Jan O'Sullivan (Limerick East, Labour)

The Minister of State moved the Government amendment, which states that Dáil Éireann "welcomes the unprecedented level of funding being invested in mental health and commends the Government for the allocation of €51.2 million since 2006, which represents a third of the additional resources required to implement A Vision for Change over the stated 7-10 year period". This misleads the House because the implication is that the €51.2 million is being spent on implementing A Vision for Change. Last Thursday, during Oral Questions to the Minister for Health and Children, a number of Deputies about A Vision for Change. Part of the Minister's reply was as follows:

The Department of Health and Children has been advised by the Health Service Executive that the additional €51.2 million development funding was not used as planned because of competing expenditure pressures and the overriding obligation on the Health Service Executive to live within its approved overall allocation. As a result, some of the planned developments in mental health services have been delayed.

There is a very nice phrase in the paragraph which states: "It is appropriate in 2008 to pause and review the situation to ensure consolidation of the investment to date". In my opinion, that is traitorous to people with mental health needs. A clear commitment was given in the document A Vision for Change and funding was allocated but it has clearly not been spent. I share Deputy Neville's frustration and I do not blame him for leaving this debate tonight because he has fought on this issue over a long number of years. The fact is, however, that the money allocated for mental health was diverted to balance the HSE's books. That was clearly stated last Thursday in a reply to a number of Deputies from the Minister for Health and Children, so let us not cod ourselves that this €51.2 million, referred to in the Government amendment, has been given to mental health because it has not. It is shameful considering the patients we are dealing with in this health service sector. These people have been let down over the years. They finally got a document that was supposed to address their needs, including a commitment that money would be spent, but it was diverted to other services in order to balance the books. That is absolutely disgraceful. On top of that, capital moneys from the sale of old psychiatric hospitals was meant to be ring-fenced. The former Minister of State, Deputy Tim O'Malley, clearly stated on the record that that money would be spent on mental health services but we are now told it will be spent on health services. Therefore people in the mental health sector have been let down again.

I wish to reiterate the proposal from the Labour Party and Fine Gael in advance of the general election, which was that we would ring-fence 10% of health spending on mental health. The only way the needs of that sector will be properly addressed is to ring-fence money in the health budget. The HSE is leaking money right, left and centre but is not spending money on areas for which it has been allocated. It is the Minister's duty to ensure that money is spent according to budgetary allocations. If the Minister, Deputy Harney, was present I would clearly call on her to do that. I did not get an opportunity to read these replies during oral questions last week as they came in later. The situation is shameful, particularly as children are in adult psychiatric wards because we do not have enough beds for them. There are 12 child and adolescent psychiatric beds in the whole country. We have been told the number will rise to 30, although the figure in A Vision for Change is 80. We are going to have such beds in Dublin, Galway and Cork but in the entire mid-west region, including my own constituency, not one single child and adolescent psychiatric bed has been, or will be, provided. Many moons ago when I was on a health board — and we keep hearing health boards being castigated — funding for such beds was to be delivered in the service plan. That funding was meant to be supplied for beds in Limerick as well as in other areas. We now have waiting lists for years for young children to be assessed for speech and language therapy by community care teams. That is disgraceful because it holds children back when we could so easily address their problems when they are young and give them some kind of quality of life. The mental health services are being treated dreadfully so I hope the Minister of State, Deputy Devins, will fight his corner for funding because there is a big fight to be fought.

I commend Fine Gael on tabling this motion and in the time remaining I wish to address some other aspects of it. I agree with Deputy Clune that it is wrong that people should have to campaign in the media for health services. Young people with cystic fibrosis went on the Joe Duffy show coughing and in obvious distress. We hope they will now get the required temporary unit of 14 beds before the end of the summer, along with a commitment to a more permanent unit in St. Vincent's by the end of 2010. I agree with previous speakers that the timeframe is extremely long but it would not have happened if those young people had not gone on the airwaves. We do our best in here but sometimes I think we are wasting our breath because the battle is all being fought out on the airwaves, which is how people can get their health services. It is crazy that people must try to climb over others to get attention in the media for their basic health needs.

I want to highlight the case of Ann-Marie Kelleher in Cork and will read out some of what I read about her in the The Irish Times of Saturday, 2 February 2008. She has curvature of the spine which, by the time she got to see a specialist in England, was over 100%. On 6 September 2007, her mother and father wrote a letter to Crumlin Hospital where she is on a waiting list for surgery, which stated:

She cannot sit up any longer, she cannot sleep as she is literally wriggling around her bed hoping she will get a comfortable position that will allow her to sleep. She would need changing three to four times throughout a single night due to the sheer exhaustion of trying her best wriggling about her bed trying to get comfortable for sleep. She is in a ball of sweat constantly dealing with the sheer discomfort. It is nothing short of cruel watching over her. It is heart-breaking when surgery can change her life.

That letter went to the hospital and subsequently she was supposed to have an appointment either on 28 November or 2 December. It turned out that was never actually pencilled in, even though it was notified to the HSE. Then she was to have had another appointment which had to be cancelled because an anaesthetist was not available. In the meantime, she had gone to the media and had visited a doctor in London who said the curvature was over 100%. He said he was confident the surgery, which would have to be done at two different sittings about a week apart, could be arranged fairly swiftly.

The waiting list for children in need of spinal surgery in Crumlin is, according to the hospital, up to 12 months long. The hospital has said that 46 children are awaiting such surgery there. They cannot go to Temple Street Hospital because there is an excessively long waiting list there also. This child is one of many waiting for spinal surgery but when she went to the media the problem was suddenly gone and she could have her treatment abroad.

The HSE says it is getting €370 million less than it needs to maintain services next year, so we will have a continual build up of waiting lists. Three months before the end of last year, the HSE had to bring in an embargo even thought it received a much increased allocation in 2007. I do not know what will happen to the health services over the next year. We were told that many developments were delayed because of the consultants' contract negotiations and we are now told that because that situation has been sorted we will suddenly get new services. The fact is, however, that people in the HSE balance their budgets by using money that was supposed to be for new services. They could not bring in those new services because they were told they could not employ new contracts because of the consultants' contract situation. If we are to bring in the new consultants and the fair deal, which was another big chunk of money they did not have to spend last but will spend this year — along with the payback to people who were wrongly charged in nursing homes — how will the HSE balance its books this year? How will people on waiting lists get treatment?

On 31 December 2007, a newspaper article stated that in some cases people were waiting over four years for outpatient appointments in parts of the country. I fear for the health services in future because I do not think the HSE has the capacity to deal with these issues. People like young Ann-Marie Kelleher are waiting in distressing pain, yet we will have more and more such stories on the Joe Duffy show because people see that is how they can obtain their health service requirements. Somebody will have to call a halt to this.

Last Saturday week, I held a meeting in the Mansion House on universal health insurance. We must have a system whereby money goes towards treatment. At the moment, if one is running a big public hospital it does not make sense to have many acutely ill people because they cost a lot of money. One must balance the budget one gets irrespective of how many patients are treated. Patients cannot be discharged because there are not enough step-down beds, so it makes sense to have people occupying beds who do not need a large amount of acute treatment. The whole system is designed to use money badly and not to provide services where they are needed. I am afraid that more and more people will approach the media in order to get basic health services. I fear people with mental health problems and others who cannot shout very loudly will be put to the back of the queue. Money must be ring-fenced, in particular, for mental health services. Unfortunately, we will have many debates on health issues this year. I hope solutions will be proposed but given that the HSE has been in existence for three years, we need to go back to the drawing board regarding the delivery of health services.

See this speech in context