Mon, Sep 27, 2021
Read in 13 minutes
Before a session of the Joint Sub-Committee on Mental Health Neasa questioned representatives from the HSE on the proposed closure of the Owenacurra centre in Midleton, County Cork.
Deputy Neasa Hourigan: I thank our witnesses for taking the time to do this because it is very important. I want to cover a couple of areas, starting with the building itself. Most of us have read the building report in detail and we can recognise the significant work that would have to be undertaken. I want to take a moment to understand the timeline of this process and how we got here. The first report in this inspection process was in 2016 when 14 areas of non-compliance were recorded. The premises was considered non-compliant with regulation 22, which is what we are discussing today. There was a moderate level of non-compliance. By the way, the rates of compliance and risk rating seem to change every year, which is not great in terms of trying to follow inspection reports. In 2016, the non-compliance was rated as moderate. We will not go through all the reports. The 2016 report referred to a lack of communal space, three-person rooms not being of a suitable size and the use of keys. The report stated it required improvement. It was also pointed out that there was no maintenance budget in the centre.
In 2017, the premises was considered compliant with regulation 22. The report states the quality rating was satisfactory, the building was in a good state of repair internally and externally and there was ample personal space. In 2018, the building was considered non-compliant again, with moderate non-compliance. That report stated the building was not in a good state of repair internally or externally. A change in external bad repair over a year is unusual, speaking from a professional point of view. Buildings degrade over a long period and, therefore, this is interesting. What seems to come up in a number of reports is that the toilets and bathrooms were not in good repair. In 2019, the building was back to being non-compliant with regulation 21 but the risk rating was considered low. There was a requirement for significant renovations. Some of these renovations have been done. The toilets and bathrooms were considered to be clean, hygienic and in good repair.
I have a number of questions about this timeline. In 2019, the report stated significant renovations were undertaken. Will Mr. Fitzgerald outline what the they were and the cost
Mr. Michael Fitzgerald, HSE: I do not have that information to hand but I can certainly send to the Deputy afterwards
Deputy Neasa Hourigan: There was also reference to funding granted for a new wet room. Was that work undertaken?
Mr. Michael Fitzgerald, HSE: I will have to come back to the Deputy on the specifics of that particular wet room. I will include that
Deputy Neasa Hourigan: The report states funding was sought and granted for a new wet room. Will Mr. Fitzgerald also supply us with the cost of this and whether it was used? We are trying to work out whether that wet room was built. The report states it would provide a total of three showers, including one assisted shower. This seems to be significant work. The 2020 report states all the lighting was upgraded to LED standard and all the fans in the bathroom were retrofitted. I presume this work was undertaken. Do we have a cost for this?
Mr. Michael Fitzgerald, HSE: I will forward that to the Deputy. I do not have it at hand.
Deputy Neasa Hourigan: Would Mr. Fitzgerald like to make a comment about the fact that all the risks outlined in the previous building reports were categorised as low to medium?
Mr. Michael Fitzgerald, HSE: Yes, they were. I suppose in reality the building itself, and it is important that I outline this, was not necessarily coming up in lights, for want of a better phrase, in terms of having significant issues. As there is in any of these particular buildings, there is an ongoing minor capital spend and an ongoing maintenance programme to pick up on specifics.
At the same time, the condition of the fabric of the building and its layout are of concern and have always been of concern. It does not have large room sizes and it can be quite a cramped space, especially for people with a significant level of dependency.
Our estates department sought an external review from external professionals with regard to same. The Deputy earlier referenced those reports, that really centred on the prevalence of asbestos and fire-related issues. It then reached the conclusion, which we absolutely accept, with regard to doing works on the building even on a phased basis, given what would be required to bring it to modern design requirements that should be expected by those who would reside there, that the building itself is just not fit for this particular purpose.
Earlier, the Deputy pointed to various ongoing issues. There has been an ongoing issue with privacy and dignity. This is a design issue with the building. The building has been there since the early 1970s. We are speaking about a building that was of its time 50 years ago. Any renovation we try to do, whether a new build or refurbishment, is done to bring a building up to a standard at which we are protecting people’s privacy and dignity, creating adequate space for circulation and privacy and creating a modern build. It was in this context that we looked at significant refurbishment of the building so we could deal with these issues and the expectations of the residents
Deputy Neasa Hourigan: Are there any other residential units in the Cork and Kerry healthcare area that had moderate non-compliance with regulation 22 for three years in a row.
