following the national policy, A Vision for Change, which-----.

How many residential places would be required to meet the needs of that population?

Dr. Sinead O'Brien

As per A Vision for Change, the exact number can change over time. This is dependent on people who are availing of early intervention services and rehabilitation of high-dependency-----

The exact number may change over time but there is an average number in the context of the level of need and demand in the area. What is Dr. O’Brien's assessment of the average level of need in respect of high-dependency residential services for that population?

Dr. Sinead O'Brien

As I mentioned, in Cork we have in excess of 120 high-support hostel places and we have more-----

Dr. Sinead O'Brien

-----than 60 continuing care places. It is our view that this is adequate. We have vacancies in our service at the moment.

I am not talking about high-dependency hostels; I am referring to residential facilities that have round-the-clock nursing care. I am asking what is the level of need that the HSE has assessed to serve the population in east Cork?

Dr. Sinead O'Brien

The high-support hostels I am referring to have 24-7 nursing care and that answers the question that the Deputy has asked.

That is a different facility-----

This is the Deputy’s last question.

-----to residential facilities. A high-support hostel is a different facility to a residential facility.

Dr. Sinead O'Brien

We talk about continuing care facilities and the continuing care facilities in Cork are in Owenacurra and in St Stephen’s-----

The Deputy has one last question.

My final question is on the existing site. The HSE does not appear to have specific proposals for the use of the site. There is general talk about the possibility of housing. Why has the HSE not proposed a replacement 24-hour staffed residence for that site?

Mr. Michael Fitzgerald

The Deputy is correct in that we have not proposed a 24-hour nursing care centre for this site. It is our intention that we want to provide the type of independent supported living that we talked about. That, along with the supports we intend to put in and actually have in place at the moment in east Cork, is what we feel to be sufficient to meet the needs of the particular area. If we need a long-stay continuing care facility, it will have to be across a greater geography than just east Cork. Up the main road from us, which is only 15 to 20 minutes away, we have a very substantive HSE-owned site at St. Stephen’s. The St. Stephen's centre, and the Deputy is correct as she mentioned these a little earlier, certainly struggles from a compliance perspective and does not have all of the services in the proper environment that we would like. Our intention would be to replace the unit in St. Stephen’s, which would then be used as a facility for a broader part of the area in the context of the provision of continuing care.

We are discussing Owenacurra Centre and the needs of the current and future residents there. I am sure that Mr. Fitzgerald would accept that best practice is that in a long-stay facility, residents in that facility would be integrated into the local community, as they are in Owenacurra.

I am moving on to Deputy Hourigan.

I thank the Chairman.

I was going to begin with another question but I wish to stay on that issue. Can I take it from that then that the HSE’s plan for east Cork is to have zero residential facilities and to move people to St. Stephen’s facility? That seems to be what the HSE is saying, namely, that it sees no qualitative difference between that and long-stay hostels and that it has no intention of replacing these residential places. The reason I ask is because that is directly in conflict with the Sharing the Vision policy, which suggests that one needs three sites with around ten placements for a population of that area. The previous speaker was not able to give that number, but I have it and it is three sites of ten placements for that population size. Is Mr. Fitzgerald saying that the plans that the HSE has are directly in conflict with Sharing the Vision.

Mr. Michael Fitzgerald

It is not at all in conflict with the Sharing the Vision policy which talks about a reducing number of people in continuing care into the future.

My apologies, Mr. Fitzgerald, but the policy gives guidelines around the numbers of residential facilities for 24-hour care. Are we now saying that there are no waiting lists in east Cork for these kinds of placements?

Mr. Michael Fitzgerald

I am saying that earlier we were asked if we are replacing Owenacurra-----

And Mr. Fitzgerald replied “No”.

Mr. Michael Fitzgerald

That is correct.

Yes, I thank Mr. Fitzgerald. He denied the request of families to appoint an independent engineer to review the veracity of the HSE’s building reports. Why was that?

Mr. Michael Fitzgerald

I will ask Mark Kane, our estates officer, to respond to that question. I thank the Deputy.

Mr. Mark Kane

I thank Mr. Fitzgerald and Deputy Hourigan. I have no doubt that the Deputy will be aware from the number of reports given that we have carried out a significant number of assessments already.

My apologies. I do not wish to cut across Mr. Kane but I have read all of the reports. As he may know, I worked in this area in the past. I appreciate the amount of information that he has provided. In fairness to Mr. Kane, this is more a question for Mr. Fitzgerald because I believe it was he who was in contact with those families. I am asking him why this request to review the building was denied.

Mr. Mark Kane

Before I hand back to Mr. Fitzgerald, perhaps I could give an opinion in that regard. The Deputy will appreciate this point having worked in the sector previously. One of the most fundamental things that would have to be issued in advance of anybody carrying out an assessment is obviously a brief. The latter is what we measure the assessment against. It would be very difficult to develop a brief in respect of Owenacurra Centre when we-----

Sorry, I will have to disagree with Mr. Kane there. We have talked a great deal today about the size of the building and about room sizes. In some of the building reports we were furnished with, the room sizes are listed differently and various numbers are given. The request from the families was to carry out a review of the veracity of the claims made in the report, That review was denied. I do not think it is an unreasonable request considering that there are various pieces of information that are at odds with each other have been provided. It would be fairly standard and par for the course that there would be a review of the building reports.

If Mr. Kane wants to continue, I would like to take him up on his discussion around the future of the site. I would like to understand the figures he gave us in terms of occupancy. Are those numbers run for a 24-bed site or for a 15-bed site? It is completely unclear. I would also like to understand if the calculations were done on the basis of a single-storey building. That would probably be extraordinary in this setting.

As estates manager, perhaps Mr. Kane can address the issue of the size of rooms. He and I both know there is no statutory requirement in respect of the size of a room in a nursing home or residential care facility. I know that because I am trying to have it made a statutory requirement. We can have best practice but it is not enforceable. Saol Nua in Skibbereen has smaller rooms. Is the HSE intending to close Saol Nua?

Mr. Mark Kane

On room size, I mentioned earlier to Deputy O'Connor, which feeds into Deputy Hourigan's question, that if we look at a circa 20-bedroom unit, we are looking at upwards of 2,000 sq. m.

Is that on a single storey?

Mr. Mark Kane

That is a single-storey unit.

Why would we review it as a single-storey unit?

Mr. Mark Kane

In the first instance the Deputy asked about the standards this is based on. This is based on standards recognised by the regulator in mental health and the HSE-----

I thank Mr. Kane but there is not a statutory requirement. Is that correct?

Mr. Mark Kane

It is not a statutory requirement but----

No. The HSE has reviewed it in terms of a single storey-----

Mr. Mark Kane


I just want to be clear on this. Mr. Kane has given us those numbers on the basis of a non-statutory best practice and a single-storey building.

Mr. Mark Kane

Could I answer the question?

When the Deputy asks a question could she let the witness respond, please?

Mr. Mark Kane

I appreciate time is short and there are a lot of questions. It is not a statutory requirement but it is the requirement upon which we are assessed. If we fall short of that standard in an assessment we run a very significant risk that we will not be allowed to continue. By default it becomes the standard to which we will design and build all our buildings. It is the recognised, accepted standard.

