Dan Neville (Limerick West, Fine Gael)

I welcome the opportunity to address the report of the independent monitoring group on A Vision for Change. The group is chaired by an eminent person, Dr. Ruth Harrington, and I note that a member of the monitoring group is the former Minister of State in the area, Mr. Tim O'Malley.

The monitoring group, in the conclusions of its first report which was published last year, recognised that 2006 was a year of significant challenge and change for mental health services and expressed the view that it expected to see accelerated action in the second and subsequent years. It is disappointing to report, by and large, that the recommendations of the first report of the independent group have not been addressed in 2007, but they have been prioritised for 2008. However, no resources have been allocated to introduce them because the Minister has suspended giving any further resources to implementing A Vision for Change.

The main concerns of the monitoring group on the implementation by the HSE include the absence of clear, identifiable leadership within the HSE to implement A Vision for Change. The monitoring group considers that the Health Service Executive was mistaken in its decision not to implement the recommendation to establish a national mental health service directorate to drive the changes recommended in the report. The monitoring group does not believe that the administrative arrangements put in place by the HSE are appropriate to the scale of the changes requires. The monitoring group notes that the HSE appointed a director of cancer services in 2007, which was mentioned earlier, to lead implementation of the cancer strategy, and the reform of the mental health services, it states, requires a similar approach. The national steering group appointed to manage the planning and implementation for A Vision for Change is not multidisciplinary and includes no service user or carer representative, as recommended. In addition, the role and relationship of the steering group to the HSE expert advisory group on mental health and the implementation group is unclear. There is a confusion of roles in that regard.

The HSE implementation plan relates to 2008 and 2009 and spans 11 chapters of A Vision for Change, and it identified six key priorities to do so. The plan is selective and vague and is mainly limited to the years 2008 and 2009. Although many of the recommendations require a longer time span for implementation, it does not address the impact of the employment control measures with the HSE on the recruitment of key staff necessary for the implementation of A Vision for Change.

The monitoring group has been informed that a comprehensive plan will be provided by the HSE before the end of 2008. The group regrets that a comprehensive plan has not been published heretofore.

The recommendations of A Vision for Change are not being addressed as a comprehensive package. The monitoring group is concerned that the HSE transformation process is taking precedence over the implementation of the recommendations.

The resourcing of multidisciplinary community health care teams is not being adequately prioritised, an issue which we have raised repeatedly over the past three years in this House. There appears to be a lack of clarity regarding the key central role of multidisciplinary teams, as envisaged in A Vision for Change. Primary care and significant aspects of specialist mental health care, including the multidisciplinary community mental health care group, are concerned about the potential for a blurring of boundaries.

The monitoring group also raises the issue, highlighted on several occasions in the House, of the use of funds. Some €24 million of the €51 million development funding allocated to the HSE for the implementation of A Vision for Change was not used as planned. It was hived off elsewhere and it is not apparent to the monitoring group who in the HSE has budgetary responsibility for mental health services or how budgetary decisions affecting mental health services are made. Will the Minister of State identify who is responsible for making these budgetary decisions? As he has come into the House with a prepared script I am sure the matter will not be addressed.

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