Mr. Michael Fitzgerald, HSE: There are a number of centres in Cork and Kerry where we have ongoing works and ongoing plans in our modernisation programme.
Deputy Neasa Hourigan: I do not mean to cut across Mr. Fitzgerald but I am very aware that other people will want to come in to ask questions. Do these other buildings have reports that state they are between a low and moderate non-compliance level under regulation 22?
Mr. Michael Fitzgerald, HSE: I am sure they do and I can supply some of these to the Deputy. I will certainly check for the Deputy
Deputy Neasa Hourigan: That would be very useful. Is the HSE planning to close them?
Mr. Michael Fitzgerald, HSE: Our view is that we want to have a plan that will see the modernisation of many of our residential services to ensure we provide the appropriate service in the appropriate setting.
Deputy Neasa Hourigan: Mr. Fitzgerald can absolutely see, from the point of view of residents and families, that if it is not flagged in the annual reports it leaves everybody in a residential unit in this country in a difficult position. I am aware of my time. In terms of the asbestos testing, in 2019 there was a significant report on asbestos. Mr. Fitzgerald mentioned a further inspection in February. Was that a more complete asbestos report?
Mr. Michael Fitzgerald, HSE: It was not specifically asbestos.
Deputy Neasa Hourigan: Is a further asbestos report available since the October 2019 report?
Deputy Neasa Hourigan: If Mr. Fitzgerald has one I ask him to pass it on. Otherwise the asbestos report we are looking at is from two years ago and the question becomes why we are here, two years later, with a four month window to move people out of their homes.
The 2020 report states capital funding has been approved for a major refurbishment, the estates department has been engaging with the design team, the overall project has been costed and detailed drawings were included as supporting documentation. I cannot find this information. What was the total cost for the refurbishment project as proposed before this decision was taken?
Deputy Neasa Hourigan: Does the HSE have plans for the site?
Mr. Michael Fitzgerald, HSE: We do not have specific plans for the site. We certainly recognise its value. As already stated, we will consider the healthcare needs of the area and identify any particular needs that would be well served by some development on that site
Deputy Neasa Hourigan: Has Mr. Fitzgerald undertaken a valuation of the site?
Deputy Neasa Hourigan: Yes
Mr. Michael Fitzgerald, HSE: No. I have not
Deputy Neasa Hourigan: Apologies, Chairman, I am aware I am over my allotted time.
Deputy Neasa Hourigan: I have a number of questions I did not quite get to but they speak to Deputy Stanton’s previous points about the timeline. I am trying to understand how this timeline came to be and how we got here. To be clear, the decision was made in June and the residents and families were told in July, but the newest building report or estates review was done in February. Is that correct?
Mr. Michael Fitzgerald, HSE: On the reports we got, it was on the basis of a report provided to us from estates, having taken account of a number of reports the Deputy will be aware of, that the decision was made. That was made available to us on 18 June.
Deputy Neasa Hourigan: Okay, but Mr. Fitzgerald said earlier that the estates section compiled that report in February.
Mr. Michael Fitzgerald, HSE: I am not sure what I said about that particular piece, but we got the culmination of various reports the estates section had undertaken on 18 June, which was inclusive of the fire report, the earlier report on asbestos the Deputy referenced and the estates section’s own condition survey.
Deputy Neasa Hourigan: Was there new information, or surveys undertaken, between December 2020 when the building inspection took place and the report the HSE received in June?
Mr. Michael Fitzgerald, HSE: The simplest way of saying it is that it was on the basis of the fire report, the earlier report on asbestos and the general report undertaken by estates itself. It was on the culmination of those that we acted upon. To answer the Deputy’s question, was there—–
Deputy Neasa Hourigan: Were there new building surveys between December 2020 and June 2021? Did somebody go into the building to undertake new testing or new surveys?
Mr. Michael Fitzgerald, HSE: Yes. Our estates department, on foot of the information it had, did.
Deputy Neasa Hourigan: To be clear, did it compile the report in that period or did it undertake new surveys?
Mr. Michael Fitzgerald, HSE: It compiled the report in that period.
Deputy Neasa Hourigan: Okay. In that period, was a stand-alone, new fire inspection and a stand-alone, new asbestos report and set of testing done?
Mr. Michael Fitzgerald, HSE: I will come back to the Deputy about the timeline and detail of the specifics regarding asbestos and the fire inspection.