Why is Mr. Kane giving us those numbers on the basis of a single-storey building? That is extraordinary.

Mr. Mark Kane

I gave the figure of 2,000 sq. m. for the gross internal floor area. If we were to start bringing residents into a multistorey accommodation it would be far from optimal for a number of our residents. As Dr. O'Brien has already pointed out, a number of our residents need continuing care.

Is St. Stephen's Hospital a multistorey building?

Mr. Mark Kane

Our challenging behaviour units are not.

Is St. Stephen's not a five-level building?

Mr. Mark Kane

Buildings 1, 2, 3 and 4 are all operational and they are all single-storey buildings with direct access to external therapeutic spaces, and for very good reason. We know our residents' ability to access external spaces is incredibly important. We do not intend to put residents on upper floors where they get quite restricted accommodation.

We just had a discussion about putting people into the community which Mr. Kane and I both know mostly means normal houses. The idea that we would always have single-storey buildings is extraordinary. I have never come across it. The benefit to people who have mental health difficulties of a site that is in the centre of a town would be significant. I cannot understand the choice to make that single-storey calculation.

I want to move on to the Mental Health Commission report. The HSE has said in a lot of its correspondence with me through parliamentary questions and in other documents that the decision was made in June. The Mental Health Commission reviewed the building in February. When it came back in June, nothing had been addressed. I am wondering if the decision was really taken in June. Otherwise, surely there would have been action on some of the issue the commission raised. Where does this leave us with the Mental Health Commission? It is interesting that it declined to come to this session. The HSE has effectively weaponised its report. In no place did it say we should be closing Owenacurra. It said it was not fit for purpose but it said that about many other facilities. I would say there are very few facilities in Ireland that actually meet the requirements of mental health residential care. If we held every mental health facility in the country to the standards to which the HSE is holding Owenacurra, we would have a tsunami of closures.

Mr. Mark Kane

I can only answer from a buildings perspective. In respect of when decisions were made, I will hand over to my service colleagues. Before I do so, it is important to note two critical points. The Mental Health Commission described the premises in Owenacurra as a critical risk. We have very few facilities containing bedrooms of 7.5 sq. m. with no en suites. I do not think anyone here would support a continued use of premises-----

But we have it in Saol Nua.

Mr. Mark Kane

Rooms of 7.5 sq. m. with no en suites is not something we are going to continue to support.

We have it in Saol Nua.

Mr. Mark Kane

As my colleague, Mr. Morrison has already commented, we have difficulties with a number of our facilities and the Deputy is quite right that those facilities are not just in Cork and Kerry.

Before we hand over to Mr. Fitzgerald, unit 8 on floor 2 is in St Stephen's, right? That is an upper floor, just to be clear.

Mr. Mark Kane

That is correct. That is for one unit per storey, no more than that, and it would not be an optimum location or one we would set out to deliver.

The HSE is going to be moving people to St. Stephen's and probably to that ward.

Mr. Mark Kane

We would not seek to put people on upper storeys and we certainly would not invest in new buildings that put people long term in upper storeys. That would be a retrograde step.

Would Mr. Fitzgerald like to answer my final question around the lack of action between February and June on the Mental Health Commission's report? What are the implications of weaponising the report in the way the HSE officials have done?

Mr. Michael Fitzgerald

I suppose "weaponising" is the word the Deputy is using herself.

Mr. Michael Fitzgerald

We have acknowledged publicly that there are a number of centres, particularly in Cork, that fall short of the requirements from the point of view of the regulator. We are working on two fronts in respect of that. First is to replace where we can some of those units and, second, in the interim to do works that would maintain them and keep them at some level of ongoing delivery of service. Those are two important pieces of it.

In the context of the Owenacurra Centre, taking account of the information that became available to us and considering what we could or could not do in terms of the future, I took the decision that we would cease the service in Owenacurra in its current state. In fairness if the Deputy takes a view of Owenacurra, there were day services provided at the centre of it, there were offices for staff and a variety of therapeutic services ongoing inside in the middle of where people lived. When we hear of the small rooms without an en suite, when we know and see the type of building that it is-----

The HSE has invested almost €3 million into St. Stephen's in ten years, which is in far worse condition.

Mr. Michael Fitzgerald

St. Stephen's is a very large centre with a lot of different complexity. It also entails an acute service at this time. It is a very significant and important service for us to maintain. It is also a centre we want to replace fully, actually. The Deputy is correct that we do not actually want-----

Is the HSE going to close that too?

Mr. Michael Fitzgerald

I want to replace it and I want to use it as a facility-----

The HSE is not going to replace Owenacurra.

Mr. Michael Fitzgerald

I want to use it as a facility for the services across Cork city.

The HSE is not going to replace Owenacurra.

Mr. Michael Fitzgerald

I have said that what we are going to do with Owenacurra is provide it as an independent living type of accommodation with supports to people who can live in the community.

Deputy Gino Kenny is next.

I thank all our witnesses. I do not claim to know all the complexities of this issue. I gather there is a situation where we have a unit in Midleton and residents have been there for decades in some cases. It is largely a successful place where people can live their lives and so forth.

There is obviously a lot of emotion attached to that, whether people are residents or a relative of a resident. My understanding from the last number of months, when I got to know this issue, although it has gone on for much longer, is that the HSE intends to close the facility and does not have an alternative as such, so the residents will be divided and allocated to other locations. That is an extremely traumatic situation for the residents and their relatives.

My main question is this: is the closure of Owenacurra final? Is that the final decision or can this be reviewed again in regard to an alternative for the residents? Is there any alternative facility in the vicinity of Owenacurra? That is my first question and I will ask a second question after that.

Mr. Michael Fitzgerald

Yes, the decision is final. We did not take that decision lightly, as I said in my opening statement, but on the basis of the various reasons that I outlined. The condition of the building was the main concern we had. When it came to the spending of money on it, we could not guarantee that we could bring it up to a standard that would pass muster into the future. That is the reality.

The second piece concerns the residents. The Deputy is right that it is difficult for the residents and we completely appreciate that. There are people who have lived for a long time in that residential setting. As Dr. O'Brien said, we are working with each of those residents very carefully and with their families as well. Of course, it is very traumatic and we are working with them in terms of an appropriate placement, some for nursing home care and some for high-support hospital care. It is hoped that some people, with more intensive rehabilitation, will be able to return to more independent living. For that purpose, we are examining at least one residential setting that we would like to have as a start-off in the town. We could bring people there, if they so choose and if they have the ability to do so, in order to again commence independent living. As we said, we would also be working with the local authority to replace the unit for the purposes of independent living into the future.

Some of the relatives have been in contact with members and we have had chats with them, and so forth. Obviously, the 15 residents have been there, some for a very long time, but they cannot be on these calls. What are their thoughts on the issue of Owenacurra closing down? At the end of the day, that is the important voice in all of this debate. Has the HSE talked to the residents about the fact that the facility is going to close in the very near future and that this is the alternative? What do the residents think about the decision to close Owenacurra?

