Dan Neville (Limerick West, Fine Gael)

I welcome the opportunity to contribute to the debate. I wish to raise with the Minister of State, Deputy Tim O'Malley, the issue of Limerick Regional Hospital. Yesterday 12 people were on trolleys in the hospital, although it has one of the better accident and emergency departments. I raised the accident and emergency department issue with Professor Drumm when he appeared before the Oireachtas Joint Committee on Health and Children and he highlighted three hospitals, one of which was Limerick Regional Hospital, that were doing well in this area. Each day we read the Trolley Watch figures and usually between four and six patients are on trolleys in the hospital. On one occasion, the number reached 35 because there was a crisis but, overall, the hospital in Limerick is one of the better ones in this regard.

I cannot understand, therefore, why it was fined €1.2 million for being inefficient. I do not understand the criteria for evaluating hospitals, given that it is accepted that the efficiency of a hospital has a great deal to do with the operation of its accident and emergency department. In other words, the department is a barometer of a hospital's efficiency. How could Limerick hospital be fined €1.2 million when other less efficient hospitals obtained an increased allocation because of their efficiency? That does not make sense and I hope the Minister of State addresses why the hospital was fined in this fashion. The implication is the hospital is efficient but it is being fined €1.2 million to make sure that efficiency does not continue. However, if the hospital's budget is reduced, its efficiency will not be maintained.

The manner in which elderly people are treated in hospital is an issue. It is accepted the number of elderly people who will attend hospital will increase substantially because of our ageing population. The way they are treated leaves a lot to be desired. I dealt with a case in this regard last week. When an elderly person is in hospital, he or she is practically ignored while discussions take place with family members and decisions are made on their treatment, continuing care, transfer to a nursing home, the winter initiative and so on. The patient, who is the key person, is often not consulted. It is almost as if when one reaches a certain age, one does not have a view or one should not be consulted on one's treatment and so on. Families face difficulties because of a lack of information about the care and treatment of their elderly relatives and it is a sensitive issue. Discussions take place on whether a patient should be transferred to a private or public nursing home, but criteria should be laid down, as far as possible, in this area so that people can fully understand what is happening and decisions are explained to them.

Last week I was contacted by a family regarding an elderly relative in hospital who was told she was being transferred to a nursing home. When the family members visited the hospital, the elderly relative was dressed to go to the nursing home. She did not understand that she was being transferred to a nursing home for two weeks under the winter initiative and that was not explained to her relatives. They were worried about how to pay for her care in the nursing home because she was only on an old age pension and the relatives were not a son or daughter. The person most affected by the move was the patient, who was not consulted and did not know what was happening.

I refer to the waiting lists for initial psychiatric assessment for children. I received a letter from the HSE on 7 April, following the referral by the Minister of State of a parliamentary question I tabled a number of months ago, in which I was informed there is a considerable waiting list for assessments and the waiting times are also lengthy. If this is not an emergency, I do not know what is. It is accepted that early intervention for children with difficulties who are in need of psychiatric assessment is vital to their recovery. The waiting times can vary significantly. For example, 214 children are waiting in Kerry and the waiting period is between 22 and 41 months. It is surely not acceptable that a child in need of psychiatric assessment must wait up to 41 months. In Cork, there are 267 children waiting between 12 and 17 months. In south Tipperary, 40 children are waiting 18 months. Professor Drumm has noted the efficiency of Waterford, where only four children are on the list, waiting between six and eight weeks. There are 300 children waiting an average of ten months in Limerick, Clare and Tipperary.

Very little attention is paid to the issue of waiting lists for psychiatric illness, especially child psychiatric illness. Early intervention for children with psychiatric difficulties multiplies the chances of early recovery. It represents bad economics to allow children become chronically ill before they are assessed. If early intervention can be achieved in Waterford, why can it not be achieved in the mid-west, in Kerry, Cork and elsewhere? There is a ten-month waiting list in Dublin. There is a waiting list of 1,000 in the Lucena clinic, with a waiting time of approximately two years.

The report of the Irish College of Psychiatrists into child psychiatric services, published last autumn, showed that in excess of 200,000 children have a mental or behavioural problem at any one time. While in excess of 100,000 of these have a mild disorder, 80,000 have a moderate to severe disorder and 20,000 have a disabling disorder. Dealing with this serious situation effectively requires 236 inpatient psychiatric beds, but there are currently only 20 beds in Galway and Dublin. Responding effectively to the psychiatric needs of these children requires 150 consultant child and adolescent psychiatric posts, but there are currently only 62 psychiatrists in this field of the profession.

The lack of psychotherapists, family therapists, clinical psychologists, occupational therapists and other key staff seriously inhibits the internationally acknowledged best practice for the provision of child psychiatric services through multi-disciplinary teams. When a child gets into emotional or psychiatric difficulties, early intervention is crucial to deal with the situation urgently. It may have a profound effect on the future life opportunities of that child.

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