Simon Coveney (Cork South Central, Fine Gael)

I am pleased to have an opportunity to speak on the Bill on Second Stage and to make general comments on the health sector and health reform. There is a genuine desire on the part of the Government to make a change for the better in the health area. It is the key political challenge for the Government over the next two and a half years.

I wish to share some ideas from my experiences on the Southern Health Board and as a Deputy. The first area concerns mental health and the share of the overall health budget that goes to that discipline. There has been a steady decline in its share of the overall budget. In the recent Estimates its share is 6.15%, having been reduced from 6.69%. I am not trying to compare politics or Governments, but if one goes back to 1997-98, the share was 10% or 11%. This trend is of great concern, especially for those working in the area and for families. I understand from a capital programme point of view the specific need to build in respect of accident and emergency units and hospitals generally and the general trend towards moving away from institutional care to trying to support community care in the mental health sector in particular. However, it is unacceptable to allow the percentage share of current expenditure on mental health services, including staffing, to continue to reduce at a time when one in four Irish people suffers from a mental illness at some stage in his or her life. One in six or seven suffers seriously from a mental illness of some description, be it depression, schizophrenia or other conditions.

I was on the psychiatric services committee of the Southern Health Board for four years. It was an absolute eye-opener for me. We held our meetings in different institutions and community service locations for mental health services in Cork and Kerry. There was, and still is, a strong determination to move people from institutional care to independent living/supported independent living in community care. I support this but it can only work if one is replacing the support people are receiving in institutional care with sufficient support in the community. The tragic consequence of failing to do so is that those affected are left with the worst of both worlds. They no longer have institutional care because one is trying to reintegrate them into the community, yet the necessary support services are not being provided to allow the transition to occur successfully. This leads to desperate circumstances in which one has insufficient support in the community and no institutional care to which to return. A number of such cases have been documented in Cork, where people ended up living on the streets because of mistakes made during the transition. I refer to Cork only because I have experience of mental health services in that county. The making of mistakes in the transition is one reason I am so concerned about the reduced current expenditure, in percentage terms, on mental health services, even though it may be increasing in net terms.

We need to continue to promote community care, community support and independent living for those with mental health difficulties, just as we need to promote them for senior citizens. Will the Minister increase the priority accorded to expenditure on mental health services?

This leads to the subjects of senior citizens and psychogeriatric care, on which I have one or two ideas that the Minister might like to pursue. There are now some very good templates available that serve as examples of how we should be supporting senior citizens who do not want to enter institutional care or nursing homes but who are no longer able to live at home by themselves as they may have no families to support them. One such template is the Westgate Foundation in Ballincollig. I am not sure whether the Minister has ever had a chance to visit it. It was established because of the drive and determination of the Ballincollig Senior Citizens' Association. The centre is like a village in itself. There are approximately 36 one-bedroom houses surrounding a courtyard, in the centre of which there is a community centre with a social hall, in which a range of activities takes place and where medical assistance is offered. Both mental and physical well-being are supported in the complex. It is in the heart of Ballincollig, which has a population of approximately 17,000. The centre results in a win-win situation for all concerned. It is far cheaper to stay there than elsewhere. Many of the senior citizens contribute to renting their accommodation and at the same time receive support from the State and from a very professionally run system.

The State would not have established this complex if it had not been for the drive of the community itself. I encourage the Minister and the Department to consider such examples — they are also to be found in other parts of the country — so we can provide the kind of community help people deserve in their old age. This would allow them to retain their sense of independence, pride and self-respect at a very vulnerable time in their lives.

Another area of concern relates to adolescent and youth psychiatric care, particularly the emergence of conditions such as ADHD, AHD and a range of other autistic spectrum disorders. The State has not responded sufficiently to these conditions. Whenever I talk about ADHD, I recall a speech that John Lonnergan made in Cork some years ago at a conference for parents. It was attended by more than 1,000 people. Mr. Lonnergan made the case that at least 40% to 50% of the prisoners he supervised had the exact symptoms of ADHD in particular, indicating that a whole group of people is falling through the net. The State should be trying to offer those with ADHD and other conditions early intervention, early assessment and support. If these conditions are subject to early intervention, they can be dealt with in a very manageable manner by the individuals concerned and their families.

Youth suicide has been raised in the House time and again, particularly by my colleague Deputy Neville. A lack of time prevents me from stating all the relevant figures but I am sure the Minister of State, Deputy Brian Lenihan, could reel them off himself. Suffice it to say that if one compares the youth suicide figures of the United Kingdom with those of Ireland, one will note a steady reduction in the suicide incidence of young men in the United Kingdom and that the opposite is the case in Ireland. We need to start asking ourselves why. When one considers the time, effort, money and PR that the Government rightly devotes to the prevention of road carnage, particularly among the young, one will realise that we need, at an absolute minimum, to implement immediately the recommendations of the recently published report on youth suicide that was rightly commissioned by the Government.

On accident and emergency services, I welcome the controversial new medical card scheme. Let us be honest and admit that the cards are not full medical cards but GP cards. However, the Minister for Health and Children made a brave and correct call in this regard. We need to encourage people to go to their doctors more often for check-ups because early intervention and assessment prevent diseases and other conditions from becoming more serious. We want to keep people out of accident and emergency departments. The choice the Minister had to make was between issuing another 70,000 full medical cards or 200,000 GP cards. She made the correct choice in choosing the latter. It was a brave political decision to make and I encourage her to stick to it.

We need to keep investing in the type of care that keeps people out of hospital. GPs play a major part in this process. With this in mind, we must encourage people, men in particular, to visit their GPs as often as possible, and encourage parents to take their children to their GPs when necessary.

A hobby horse of mine is the percentage of people presenting at accident and emergency units who are heavily under the influence of alcohol. This is an issue on which the Government should take some brave decisions. If someone staggers into an accident and emergency unit because they are too drunk to get home, and have fallen and hit their head off the pavement and require stitches, they should be made to pay for the service. There should be some deterrent to people under the influence of alcohol going into accident and emergency units and often causing difficulties for the nursing staff on Friday and Saturday night. If a person is in an accident and emergency unit primarily because they are drunk, they should pay for the cost of their care so that they will think twice about ending up in hospital rather than in their own bed.

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