Dr. Sinead O'Brien

I have met with a number of the residents and their families, as has Dr. Ruth Collins, clinical director, with the clinical team. Yes, the residents expressed shock initially, when the announcement was made. We have had a series of meetings with the families and there are very constructive meetings around discussing the real options in terms of alternative accommodation and the support services that will be in place for each of the individuals, based on their assessed needs. That is an ongoing process. I accept that the announcement was not an expected announcement, and the families and the residents have been working very constructively with the team in terms of finding the best solution to meet the assessed needs of each individual.

Thank you. I call Deputy Durkan.

I am not as familiar with this subject as my colleagues from Cork and I bow to their knowledge. Nonetheless, there are a couple of questions that have come to my attention. First, when was it initially decided that there was going to be a change of the service in Owenacurra and when was it announced?

Mr. Michael Fitzgerald

The Deputy wants to know the date of announcement.

Yes. This is a policy matter. I am asking where it came from. Who was driving it in the beginning? When was it first mooted?

Mr. Michael Fitzgerald

The concern was raised. Initially, we were considering that we would refurbish this unit and at least keep it going and bring it up to some level of standard. When we were able to see the totality of information from the professionals who examined the centre and bring totality on all of the different aspects from the perspective of fire protection and the fabric of the buildings within the total environment, it became clear that if we were to continue to invest in it, we could not guarantee that it would be brought to a place where it would be fit for purpose or that it would not be found wanting. That is what emerged in the course of that work.

How did that change of mind take place? Originally, it was intended to carry on, to refurbish and to upgrade insofar as was possible, and to continue providing services. That changed as a result of what? I am not as familiar with Owenacurra as I would like to be but I am familiar with the procedures that apply in such circumstances. I would like to know who decided, “Sorry, we are going to change the whole system, we are going to shift this around, we are going to put it to a different use altogether and do whatever else we are going to do with it.”

In addition, what is the long-term intention? Anything I have heard so for is not in concert with what I would regard as the long-term intentions for that site. That is an added question. What are the long-term intentions?

Mr. Michael Fitzgerald

On the first part of the question, it was as a result of us having got full sight of the totality of the professional reports following examination of the building. It came to the position where I decided, as I am the chief officer for the CHO and I take responsibility for these particular services, that we were not in a position to invest additional funding into this unit because it was not fit for purpose and we could not make it fit for purpose, regardless of what investment we could put into it.

To answer the second question-----

Excuse me. I want to hone in on that for a second. What part of it was not fit for purpose? Was it the structure itself - the buildings, the walls, the foundations, the roof? What was it?

Mr. Michael Fitzgerald

I will ask Mr. Kane to go through those particular pieces for the Deputy.

Mr. Mark Kane

I will give a summary as I am conscious that, as he said, Deputy Durkan is not as familiar with the facility as some of his colleagues. We had a condition survey carried out of the premises. That was done by way of an independent building surveying consultancy that is internationally recognised, and they applied an internationally recognised approach to their assessment. They would have identified some of the mechanical and electrical services within the building as being what they describe as either a condition C or a condition D. To put that in English, condition C is for systems that are defined as “poor condition with evidence of major defects” and condition D is defined as an “unacceptable condition”. For example, certain mechanical and electrical systems - some of the electrical distribution, some of the heating, some of the hot water systems and some of the building fabric itself - would have ranked at C or D when we had it independently recognised.

That is part of the decision-making criteria that we would have fed back to our colleagues in mental health.

We would have also carried out - to address one of the points the Deputy is making on the grounds of fire and fire safety and the building fabric - an asbestos survey. Given the age of the building - it is a Roh-Fab building which was built in the very early 1970s - it would have been developed and constructed at a time when asbestos was a reasonably commonly used building material. As a result, we identified elements of asbestos in the building as well which are being managed safely today. If there is any work to be done and it is disrupted, it causes a significant risk in the context of how we manage the dispersal of asbestos.

That is not a reason for a complete turnabout in policy in relation to it. There is asbestos in many buildings and it is being extracted under strict safety guidelines that are in operation all the time.

I will end with this. There are many old buildings throughout the country that were previously semi-derelict and that have been converted in recent years. Some have been converted into housing accommodation, hotels and various other alternatives. This was done satisfactorily and with all the grounds necessary kept in mind. Is there something relating to Owenacurra Centre that would not apply to all these other buildings? I go back to my original question. What are the long-term intentions for Owenacurra Centre? What else will happen in the area that might affect its long-term use.

Mr. Mark Kane

I will answer the first part and then hand over to my colleagues for the question on long-term position. Deputy Durkan is correct. The HSE has brought a number of its older buildings back into use. I cannot ignore that this is a Roh-Fab building and the fact that it was envisaged to have a lifetime of 40 to 50 years. We are now at the outer end of that and the building, in the context of its fabric and structure, has reached the end of its useful life. We have workhouse buildings that were constructed using cut-stone granite. These are much more robust and have greater longevity and that is why they are being reinvested in. We can invest in them with a level of certainty. Unfortunately, when I look at documents such as the climate action plan, I will not be able to bring a Roh-Fab building in line with current climate action requirements, as outlined by the Government. A significant amount of the mechanical and electrical system are at their end of useful life, as independently confirmed for us.

When you look at Owenacurra Centre in the round and consider the unacceptable deficiencies in the accommodation with 7.5 m2 bedrooms that do not have en suites, the level of investment that would be needed in order to bring the building fabric and the mechanical and electrical elements to a reasonable standard, the age of the building, how it was constructed and the fact that it is beyond the end of its useful life the restricted size of the site, all the essential systems, such as those relating to heating, electrics, etc., being at their end of useful life and the premises falling short in terms of what is needed, those are the considerations that probably set Owenacurra Centre apart from some of the other buildings Deputy Durkan quite rightly refers to that are even older but that we have invested in. I will hand over, maybe to Mr. Fitzgerald and colleagues, for the second part.

Mr. Kevin Morrison

On the second part of Deputy Durkan's question, the intention would be to utilise the site, following on from A Vision for Change and from what we want to do with services in the area, to be able to provide a housing solution with wraparound services for mental health service users who would be able to avail of that particular type of service in the community in a good location in the centre of Midleton. We have already had preliminary discussions with the local authority, and we will be engaging with it and with the approved housing bodies in relation to bringing that plan to fruition.

I will move on. Senator Black is next.

I thank the HSE management for joining us to discuss this important issue.

I want to highlight the fact that when we had the first meeting of the Joint Sub-Committee on Mental Health on this issue in early September, two family members of Owenacurra residents were present.

It was probably one of the most moving, emotional and powerful meetings that we have had. It gave the committee members an significant insight into the impact this closure would have on the residents and what was ahead for them.

I am conscious that we have not heard from the residents directly in these Oireachtas meetings so far. I want to highlight the wonderful work that the broadcaster, Mr. P.J. Coogan, did. I would recommend that anybody who is watching here today look it up. Mr. Coogan interviewed the residents and their families. I believe Mr. Coogan won an award for these interviews. I would recommend anybody, including anybody from the HSE, to listen to those because it was such a huge impact on those families and the residents.

