Mr. Dean Sullivan:

My name is Dean Sullivan. I am deputy director general in charge of strategy and planning for the HSE. I am very grateful for the invitation to attend this meeting of the Committee on the Future of Mental Health Care. I am joined today by three colleagues. Mr. Pat Healy is national director for community strategy and planning. To my left is Ms Anne O’Connor, national director for community operations, and to Ms O'Connor's left is Mr. Jim Ryan, who is head of operations within mental health.

I am very pleased to appear before the committee today to speak to members about the future of mental healthcare and, more specifically, the structures that have changed within the HSE in recent months. I will begin by giving an overview of those changes that have taken place since 1 January.

We have a reform programme within the HSE, which is focused on how we work and the structures we work within. As part of building a better health service, the HSE is implementing changes to the way in which we are organised, particularly in the context of the appointments last summer of John Conaghan as chief operating officer and of me as chief strategy and planning officer. More recently, in April 2018, Dr. Colm Henry took up the role of interim chief clinical officer and we, as three senior managers within the HSE, are now working in a triumvirate manner in line with the new ways of working we are seeking to take forward as an organisation.

With effect from the beginning of January, the roles of a number of existing HSE national directors have changed to facilitate the separation of those activities relating primarily to strategy and planning from those relating primarily to operations and delivery. In this regard, Anne O’Connor is now responsible for the delivery side of the house in terms of her role as community operations and Pat Healy is responsible for community strategy and planning. Dr. Philip Dodd remains in his role as national clinical lead for mental health services.

These and other changes have been signalled for some time in the context of the journey to transform the way in which we deliver services in order to build a better health service and strengthen governance and accountability arrangements. This is fully in line with Government policy and the recommendations of the Sláintecare report, which refers clearly to the need for the HSE to be re-orientated to a more strategic, leaner national centre.

Since the establishment of the mental health division in 2013, there have been tangible service improvements for patients and clients with an increase in the percentage of funding going towards mental health from the overall health budget. Since 2013, mental health expenditure has increased by 22% from €709 million to €867 million. I assure members that all funding allocated to mental health by Government is being spent on mental health services.

In recent years, there has been an increased recognition of the need for an integrated approach to the design and delivery of health services to people with mental illness and other co-morbid illnesses. The organisational changes now being implemented within the HSE are designed to build on successes to date through a separate, though integrated, approach to strategic planning, operational oversight and the delivery of mental health services. Having developed a strong delivery system through the introduction of community healthcare organisations and hospital groups, it is important that the role of the centre within the HSE changes to one which supports and enables the delivery of services as opposed to actually being involved in the day-to-day delivery of those services.

In her role as head of community operations, Anne O’Connor is supported by a dedicated operational lead for mental health who is with us today, Jim Ryan, working closely with a dedicated planner for mental health, John Meehan, from community services strategy and planning, that is, on Pat Healy's side of things. In addition, these specialists and their teams will work alongside a number of other teams and networks with a focus on integration. The establishment of the chief clinical officer role within the HSE also brings an additional clinical focus on mental health, working closely with both my side of the house on strategy and John Conaghan's side of the house on operations.

Mental health services in Ireland are integrated with primary care, acute hospitals, services for older people, services for people with disabilities and a wide range of community partners. Services are provided in a number of different settings including health centres, day hospitals, inpatient units and sometimes in the user’s own home. Over 90% of mental health needs can be successfully treated within a primary care setting, with less than 10% being required to be referred to a specialist community based mental health team. Of this number, approximately 1% are offered inpatient care, with nine out of ten of those admissions being voluntary.

Regionally, the nine community healthcare organisations, CHOs, have responsibility for the delivery of community healthcare services within their respective geographical patches. While the chief officer of the CHO has overall responsibility within each organisation, the head of service for mental health, in conjunction with the executive clinical director, is responsible for the delivery of mental health services across the respective CHO areas.

As members will be aware, forensic mental health services operate on a national basis.

These organisational changes are intended to achieve the following benefits: an appropriate organisational focus within the HSE centre on strategy and planning and oversight of operational delivery; strong and visible clinical leadership at the most senior level; robust planning arrangements including assessment of needs, inequalities, outcomes and access to services; a more structured approach to the identification of issues with a clear focus on the development and implementation of plans for improvement informed by service user experience and best practice; effective integration of services at national, regional and local levels; and robust performance management and service improvement arrangements across the system.

In relation to service users, the organisation changes are intended to achieve improved access to services, improved flow through services from mental health to primary care or to acute hospitals and returning to the community and more consistent support to service users to ensure they receive the right service, at the right time, in the right place, by the right team.

To conclude, I highlight the point that complex system-wide change, such as the type that I have outlined, will take time to complete and it is vital that we maintain stability during the transition phase. Notwithstanding the changes under way, there is a firm commitment within the HSE to the ongoing delivery and development of mental health services for all age groups.

I look forward to answering any questions the committee may have.