Alan Kelly
Ceist:32. Deputy Alan Kelly asked the Minister for Health his plans for Our Lady's Hospital in Cashel in view of the volume of capital investment in the facility. [4409/17]
Amharc ar fhreagraWednesday, 1 February 2017
Ceisteanna (32)
Freagraí ó Béal (28 píosaí cainte)
The date 24 October will long live in the Minister's memory because it was the day he visited the, for want of a better phrase, "phantom hospital" in Cashel. By any standard, it was bizarre, and I think the Minister acknowledged that fact. The hospital being visited by the Minister for Health did not have a single patient. A huge amount of funding has been put into the hospital and that spend will come before the Committee of Public Accounts, of which I am Vice Chairman, in the coming months. However, the real issue is that we have an empty state-of-the-art hospital. Following the agreement reached between the Cashel hospital action group and the health board as a result of the 1996 High Court case, many promises were made by many predecessors of all political colours on the services this hospital would provide, but all those promises have fallen by the wayside. The hospital in Clonmel has one of the worst overcrowding situations in the country, yet up the road we have this incredible facility. Will the Minister tell us today of a plan for this hospital?
That day is etched in my mind because what I saw when Deputy Kelly showed me around was a beautiful facility that was not being fully utilised. The Deputy knows the history better than I, but Cashel Health Campus in County Tipperary, which includes Our Lady’s Hospital, provides mainly primary care services. There is a small residential facility on the site, together with other services including day and outreach services. The residential unit, which includes elderly, mental health and intellectual disability beds, is currently fully occupied.
The development of the campus as a centre for non-acute health care services arose from a decision by the former South Eastern Health Board to centralise acute hospital services for the south Tipperary area on one site in Clonmel. This took place in 2007.
This development of the Cashel campus occurred over two phases. Phase one of the construction work was completed by the HSE in 2009 at a cost of approximately €9 million, which it assures me was within budget. It focused on new residential facilities, including elderly care, mental health and intellectual disability beds, all of which are occupied.
Phase two concluded in 2011 and, according to the HSE, also came within budget. It tells me it had a budget of approximately €14.5 million. Phase two was focused on facilitating day and outreach services in the former Our Lady’s County Surgical Hospital. The Cashel primary care team is based at the campus and a range of services are provided on and from the site, including physiotherapy, occupational therapy, public health nursing, social work and disability services as well as home help co-ordination and community mental health nursing. Upgraded space for the minor injuries unit was also provided for in phase two. Other services include the south Tipperary community intervention team, of which the Deputy will be aware, which is a nurse-led service supporting both early discharge and hospital admission avoidance. There is also an ambulance station located on the campus.
That is the history, but I agree with the Deputy - I am going off script here - that there needs to be a plan to do much more at the site. This is why I instructed the HSE to come up with one. While South Tipperary General Hospital in Clonmel is under significant pressure on an almost ongoing basis, we have this fine facility in Cashel.
On spare capacity within the building, and acknowledging what is going on within it, CHO5 in conjunction with the acute hospital south west group has now developed a vision for the future of service provision in an integrated way which would be based in Our Lady's Cashel campus and, in particular, the old building. This proposal would see the use of areas for the purposes of day hospital assessment services, extended diagnostics and outreach rehabilitation services, which would work in conjunction with both community services and hospitals, provide alternative pathways, particularly for older people, and respond to the current emergency department pressures. This is where we need to get to. The proposal is still being discussed through the ongoing winter initiative weekly meetings that I chair. I believe that these developments would support the acute hospital in south Tipperary in addition to developments that should take place in Clonmel.
The Minister has gone well in excess of his time.
I apologise. I can come back with more detail on it.
Additional information not given on the floor of the House
I have been assured by the HSE that it will continue to explore and maximise the ongoing and future use of the Cashel campus and that services provided will continue to play a significant role in the provision of overall health services within the south Tipperary area. I have requested that the HSE explore what additional supports Our Lady's Hospital in Cashel can provide in alleviating pressure in South Tipperary General Hospital, including pressure on the emergency department. This work is ongoing.
I thank the Minister for his reply. There is welcome news in it given that a plan is to be put in place. However, let us get down to brass tacks. The hospital in Clonmel is under incredible pressure and the accident and emergency unit is overcrowded. It does not have enough space. In the past few weeks, the HSE turned down a request for extra nurses and staff. It turned it down, despite the proposal having been made by the HSE management and nurses together in a process that was independently chaired by Professor Jonathan Drennan.
