Dan Neville (Limerick West, Fine Gael)

I am disappointed this Bill fails to make protection of all patients its aim. Specifically, it excludes private and public psychiatric institutions and compounds the stigmatisation of psychiatric patients. The Bill falls short of proposals for a patient safety authority made by Fine Gael and Labour, which would have offered protection to all patients in the health services. This second rate solution includes protection for whistleblowers, sprung on us at the last minute, without providing details on how it will operate. This aspect will only be debated after Second Stage.

The Bill does not include an advocacy role for patients and this illustrates the failure of the Government to take the views of the public on board when formulating legislation that affects the well-being of the public. A Vision for Change proposed an advocacy role for patients and their families. This is not included in the Bill even though patients and their families should have a role in influencing Government legislation. The Health Information and Quality Authority has been conferred with several distinct roles and a scope so broad that it will fulfil none of its roles well, impeding patient safety.

The need for patient safety measures could not be clearer, as highlighted by the report on Dr. Neary. In recent times, the scandal at Leas Cross exposed horrendous conditions in some nursing homes. I refer also to Mr. Pat Joe Walsh and the death of Ms Anne Carroll on 17 October at Cork University Hospital, hours after being readmitted to the psychiatric unit, and the death of Ms Anne O'Rahilly in 2002 within 13 hours of being admitted to the Mid-Western Regional Hospital, Limerick. In the latter case, the High Court made a compensatory award that will never compensate the family for its trauma. A record number of patients are lying on trolleys in our accident and emergency units and MRSA and other hospital acquired infections are in our hospital wards. Such patient safety matters demand an appropriate response. This proposal falls short of protecting patients in all settings and will create conflicting roles that will impede the objective of patient safety.

The omission of psychiatric institutions is one of the defects of the Bill. I urge the Minister to re-examine this. The Mental Health Commission examines units with regard to the delivery of psychiatric services. A broader examination of patient protection should apply because exclusion stigmatises psychiatric illness further. At a press conference yesterday, the Irish Psychiatric Association stated that nothing has happened in the 12 months since A Vision for Change was published and accepted as Government policy. The experience of the association is that its degree of enthusiasm was not matched by the Minister and the Department. The association referred to betrayal and disappointment at the approach of the Minister, the Department and the HSE. It was disappointed and dismayed at the rate at which the Government is implementing the recommendations of A Vision for Change. The association issued a wake-up call for the Government with regard to the work that remains to be done.

A key recommendation of A Vision for Change was the establishment of community based, multidisciplinary units to serve those with a psychiatric illness. This was proposed 22 years ago in a report to the Government but was never implemented. No such community based team exists in Ireland. One third of the community based teams had less than 50% of the recommended staff number. Last year 24 posts were sanctioned where A Vision for Change recommends 650, a figure the Government was committed to filling in seven years. Now it states that this will be completed in ten years but, at the current rate of progress, it will take 25 years to fulfil the recommendations on psychiatry, psychotherapy, occupational therapy, family therapy and nursing made last year in order to create a 21st century service.

The inequity of the service has not been addressed at all, despite it being evident in a report from four or five years ago from the Irish College of Psychiatry. It indicated that wealthier areas have a much better service than poorer areas in the State, with this being particularly evident in the capital city. This issue has not been addressed and there has been no movement in 12 months to the large catchment areas recommended for delivery of the service.

The capital development area was yesterday described as shameful, shabby and shoddy. These are not my words but those of the Irish Psychiatric Association. There is no capital plan to enable the development of the required units. In A Vision for Change, it was highlighted by the Government that the assets available to the psychiatric service would be sold to provide necessary infrastructure. In a time of plenty, psychiatric services deserve money out of State coffers and should not have to sell off their assets. Be that as it may and accepting that assets will be sold, there has been no plan to move on this even 12 months down the line.

In order to provide multidisciplinary teams we need capital investment, which will ensure that if a psychotherapist, psychologist or occupational therapist is brought into the community, there will be an office for them to work out of and an area in which to meet patients. Such facilities do not exist at the moment.

The national mental health directive, a key factor in A Vision for Change, has not been introduced, despite it being cost-neutral. The Government does not even have an interest in introducing crucial components to the psychiatric service even when they are cost-neutral.

I will not speak much about the embargo, an issue I raised this morning in a meeting of the Joint Committee on Health and Children. I was told there was no embargo but a ceiling on the number of people who can be employed. Perhaps the Minister of State can explain the difference between an embargo and a ceiling on the number of people who can be employed. The reaction of the joint committee this morning was a guffaw.

It is extremely disappointing that despite our efforts last year, the level of investment in the psychiatric service was just 7.3% of the total health board service budget. The level ten years ago was 11% and it will be less than 6% this year. Is that progress?

See this speech in context