Cork North West TD Michael Creed has warned the Minister for Health Mary Harney of the dire consequences of closing Community Hospitals in Macroom, Kanturk, Millstreet and Dunmanway.  Speaking during a Dáil debate on Health Deputy Creed said:

The primary purpose of the Bill is to provide for the dissolution of the board of St. Luke’s Hospital and the transfer of its staff, properties, functions and liabilities to the Health Service Executive. I listened with interest to numerous speakers who are more familiar with the operation of St. Luke’s Hospital than I am and who highly praised the staff and the service they deliver.

My contribution primarily concerns the miscellaneous amendments in the legislation but I would like to comment on St. Luke’s Hospital and perhaps go from the particular to the general. There is an increasing trend of the HSE taking small State-funded hospitals under its remit and I am not altogether sure that is welcome. I have no doubt that in years to come we will reverse this process and recognise that small does not necessarily mean inefficient. I accept the need for centres of excellence and I am not opposed in principle to the reconfiguration of the health service, but the HSE is a monolith and is unaccountable and this just adds more fuel to that fire which I am not sure best serves the public.

The primary purpose of my contribution concerns the miscellaneous amendments in the legislation, nursing homes and the new fair deal scheme which, broadly speaking, has been widely welcomed by all parties in the House. There was much uncertainty for families with ageing relatives in need of full-time care, how affordable it would be for them and what would happen when their financial resources ran out. This scheme has brought some certainty in regard to their entitlement to support from the State, which I welcome.

As I was coming into the House, I saw the retiring chief executive of the Health Service Executive, Professor Drumm, presumably heading into the dungeons of Leinster House to a meeting of the Oireachtas Joint Committee on Health and Children. I wish him well in his retirement and I welcome the new chief executive designate, Mr. McGee, who I understand has a history in the health service in the north west where he was involved in the provision of community facilities which, I believe, will be the next battle ground.

Reconfiguration has happened in respect of centres of excellence for cancer services. It has happened in the mid-west in Ennis and Nenagh and in the north east. It is now happening in the south and there are question marks over the future of Bantry and Mallow General Hospitals. What is relevant to this Health (Miscellaneous Provisions) Bill and the nursing homes legislation is that the reconfiguration process is moving into the delivery of community-based nursing home facilities. I wish to put down a marker here for the HSE that it should make haste slowly.

Community-based medical services can thwart the onward march to acute hospital facilities if properly structured and delivered. A key component of that is community nursing facilities – the district hospitals. In my constituency, there is Kanturk, Millstreet and Macroom District Hospitals and on the fringes of my constituency, there is Dunmanway District Hospital. I see a threat hanging over those district hospitals. When concluding the debate, I would like the Minister to reassure me about their future.

It is important we have a public-private mix. The fair deal scheme does not differentiate and people now have a choice. It is not right that we phase out these community hospitals by stealth and I would like an assurance that will not happen. What is happening is that the Health Information and Quality Authority is carrying out inspections in these district hospitals and there is a real danger that a combination of HIQA and patient choice about whether to choose a private nursing home or a HSE run facility could mean district hospitals will be starved of funding to meet the HIQA standards and that, ultimately, the HSE will say it does not have the capital budget to spend to meet the HIQA standards and that patients have a choice and can go to the private nursing home facility. Maintaining a public-private mix in terms of provision for elderly people is critical.

The new fair deal scheme is very much in its infancy. I support the idea of patients having choice but there is some evidence that patients initially opted for private facilities in large numbers but are now opting for community-based nursing facilities. It is vitally important that the Minister assures us that the combination of HIQA inspections and the fair deal scheme is not the pretext under which the HSE will say it does not need community facilities. I acknowledge the tremendous service those community hospitals have delivered on a shoestring for large numbers of patients over many years.

There is another matter about which I am concerned in regard to the HSE’s tactics on this issue. Almost all the patients in those community nursing facilities are high dependency and, therefore, the rate per patient could prove higher than the rate in a private nursing home. Will the private nursing homes cherry-pick and say the high dependency patients can go to the district hospital and that they will take the low dependency patients where the care requirements are not as complex and where they can meet their profit demands which the community-based facility does not have? I would like an assurance that agenda is not afoot in the HSE and that the community hospitals will continue to play a role.

Deputy O’Rourke mentioned Alzheimer’s care. There is a great and growing need for facilities to care for patients with Alzheimer’s. There is also a great need for respite care places. The reconfiguration process has been undertaken in acute hospital services in HSE south and is beginning to happen in respect of these community hospitals. That process must be open and transparent and I would like communities to be involved in it. I do not want closure by stealth, which I fear.

The Minister cannot hide behind the HSE in this regard. She must clearly state that she supports the principle of retaining a public-private mix in terms of choice for patients in terms of long-term care. I would like to be reassured that the great and growing need in regard to respite care places and care for patients with Alzheimer’s is met whether through the community hospitals or otherwise. That can be dealt with in the context of reconfiguration. However, due to a combination of factors, including the fair deal provision, patient choice, HIQA inspections and the cost of care having regard to the high-dependency nature of the patient in community hospitals, I do not want the HSE to arrive at a juncture and decide that such provision could be done better in the private sector. The straws are in the wind in that regard.

The HSE has recently built a new community nursing facility, paid for by public funds, in Ballincollig in my constituency. It is very welcome but no sooner was the building completed than the HSE decided to put it out to public tender. It will now be given to the private sector to operate. I am not opposed to that – there is a role for the public sector and the private sector in such provision. If that is a signal of where the HSE is going in respect of its own facilities, it raises the most serious questions in respect of the future of the aforementioned community hospitals in Kanturk, Millstreet, Macroom and Dunmanway. There are 21 public long-stay HSE operated facilities in the south west in which local communities have significantly invested. I want to be reassured by the Minister of State, when she replies to this debate, that the HSE, at her direction, will not be allowed to wind down its involvement in community nursing facilities for the elderly.