I am also aware that the families of Owenacurra are mindful of the many other families who require these respite and long-stay placements for their loved ones in east Cork. These families, who have been in contact with us, want us to focus on the broader service loss to the region going forward.

I am conscious I have not got a huge about of time but I have a few questions. The first question I would like to ask our witnesses today is, do they agree that people who require the framework of a 24-hour staffed residential placement have the right to live in their own community? The importance of the residents living in their own community was highly stressed in that programme by Mr. Coogan. They are able to go out their door. They are able to walk down the street in their own community. They are welcomed into shops and into the library. They feel at home there. Do the witnesses agree that people who require the framework of a 24-hour staffed residential placement have the right to live in their own community?

Dr. Sinead O'Brien

I thank Senator Black. It is of such importance that each individual is supported to live as independently as possible with a focus on quality of life. We are committed to delivering on the model of care, as outlined in A Vision for Change, where people have early intervention and access to rehabilitation teams. It has been recognised that early intervention can result in recovery. We all know that recovery is not a single point; it is a journey. It is important that people have that support over a period of time.

It is recognised that some individuals will need focused residential rehabilitation. The focus is very much on rehabilitation and having the advantage of experts from different disciplines, such as social work, occupational therapy, psychology, clinical nurse-----

Can I interrupt Dr. O'Brien there because I am concerned around my own time? I heard, from the residents and from the families, how important for the residents' own mental health it is to live in their own community. It was one of the top priorities. I merely want to know what the witnesses' own belief is around that. Do they agree that it is absolutely vital that the residents have the right to live in their own community? That is so important. It is important that that is stressed here today, on behalf of the residents and on behalf of the families.

Dr. Sinead O'Brien

I believe that it is vital that we support people to live in the area that they want to live in. For that purpose, it is important that we provide evidence-based rehabilitation services so that people themselves can choose where they want to live and they have the appropriate level of support to enable them to do that.

Why is the 24-hour staffed care being removed from east Cork which has a population, between the two mental health teams, the Midleton-Youghal team and the Cobh-Glenville team, of nearly 100,000? Why are they being taken out of east Cork?

Mr. Fitzgerald stated that it is only down the road. It is half an hour down the road for those residents.

It is a good distance. They cannot just walk out of their home and go down to the shops. I am very concerned about that. I will move onto another question on that issue. There was a Mental Health Commission inspection of St. Stephen's Hospital and one of the alternative facilities for east Cork service users who require long-term placement. The 2021 inspection report has not yet been published but some Owenacurra centre families are keen to know what the compliance rating for St. Stephen's Hospital was and what issues were raised by the commission as concerns or reasons for enforcement action. Will Dr. O'Brien please talk us through those issues?

Dr. Sinead O'Brien

We have mentioned St. Stephen's Hospital a number of times today. Obviously, I need to be very conscious of the confidentiality of the individuals concerned. The St. Stephen's campus is only being considered for a very small number. In fact, only one resident has expressed a wish to go to that campus. It is not actually being suggested as a suitable location based on individuals' assessed needs. That is very individualised. As we said earlier, we recognise that the premises in St. Stephen's Hospital needs significant investment. We hope that can be provided over the coming years. With regard to the individuals in the Owenacurra centre, I cannot stress enough that there has been a multidisciplinary assessment. Each individual has had nine assessments to determine the level of support and expertise they need to live a life they have identified as what they would like. They have had significant input in deciding where they would like to be based.

Am I correct in saying that senior management would have been there for those inspections this year?

Dr. Sinead O'Brien

Senior management would have been present for the feedback meetings for each of the Mental Health Commission reports.

Will Dr. O'Brien give us an overview of the issues that will be covered in more detail in the report?

Dr. Sinead O'Brien

With respect to St. Stephen's Hospital, issues regarding the premises have been highlighted. Mr. Kane can advise on some of the works that have been done on the campus to address some of the issues highlighted in order to improve compliance. Regardless of that, it is fair to say that we will be looking for significant investment in the St. Stephen's Hospital site to develop a modern focused service where we can focus on rehabilitation and the psychiatry of later life.

St. Stephen's Hospital will be used for many other service users in the future, many of whom will be from the east Cork area. Am I right in saying that?

Dr. Sinead O'Brien

The services we provide in Cork are available to all individuals from Cork. Some people have already identified a wish to move to different parts of Cork. This may be based on people having family in the area or wanting to return to where they were originally from. As I said earlier, it is important that we provide support for people to live in the area in which they would like to be based.

To clarify, St. Stephen's Hospital will be used for east Cork service users into the future rather than just the Owenacurra centre. Is that right?

Dr. Sinead O'Brien

All of our services in Cork will be utilised for all of the individuals who require such services in Cork.

Families and local public representatives have written to us about the model of care provided in north Cork. There are three community residences in the area, one each in Fermoy, Mallow and Kanturk. Each residence is staffed 24 hours a day and has 14 single en suite rooms. That adds up to a total of 42 rooms for a population similar in size to that of east Cork. There is a waiting list for these north Cork residences. I understand that people who had previously been placed in ward-based settings in St. Stephen's Hospital, for instance, have been able to move to community-based living in facilities such as those Deputy Hourigan mentioned earlier, like Solas Nua, which is being established in Mallow.

Does Dr. O'Brien believe the service model in north Cork is progressive? Why does the HSE not plan to provide a comparable 24-hour staffed service in towns such as Cobh, Carrigtwohill, Midleton or Youghal to serve their local populations into the future?

Dr. Sinead O'Brien

As I mentioned earlier, we are appointing a new rehabilitation consultant psychiatrist with a team. This team will have a remit covering both the North Lee and South Lee areas. We are going to be looking at all the facilities we have for all individuals from Cork. The Senator quite rightly pointed out that a number of residents who resided in units in St. Stephen's Hospital that are now closed successfully moved out into the community. There is a multidisciplinary rehabilitation team in north Cork. The input from that team has allowed people to develop skills that allow them to live more independently. As it stands, there are some vacancies in the three residences in north Cork which the Senator mentioned.

There have been other east Cork residents who required long-stay or respite placement this year but the Owenacurra Centre was not available to them. Can Dr. O'Brien tell us what mental health facilities those service users have been placed in?

Dr. Sinead O'Brien

As well as having two community mental health teams for east Cork, we also have an east Cork home treatment team. This home treatment team can provide a five-day service to these families. We also have a weekend nursing service and, therefore, can potentially provide a seven-day service to support people in their homes. In July of this year, we also increased the number of psychiatry of later life consultants. The psychiatry of later life model predominantly involves seeing people in their own homes. People can also be seen in nursing homes to ensure they are supported. In the first quarter of 2022, the multidisciplinary rehabilitation team will also be working in this area. As per A Vision for Change, we are supporting people to live in their communities to ensure that, when they need additional support-----

I am sorry; I have to cut Dr. O'Brien off because I am concerned about my time. I want to clarify one matter with her. Will there be no 24-hour community residence in east Cork? That is really what I wanted to ask. Will there now be no 24-hour community residence in east Cork because the Owenacurra Centre is closed?