Deputy Neasa Hourigan: The timeline is important. The last significant report on asbestos reviewed approximately one sixth of the building’s floor area in the plan attached to the report, which would be standard. It found that asbestos is present and that it is in relatively good condition, as anyone who works in the area would know. If it is disturbed, it would be of particular concern. That dates to October 2019, which means that if it was of particular urgency, it would require that residents move immediately. Not taking action in almost two years is something that we need to follow up with the HSE, if there are other reports. Have other facilities received similar asbestos reports?
Mr. Michael Fitzgerald, HSE: The Deputy is asking a specific question from an engineering perspective which I would ask my estates colleagues to provide a report to her on. My understanding is that the asbestos report is an initial report if works are to be undertaken in the building.
Deputy Neasa Hourigan: The costs and such.
Mr. Michael Fitzgerald, HSE: It addresses the disruption that might be required and the care and attention needed to deal with it. It is important to say that.
Deputy Neasa Hourigan: Earlier in the meeting, Deputy Sherlock spoke about St. Stephen’s Hospital. I agreed with much of what Deputy Sherlock said. He spoke very well. Like all of the residential facilities in the country, that was also reviewed. The most recent review was in 2020. Like Owenacurra, under Regulation 22, the premises of St. Stephen’s were noted as non-compliant. That risk rating was high, unlike Owenacurra, which is considered low. Mr. Fitzgerald is not ruling out that residents could be moved to St. Stephen’s Hospital. Is that correct?
Mr. Michael Fitzgerald, HSE: I am not ruling that out but I suppose—–
Deputy Neasa Hourigan: I am sorry to cut across Mr. Fitzgerald. I have a quick question. I know other people want to get in. I requested building reports on the long stay and acute wards in St. Stephen’s Hospital in August and I have not received them. Can Mr. Fitzgerald give an undertaking to send those reports to me?
Mr. Michael Fitzgerald, HSE: We can. To answer the earlier question, I am at pains to say that it is a residential centre that is registered with the Mental Health Commission. Admission to the units in St. Stephen’s Hospital is acceptable from the Mental Health Commission’s perspective.
Deputy Neasa Hourigan: St. Stephen’s Hospital includes dormitory-style settings, does it not?
Mr. Michael Fitzgerald, HSE: It does. We are looking at whether we can upgrade those units in the interim and it will require replacement as part of our overall capital plan development.
Deputy Neasa Hourigan: Will Mr. Fitzgerald give an undertaking to the families of the residents currently in Owenacurra that anyone who is in a single room will not be moved to a dormitory setting in St. Stephen’s?
Mr. Michael Fitzgerald, HSE: I hear what the Deputy is asking. An assessment process and discussion are ongoing with the residents of Owenacurra. If I say anything here about where people might be placed or not placed, or what might be appropriate or inappropriate, that would be unfair to them.
Deputy Neasa Hourigan: What percentage of the 19 are going to nursing home care, if the witnesses would be more comfortable answering it that way?
Ms Sinead O’Brien, HSE: There is consideration of nursing home care for five individuals.
Deputy Neasa Hourigan: Five out of 19. Would those nursing home placements include single rooms?
Ms Sinead O’Brien, HSE: The nursing home accommodation has some single bedrooms. I would have to look at the exact units. There is a large proportion of single rooms but there are also rooms in nursing homes where two people occupy rooms.
Deputy Neasa Hourigan: Will Ms O’Brien confirm for the families of residents in Owenacurra that those who have been in single rooms will not be moved to dormitory-style rooms in nursing homes?
Ms Sinead O’Brien, HSE: As Mr. Fitzgerald has stated, we will fully discuss any proposal regarding—–
Deputy Neasa Hourigan: Ms O’Brien cannot give that undertaking right now.
Ms Sinead O’Brien, HSE: We are in the process of looking for approval for nursing home placements. We will fully discuss the options with individuals.
Deputy Neasa Hourigan: Are the nursing home placements that the witnesses are looking at in private or public units?
Ms Sinead O’Brien, HSE: We are looking at where people would like to go so we are looking at all options.
Deputy Neasa Hourigan: Dr. O’Brien talked about the idea that it was not planned for many of the individuals who live in Owenacurra to live there in the long term. For many, a high-dependence hostel or some kind of community setting would be appropriate. Many of the people in Owenacurra would have lived there for a decade or more? Is there a clinical concern regarding moving people who have lived in a residential setting for more than a decade into a community setting or high-dependence hostel?
Ms Sinead O’Brien, HSE: Every individual will be assessed individually to determine what level of care he or she requires. Some individuals will require ongoing, continuing care. For that to happen with the least amount of stress, it is important that staff who are well-known to the individual would follow those individuals to assist them with that transition period.