We have heard all this before. Given commitments that there will be a vision for the two developments in Clonmel, I hope they will be part of the future capital plan the Minister will announce. Two future developments are ongoing there regarding upgrading computerised tomography, CT, facilities to bring in more trolleys and regarding a temporary accommodation facility. However, the taxpayers of Tipperary do not understand why the minor injuries unit in Cashel is not upgraded to admit more people-----
Go raibh maith agat.
-----who are critically ill. They also do not understand-----
I thank the Deputy.
-----why there cannot be some form of step-down facility-----
The Deputy will have a further opportunity.
-----in order to alleviate the pressure.
The fine people of south Tipperary are not alone in not understanding it because I do not understand it either. I did not make the decision in 2007, and neither did the Deputy, that the site at Cashel should be exclusively used for primary and social care. I am sure he wants to acknowledge, as I do, the hard work that is ongoing there. We had an opportunity to speak to the people who work there, and I acknowledge their work, but there is spare capacity in Cashel to do more. The Deputy can say correctly that people have heard this before, but what they have not heard before is that I as Minister for Health expect more to be done in Our Lady's Hospital in Cashel, that I have instructed the HSE to come up with a plan to do more and that the HSE has now come back with what I believe are the beginnings of a plan which sees the potential to do more in Cashel, particularly in day hospital, day assessment and diagnostic care and care of the elderly. This is in addition, as the Deputy said, to the additional measures that need to be taken in Clonmel, some of which are already funded in the winter initiative. As a former member of the Committee of Public Accounts, I welcome the fact that the committee will explore this issue. Regarding the industrial relations issue, while I note the Deputy's concerns, a process is ongoing through the IR mechanism and I do not wish to comment on that.
It is not completely an IR issue, it is a fact that the hospital does not have enough nurses, and the Department of Health needs to acknowledge that, as does the HSE. It is all very well to say the hospital will turn down the request for nurses, but I ask the Minister at least to engage at a level at which we will have a decision sometime soon because the place cannot take it at the moment.
I thank the Minister for his reply. When the decision was made to create the hospital as it is in Cashel, we were promised 25 geriatric assessment unit beds, 20 rehab beds, 15 nursing home convalescent beds, a palliative care unit, etc., so the Minister knows why the people are concerned and do not necessarily believe this will happen. What happens in Dundalk and Drogheda works well. The clinicians in Clonmel have a concern about going to Cashel - I understand that - but clinicians are only one part of the equation. We need to have a plan in which the people will believe, so I ask the Minister to not alone stress the importance of this matter to the HSE, which he has done, but also to publish a plan for this. I am anxious to know where the funds will come from. We need a plan, and I encourage him to publish one. Not alone that, I ask him to do us the service of meeting-----
I call the Minister.
-----me and other public representatives-----
Deputy-----
-----with the HSE in the near future-----
I have been more than reasonable. I call the Minister to respond.
-----when this plan is published.
The answer to the last part of the Deputy's comments is that it is a very good idea and I would be delighted to do so. He can therefore take it as given that we will have that meeting of the Tipperary Oireachtas Members. I ask that we give it a few weeks to allow-----
We should meet when there is a plan.
-----the work started already to be done. I agree that there should be a published plan. I will not stand up here and suggest on the record of the Dáil that there is a funded plan for Cashel because there is not. However, there is a review, as the Deputy knows, of capital planning and there are further opportunities to include additional capital projects.
It is rather current expenditure that is required.
That is possible. Current and capital may be required. The Deputy used a very good example of a network in Dundalk and Drogheda, and there are other hospitals in this regard. The whole idea of hospital groups is that different things are done in different hospitals and different hospitals have different strengths. The decision was made in 2007 not to classify Our Lady's Hospital Cashel as a hospital but rather as a primary care unit. I believe this was a mistake and needs to be rectified, so yes, we should publish a plan for Cashel and Clonmel working together and yes, we will have a meeting of the Tipperary Oireachtas Members.
With regard to the industrial relations point, there is ongoing dialogue with the INMO regarding not just issues in Tipperary, but also wider issues ongoing-----
I hope there is a decision soon.
-----as we speak. I hope there is a decision soon too.
The hospital needs nurses.
Question No. 33 is in the name of Deputy Seán Crowe, who has nominated Deputy O'Reilly to take it, and the Ceann Comhairle has approved.