Dr. Sinead O'Brien

That is correct. There will be-----

That is pretty shocking, to be fair. It is very disappointing. I cannot even imagine what it is like for the families and people in east Cork and for their representatives here today to hear that there will now be no 24-hour community residence in east Cork.

Dr. Sinead O'Brien

For the benefit of people listening, it is really important to emphasise that there will be access to the relevant supports. As I said, we have in excess of 120 places in high-support hostels and in excess of 60 places in continuing care. It is really important that people know that this support is available and that we have expanded our-----

It is not good enough. I am sorry, but it is not good enough that, because the Owenacurra Centre is closing, there will be no 24-hour community residence in the east Cork area. That is very disappointing. Something needs to be changed in this regard.

We have heard unbelievable feedback from residents and family members about the importance of this service to them. This is their home where they have lived happily for many years and they are now being upended. It is shocking. We are talking about people's real lives. There is a lack of humanity around all of this. That is upsetting, particularly when you listen to what the families and residents have to say.

Apart from being absent for a few minutes, I have listened to proceedings since they began. It started with my colleague, Deputy Stanton, when he said this has not been handled well to date. This meeting demonstrates how badly it has been handled and the serious questions that remain. Is Dr. O'Brien aware that the Mental Health Commission is strong on the issue of out-of-area supports? Given what that commission has said, how can she justify a situation where somebody in Midleton or Youghal will have to travel at least an hour to get the type of 24-hour support they need and their family will have to travel at least an hour to visit them?

On top of that, there is the type of supports in terms of the staff ratio that exists, for example, in St. Stephen's, which is not to say a word against that facility, compared to the staff ratio in Owenacurra. One would have to conclude that there is much more attention to clients, patients and residents in Owenacurra. Does Dr. O'Brien accept she is going against the strong recommendations of the Mental Health Commission by closing this facility?

Dr. Sinead O'Brien

We are committed to providing services in and close to people's homes and that is why we have developed an east Cork home treatment team, expanded the psychiatry of later life model and are introducing the rehabilitation psychiatry multidisciplinary team at the beginning of 2022.

Can I seek clarification? That does not include a 24-hour residential unit.

Dr. Sinead O'Brien

That is correct. It has been well recognised in A Vision for Change that, with earlier intervention and support in a timely manner in the community, people are enabled to live independently. That is the proposed model for care of A Vision for Change. We are absolutely-----

That is not the case for everybody. Even if there are people who get timely interventions, sometimes 24-hour residential care is necessary. Would that be correct?

Dr. Sinead O'Brien

That would be correct and-----

With Owenacurra closing there is no 24-hour residential facility in east Cork. The people for whom the timely interventions Dr. O'Brien referred to do not work will have to be located over an hour from their home, which goes against the recommendations of the Mental Health Commission. Would that be correct?

Dr. Sinead O'Brien

In terms of our facilities in Cork, I have outlined that we have multiple facilities of high-support hostels and continuing care. All people in Cork have access to such facilities and now will have the added expertise of a specific rehabilitation multidisciplinary team to enable those people to move back to living independently after a period of intensive rehabilitation.

I am more concerned about the people that does not work for and who require 24-hour, seven-days-per-week supports. Dr. O'Brien is telling the committee that she is withdrawing that support from that community in east Cork. This will only get worse for the HSE. From what I have heard so far in this committee, this will snowball. I suggest the HSE changes its position on this rapidly.

I move on to respite, which has been mentioned here but not to the degree it should have been. Can Dr. O'Brien confirm the percentage of beds in the Owenacurra centre that were used for short- or medium-term respite pre-Covid?

Dr. Sinead O'Brien

Pre-Covid, two beds were used for respite. There has not been any respite provided since Covid due to the IPC measures required.

So there will be no respite facilities for people in east Cork. If they need respite, they will have to go at least an hour away from home. These people may just need respite to give their families a break or so their treatment can be reviewed. A multidisciplinary team, as Dr. O'Brien mentioned, may recommend that they need respite. If that happens, they are in a situation where the HSE is facilitating that they go outside the explicit recommendation of the Mental Health Commission and go out of area, which would be beyond an hour. Is that correct?

Dr. Sinead O'Brien

In terms of individual needs, if one of the community teams determines that an individual would benefit from a focused period of rehabilitation, that can be an option in all of our centres. That is dependent on Covid-19 and the IPC measures at a given time.

I am flabbergasted. I think colleagues on the committee are flabbergasted. There does not seem to have been any empathy shown in the decision to close the Owenacurra centre. I agree with colleagues who have spoken. This is not going away. I do not know how the committee will proceed but we may need to talk to the Mental Health Commission again. We need to do something. We cannot allow the HSE to close this facility in the manner it is being done.

When does the HSE expect to close the Owenacurra centre? It was said earlier that there are 15 residents at the moment, that two are expected to move in the next week, that here have been honest and open discussions and that six are moving to nursing home care. In response to a question from Deputy Stanton, it was said that no one would be forced from the premises. Does the HSE have a date of closure for the home?

Mr. Michael Fitzgerald

We have not put a final date on it at this point, for the reasons the Chair outlined. We will keep working away with each of the residents for the reasons given. As opportunities arise and their needs are met, we will take that decision when it comes to it. We have not a specific date placed on it at this point.

What is the average length of time the current residents have been living there?

Dr. Sinead O'Brien

There has been a range. Six of the original individuals have been there only within the past two years. Some individuals have been in the centre since 1988. There is a range in terms of the length of time individuals have been at the centre.

There are people there who would consider it their home. I was struck by the reference to moving to "high-support hostels". We are talking to families about moving a loved one from their home to, in some cases, a high-support hostel. The word "hostel" is jarring for anyone listening at home and for me.

It signals a change that would be clearly unacceptable to many of those families. I know it is just a term but it probably sums up the concerns of the families who have contacted us. They worried about family members who are moving from what is clearly their home, where they are comfortable and very much part of the community, to the unknown. The unknown in some cases could be hostel accommodation. We need to think about where those individuals are going because there are going to be difficulties. There is no date for the closure but what happens if a family takes a stand and says that it does not want their family member to move? What if there is a refusal to move? Where will the HSE be left in that situation?

Mr. Michael Fitzgerald

To be clear, we are very conscious of the need to manage very this carefully. Obviously, as Dr. O' Brien said, for confidentiality reasons, we cannot get into the ins and outs of individual cases but up to nine assessments have been undertaken with those affected. The discussion is predominantly with the people themselves but we are also talking to their families. I want to reassure the committee that great care is being taken. When we talk about high-support hostels, we are using terminology that is used for a very specific type of service or facility. Its usage is long-established. We did not make up that term. It is part and parcel of the service. It is a service provision area where people will go and hopefully have a more independent style of living. We cannot give up on that goal. What we said earlier is that some of the people who are resident in the Owenacurra centre today need long-stay care in nursing homes while others will, with support, hopefully be able to become more independent than they are right now. The future for us has to be that we are making a gain for every person who can, where possible, live independently or live independently with supports in their own home and their own community. It is in our interests to get this right. There are two cohorts of people to look after. There are the current residents but also the current and future users of services. We must ensure that they are given priority and that we can maintain them so that they do not have to enter into continuing care if that is not necessary. That is a hugely important aspect of all of this.

The other point that jumped out at me was that numbers were expected to decline. Is there an expectation that demand for services will decline in County Cork or in east Cork? I would have thought that demand was increasing in the context of a growing and an ageing population and demand would be expected to increase rather than decrease, which is why that statement jumped out at me. Ms O'Brien said that numbers were expected to decline. Was she talking about numbers at the Owenacurra centre or overall in the area?

Ms Sinead O'Brien

I would like to clarify that point. The Chairman is quite right that we have seen an increase in overall demand for mental health services. What I was referring to was the fact that with early intervention and intensive rehabilitation, the numbers requiring continuing care residence is expected to decrease, as outlined in A Vision for Change. The focus is on supporting people in the community to live as independently as possible, with the appropriate support. We have seen an increase in demand for services and that is why we have significantly increased the services in east Cork specifically. We have seen the benefit of the east Cork home treatment team, where people can be seen in their own homes or at a preferred location.

We have also seen the benefit of the support of the psychiatry of later life team for individuals who are over 65. We also have a seven-day service nursing service so people can be seen in their own home, seven days a week, if that is what is required.

We are running out of time but Deputy Ward has been waiting patiently since the start of the meeting to contribute. I invite him to do so now.

I appreciate the opportunity to speak to the witnesses. I do not know the Owenacurra centre or east Cork but I do know that people have rights. Deputy Buckley has filled me in on what went on in the past. There seems to have been a failure on the part of the HSE and successive Governments to properly resource the centre and this is coming home to roost now. It reminds me of a saying that my own nanny used, namely that a stitch in time saves nine. There has not been any stitching in the Owenacurra centre for a very long time. Red flags were raised on numerous occasions. It was reported in 2016 that electrical repairs were needed. Other reports were prepared that referred to structural concerns and the size of individual rooms. There has been an absolute failure on the part of the HSE with regard to the centre and there needs to be accountability for that. I am calling for an independent inquiry to determine how we got to this point.

The residents are being punished because of the failures of the HSE but they are the one group of people that has no say in this whatsoever. We are moving residents from their own single rooms into six-bed dormitory style rooms in places like Glanmire. In the context of human rights, do all 15 residents at the centre have family support? Have all residents seen the alternative accommodation that is being proposed? I have worked in this area and I believe that moving people from a residential setting that is their home into high-support hostel accommodation is a regressive step. I ask the witnesses to answer those two questions.

Ms Sinead O'Brien

Again, being cognisant of confidentiality, all residents have been asked to nominate family members whom they would like to be involved in this process. We also have the-----

I am sorry to interrupt but, without breaking confidentiality, have all 15 residents nominated a family member?

Ms Sinead O'Brien

People have been contacted, yes.

Have all 15 residents got family support?

Ms Sinead O'Brien

They do have recognised people in terms of nominated next of kin, yes. In terms of additional supports, the Irish Advocacy Network provides a weekly service to the Owenacurra centre. A representative of the network has made herself available to any of the residents or their families who wish to avail of support.

In terms of the Deputy's last question on looking at the different options, when options get to an advanced stage residents are getting the chance to look at different facilities. In fact, some of the residents have gone to see facilities and after reviewing them have informed us that they did not want to take up those places and that opinion has been respected.

I have another question for Dr. O'Brien who said that the numbers requiring continuing care are declining, from her perspective. She also said that while there is increasing demand for mental health services, there will be a decrease in the demand for the likes of the Owenacurra centre, a 24-7 mental health facility. At this very moment in time, however, only 5.4% of the overall health budget is directed towards mental health services but Sláintecare reckons that 10% of the overall health budget is required. In that context, I would not be very confident about seeing positive change in the near future. I would not be very optimistic in that regard.

Where are the people in east Cork at this moment who need care in the likes of Owenacurra? Where are they to be placed and do they not have a right to remain and live in their communities?

Dr. Sinead O'Brien

The focus of national policy - it is not just my view - is to support people to live as independently as possible and to promote people being able to live in the community. The national clinical programme for early intervention in psychosis has been piloted in a number of areas, including in Cork, and it has been clearly demonstrated that with early intervention, this can lead to functional and overall recovery. Investment in these areas is absolutely the way forward and can lead to people living absolutely full lives. The early intervention in psychosis service is being rolled out in east Cork and people are being supported in a very timely way with the home-based treatment team. Again, they can be seen on a seven-day basis, which is most welcome. We are all aware that services need to respond to people on a seven-day basis and not just a five-day basis.

I live in the real world as well. The reality is there will be a need for a 24-hour service encompassing a community mental health facility in east Cork. With the closing of Owenacurra, it means the service will be gone for the people of east Cork. A number of members have said that is not good enough. It is heartbreaking. I again read testimonies yesterday of the residents living there and it is absolutely heartbreaking to think these people's homes, structure and daily routines will be affected in this way. It is absolutely heartbreaking.

The witnesses mentioned they have assured families in briefings that no dangers are posed to the residents in Owenacurra from building issues. The Minister of State, Deputy Mary Butler, has nonetheless said in answers to parliamentary questions that there is a serious fire risk. How can those statements be reconciled?

Mr. Mark Kane

I thank Deputy Ward for the question. To clarify, we stated earlier that additional staffing has been applied to Owenacurra to ensure the building is clinically safe. We have always said, as we have done again today, that there are unacceptable conditions in the building. We brought in an independent conditions survey team and it has identified those items. We have done that in an independent and transparent manner in order to help us come to a decision and conclusion on how best to advance the matter.

There are specifics on building items. We have of course put in place some mitigation measures relating to fire works and we have done some interim works to de-risk the position to a sufficient level. This is not a long-term-----

Absolutely. I go back to my very first point, which is that some of these matters were raised in numerous reports over the years. These were either not looked into or taken seriously enough, or else there was not the will from the HSE at that stage to close Owenacurra. There is definitely a need to have a retrospective and independent inquiry to find out what the failures from the HSE were as they related to Owenacurra. That is so the likes of this does not happen again.

Mr. Mark Kane

It is a fair question being raised by Deputy Ward. Over €420,000 has been provided for ongoing maintenance and upkeep of Owenacurra over the past number of years. That is in response to questions being asked by the members in advance of today's meeting. The point remains and Owenacurra is probably unique relative to a number of other healthcare facilities. I mentioned that the construction is a Roh-fab material and the suppliers of such products speak of it having a 40 or 50 year life. That is the external fabric and structure of the building and it has reached 50 years. We must look at how fundamentally intrinsic some of these building matters are and they may not necessarily be applicable to other methods of construction.

We could go back to other reports by the Mental Health Commission and use the same arguments to close down other facilities. Deputy Hourigan's point earlier about weaponising the report of the Mental Health Commission is valid.

We could debate the insulation qualities or the possible retrofits on Roh-fab but we would probably bore everybody at this stage. I know I have only two minutes so I have a quick comment and question. It is incredibly frustrating when asking about 24-hour residential for the answer to speak about community mental health teams and people's placement in home care. Characterising A Vision for Change as saying we will never need 24-hour high-dependency residential placements is a mischaracterisation. We have adequately covered how there will now be zero placements in east Cork for this. To say a move towards decongregated settings and community health teams, which I absolutely welcome, will negate the need for any 24-hour placements is a mischaracterisation of A Vision for Change.

Much of what we are discussing today comes back to a duty of care for people who are very vulnerable. Families are depending on the HSE to uphold the duty of care for relatives living in long-stay mental health facilities. I inquired about this kind of duty of care aspect as it relates to vaccinations at St. Stephen's Hospital, which has been much discussed today, and elderly long-stay patients. My parliamentary question was not answered because GDPR regulations could be breached. I assure the HSE that I am not looking for anybody's name but I am asking that when the Model Business Park HSE corporate staff and staff and patients in St. Stephen's Hospital were vaccinated. I simply want to know the timeline. Will the HSE commit to sending me that information?

Mr. Michael Fitzgerald

There are two aspects about which we should be clear. It may not have been said here already, but if it has, we should be clear about it. We are not saying the need for long-stay care has been negated at all.

It certainly sounds like the witnesses are saying that. They have said there are zero plans for places in east Cork because we have community mental health teams, home care and weekend cover. That is the answer that has been repeated three or four times during this session.

Mr. Michael Fitzgerald

I am saying we have never indicated it was to be negated. I said we have many facilities across Cork providing residential care of differing types.

There is none in east Cork.

Mr. Michael Fitzgerald

I have said on numerous occasions there is none in east Cork. However, I said that our view is we will be providing independent supported living in the town and on the site of Owencurra, which is absolutely in keeping with the policy going forward.

Does the HSE have a funding commitment for that?

Mr. Michael Fitzgerald

Absolutely not, but I am saying it is our intention to do it with the local authority. It is an important point. With respect to other long-stay care facilities, we want to replace the unit at St. Stephen's Hospital. It is a very important facility where we have land and we want to replace it. There are also difficulties there with the regulatory piece but it is an important centre. We also need to replace St. Catherine's unit in St. Finbarr's Hospital. There are a number of challenges for units in Cork as they are not fit for purpose at this point with regard to regulatory issues. They should be replaced.

As Dr. O'Brien has said, we must take a broader view of where those services can be provided so we can get an appropriate date when a bed is required to meet the needs of a person with mental health requirements. We absolutely must put our full and utter focus on maintaining people in their own homes. I have worked in these services for almost 40 years, and for a good 30 of those, we spent our time trying to develop services in the community and get away from 24-hour institutional care and very large services that were difficult to close over a long period. It is an important point.

The Deputy raised a different matter on access to vaccines.

No. I am just asking about a parliamentary question while I have the witnesses before the committee. It relates to St. Stephen's Hospital and Owenacurra and the roll-out of vaccines in the past year.

I ask Mr. Fitzgerald to send me that information.

Mr. Michael Fitzgerald

We will send whatever information we can. I presume we have already responded to the Deputy-----

On the basis of a GDPR concern, the HSE would not send me the information. I assure Mr. Fitzgerald that I am not asking for personal information such as names or any other personal details. I am just asking for the timeline in respect of when people were vaccinated in the business park compared with the patients and staff of St. Stephen's.

Mr. Michael Fitzgerald

We will certainly look at that question again.

I thank Mr. Fitzgerald.

I welcome the moves towards an independent centre for day care. I always felt it was wrong that people were walking through the Owenacurra centre, which was the home of residents. Various people were walking into the centre on various days. Physically separating the two services is a good idea and I look forward to our guests letting us know where that day care centre will be located and whether planning will be needed for it. There will be a centre where people can go during the day and receive therapy and treatment and so on. I believe there were between 40 and 60 people per week availing of that. Is that correct?

What is coming from this meeting and the previous meeting on this issue is that the continuing care currently being provided in Owenacurra will be lost to east Cork. It will not be provided anywhere in east Cork. Mr. Fitzgerald has told us his plan is to build houses on the site, but he does not have a budget for that yet. If the plans to redevelop Midleton Community Hospital, which is next door to this site, are anything to go by, we could be waiting for quite a while before we see houses on the Owenacurra site.

Will Mr. Fitzgerald provide an indication of where we are with the building of the new hospital across the road? That 50-bed unit is badly needed and will free up all that complex. The HSE may have other plans for that. I suggest that rather than building houses on the site, the HSE should, as was stated earlier, build a ten-bed unit that could be used for continuing care. It could make it a two-storey building and the upstairs could be used as offices for staff and so on. That would alleviate many of the concerns that all colleagues present, and the community at large in east Cork, have mentioned. I ask Mr. Fitzgerald to consider that and revert to the committee on it. Alternatively, the HSE could consider the next step down, which is a high-support hostel, on the site. Like the Chairman, I do not like using the word "hostel" in this context. It jars with me too.

Even if the HSE were to apply today for planning permission to build on the site, it could take quite a while for that permission to come through and so on and there could be objections. In light of that fact, am I right in saying we can give comfort to the current residents that there will be no pressure whatsoever put on them to move out if they do not wish to do so? Getting back to the question asked by the Chairman, if a person states he or she does not wish to leave but rather wishes to stay in the centre, which, as was stated, has been the home of a particular person for 34 years, can that person be allowed to stay there until we have more clarity in respect of the centre? The centre is now physically safe from a fire point of view. Works have been carried out and the kitchen, which was a concern, is no longer operational. In addition, the number has reduced.

Mr. Michael Fitzgerald

To answer the Deputy's questions in the round, the day care facility and moving the day care facility out from the current residential centre is a welcome move. We are proceeding with that, as was stated earlier. As regards the new community hospital, I ask Mr. Kane to provide the most recent set of indicative dates we have in respect of that development.

Mr. Mark Kane

I thank Mr. Fitzgerald. As the Deputy is aware, the community nursing unit on the grounds of Midleton Community Hospital is part of a national programme that will deliver seven community nursing units. That national tender negotiation is currently well advanced. We expect to see the start of the 50-bed community nursing unit in summer 2021. That offers a great opportunity in terms of the ongoing reimagining of the Midleton Community Hospital campus.

We have what are locally known as the front hospital and back hospital buildings. To go back to a point made by Deputy Durkan in respect of the HSE and the repurposing of existing buildings, we envisage an absolute repurposing of the front hospital and back hospital when we have the new community nursing unit developed. We will certainly see those buildings offering a fantastic opportunity for primary care services to be enhanced in east Cork. That feeds into the fact that, when it comes to every primary care centre we do now, we work very closely with community mental health services. We see that offering a great opportunity for consolidating the community mental health teams. We will also have the ongoing enhanced community care programme and will consider how that will be rolled out and the opportunities arising from the fact we now have buildings that we will repurpose for the likes of responding to chronic disease-type issues in the east Cork area. This community nursing unit is a great opportunity and we will be noting the comments of Deputy Durkan in respect of reimagining and repurposing those existing buildings from a primary care community mental health perspective.

Could the HSE reimagine and repurpose its plans in respect of sheltered housing or supported housing on the current site? If I heard our guests correctly, a ten-bed unit could fit on the site. Could that be considered? It may be possible to provide a high-support hostel or a continuing care unit there. If the HSE does so, it will have alleviated many of the concerns and fears of members who have contributed today, as well as those of the whole community and all the families that have been in contact with us.

On top of that, the HSE might also consider a similar centre in Youghal and maybe one in Cobh. East Cork is a growing area. The population number is due to explode under the current relevant plan. It is an ageing population. These centres will be needed because the population is growing and ageing. As colleagues have stated, it is better to have people being looked after in their own communities as far as possible. I ask Mr. Fitzgerald to consider that. I do not want an answer today. Instead of going ahead with supported housing, I ask him to consider what I am suggesting.

Mr. Michael Fitzgerald

I hear what the Deputy is saying.

It has been interesting to listen to colleagues have an opportunity to question the representatives of the HSE. I am not at all satisfied by what I have heard at this meeting. Above all else, it comes down to the basic fact the HSE will strip my local area within my constituency of its existing residential mental health care services. For example, in Kanturk in north-west Cork, there are 13 single en suite rooms, while in Mallow there are 14 single en suite rooms. In Carrigabrick in Fermoy, there are 14 single en suite rooms. In terms of Midleton, Cobh and Youghal, the HSE is reducing the number to zero. It is just not acceptable for anyone to accept that, make sense of it or try to defend it, as has been so strenuously done by the HSE today. It shows an entire disregard for the needs of that area.

Deputy Stanton is right. The east Cork area is one of the fastest-growing metropolitan regions in Ireland. A new town is being built outside Midleton. The current size of Carrigtwohill is due to multiply. Youghal and Cobh are growing. The HSE wants to strip the service out of the area. What the HSE is doing is not about the physical standard of the building; it is about withdrawing a service from the community. It could rebuild the building. It could put a second floor on it if it needed the required usage of the full site. That could easily be done by putting another floor onto the building. The HSE representatives should not try to sell that one to me, the families or the people of east Cork. Simply on the basis of population growth alone, we need to retain a mental healthcare service in the east Cork area that is residential and staffed 24 hours a day.

As Deputy Buckley noted, if this is all taken away, it is very hard to see how it will come back. Given the historical issues in the Midleton area, of which all present are aware, what the HSE is trying to do is beyond comprehension. I have tried to engage with it constructively, as have all members, but there is no point asking a question because I will not get an answer. Those are my concluding remarks. It is just not good enough.

I want to return to the issue of independent living. I do not have any faith in it because the timeframe is way too long. Would the HSE consider retaining the existing services in Midleton while working around the difficulties? The witnesses referred to other alternatives but I do not believe they are there. If they are not there as alternatives, they are not an option at the moment. Would the HSE retain the existing services until everything else that has been spoken about is in position? At the moment I am very worried. The HSE is talking about building this, moving that, refurbishing the other but it does not even have money. It is like going into the bank and trying to cash in thanks; it does not happen.

I also want to touch on A Vision for Change, which refers to three community residential units of ten places each to be provided per 100,000 population. We are at just over 94,000. We have talked about policy all morning but the HSE is working against its own policy. Do the witnesses accept that under no circumstances should the HSE shut down the services in east Cork? It should expand them and, as another Deputy said, the HSE has the option to have ten-bed units in Cobh, Youghal and Midleton. Why is the HSE trying to close down a service when it knows that the demand will be more intense over the next couple of years? With a growing and ageing population, the demand for these services will only increase. The HSE is saying that there will be other services in place but it is not possible to rent a one- or two-bedroom house or apartment in east Cork at the moment because of the demand so I do not know where the HSE is going to get properties.

Reference was made earlier to east Cork community care. I googled that but could not find anything. I am trying to point out to the witnesses that services are not in place at the moment. There is no backup plan and there is no cash to do anything. The HSE wants to get rid of services while the population is growing. The witnesses quote A Vision for Change but that document says that there should be three ten bed units per 100,000 but the plan is to take 18 to 20 beds out of east Cork.

I will repeat my question. Will the HSE consider retaining the existing services until everything else they have spoken about is put in place?

Mr. Michael Fitzgerald

To be clear, we have existing services very much in place in terms of the community services that we have spoken about. We also have the home-based treatment team that Dr. O'Brien spoke about, as well as our community mental health team. They are based in east Cork and they provide services and clinics throughout east Cork in various locations. We can send details on those to the Deputy after this meeting so that he is clear about how to access those services, which is normally through GP referrals. Those multidisciplinary teams are very much in existence.

The building in which the current continuing care facility is based is simply not fit for purpose and we cannot make it thus or bring it up to a standard that is acceptable in terms of people living there into the future. We need to consider the supported living model, which we absolutely intend to do, to retain that type of service. That is in keeping with the policy to maintain people in their own homes and communities where possible. In fairness, that has been a huge success. The teams we have put in place in east Cork mean that we do not have to build more and more long-stay, 24-hour residential settings for people because there is no other alternative. The alternative is actually in place today, with people living successfully in their own homes and communities while receiving those services. We must have faith in the policy itself, which aims to keep people in their own communities.

I will make one final point. I have listened to what Mr. Fitzgerald has said. I believe we will be back here again, perhaps in 12 months' time. As many of the Deputies on this call are well aware, between 2000 and 2002, we had 69 suicides in east Cork, the majority of these occurring in Midleton. Despite this, Mr. Fitzgerald is telling me we do not need services in this town. I do not know from where he is getting his advice.

I do not know if Mr. Fitzgerald wants to add anything else to what he has said. I am about to bring the meeting to a close. Is there anything else he wants to add?

Mr. Michael Fitzgerald

No. I just want to thank the committee and, without trying to contradict anyone, to say that it is not the case that there are no services in east Cork at this point in time. There is a very significant level of service in east Cork, including mental health services. That is very important for those who use those services. I do not want to give the impression that there will be no service left in east Cork. A substantive and important service will remain in east Cork into the future. If we get more resources for community-based services, we will be delighted to broaden the service in east Cork and increase its opening hours. That is our intention. I thank the Chair very much.

I thank Mr. Fitzgerald and his team for the time they have given us today and for turning up last week in the middle of a storm. On behalf of the committee, I thank them for their attendance today. It is the committee's view that we do not want to see any facilities closing down. We want to hear news of more facilities opening. This is a difficult time for the families and loved ones of those who are facing into uncertainty. I welcome the fact that the HSE is still engaging with those individuals and families who are still in the Owenacurra Centre. I wish it well in those discussions.

That concludes the business for today. The committee will meet again in public session at 9.30 a.m. tomorrow, 15 December 2021, when the committee will meet with SIPTU, the National Ambulance Service and the Dublin Fire Brigade to discuss the issues facing ambulance services.

The joint committee adjourned at 1.32 p.m. until 9.30 a.m. on Wednesday, 15 December 2021.