Colm Keaveney (Galway East, Fianna Fail) | Oireachtas source

It cannot have escaped the notice of the Government Deputies that the wording of the motion is taken, almost word for word, from a recent statement by Mr. Tony O'Brien, director general of the Health Service Executive. It is worth placing Mr. O'Brien's words on the record for the attention of Government Deputies. He stated that "it will not be possible to meet fully all of the growing demands being placed on the health services. In particular, some service priorities and demographic pressures may not be met". The Government's amendment proposes to flatly contradict the director general of the HSE.

I will return to Mr O'Brien but I propose first to address the substantive part of my contribution to the continuing failure to secure appropriate resources for the mental health sector. This comes at a time when levels of mental ill health are increasing and many communities are experiencing serious, tragic and shattering levels of suicide. Sadly, the mental health services continue to be Cinderella of the health service. There has been a fundamental failure to build on the progress made by previous Governments, including in the Mental Health Acts of 2001 and 2008 and the full adoption of A Vision for Change in 2006. Instead, the Government is cherry-picking from A Vision for Change, selecting those aspects that save money and ignoring and dragging its feet on those aspects that require resources.

The ongoing closure of St. Brigid's Hospital in Ballinasloe is a perfect example of this approach. Recently, a sum of €3.1 million was spent on providing a state-of-the-art facility that will now be closed. Patients are instead being moved to Galway before an adequate unit to accommodate them has been identified. The accommodation chosen is in a unit that only last year was criticised by the Inspectorate of Mental Health Services. This pattern of failing to link capital spending with current spending is to be found throughout several areas of the health service.

The decision to close St. Brigid's Hospital was taken on the back of a highly curious process that seemed designed to deliver on a decision that had already been made. This approach is typical of nearly every consultation process undertaken by the Health Service Executive under this Government. It simply ticks the boxes as part of an exercise that does not constitute a genuine engagement with communities, medical professionals or service users. Members of the public see through this tactic, the outcome of which is the destruction of faith and trust in local HSE management.

The Government has actively undermined the ethos contained in A Vision for Change, a strategy that is built on a recovery model that recognises the necessity of a collaborative relationship between service users and medical professionals. Furthermore, the policy envisaged that service users would be included in policy formation and decision making. The National Service Users Executive, which was established under A Vision for Change to represent service users, recently recounted to me how it has been bullied by the HSE to the point that it can no longer function. Last October I received a letter from the HSE clearly stating that service users participating in meetings with the HSE would not be treated as equals alongside medical professionals or other public servants. This approach flatly contradicts the letter and sprit of A Vision for Change and fundamentally undermines the parity of esteem essential to the recovery model.

I recently met representatives of Mental Health Reform who expressed frustration at the delays in the delivery of promised mental health funding for 2013. The HSE National Service Plan 2014 indicates that certain initiatives, including the appointment of new staff for community mental health teams allocated for 2013 and 2014, will be "specifically targeted towards the latter half of 2014 to allow ... savings to be utilised on specific services on a timing delayed basis".

As stated by Dr. Shari McDaid, director general of Mental Health Reform:

Unfortunately, mental health needs do not operate on a timing delayed basis, and the decision to delay until the latter half of 2014 the appointment of next year's promised 250-280 new staff and the remaining staff due from 2013 will have a real human cost. Yet again, we are seeing mental health services suffer the drip-drip effect of delays.

Only yesterday, I received a response to a question I tabled to the Minister for Health in September 2013, which confirms the Government's deliberate policy of delaying the recruitment of new staff in the mental health sector. As of 30 November last year, only 137 of the 459 promised posts had been filled. The question of how many of these staff are actually working on the ground remains unanswered. These posts form part of the commitment in the programme for Government to ring-fence €35 million a year for mental health services. This promise was betrayed in budget 2014 when a cut of €15 million was imposed on the service. There is still no clarity in regard to how much of the €35 million allocated in 2012 and 2013 was actually spent. Having spoken to those working in our mental health services and from information provided to me in response to a parliamentary question, I strongly suspect that it has not been spent. The reduction by €15 million to €20 million in last year's budget in the amount ring-fenced may simply be the Government recognising the magnitude of the under-spend that has already occurred in mental health services.

Mental health services are struggling and are being starved of resources. Only recently those working in the mental health service in east Galway told me that HSE expenditure on services in that area were €3 million under budget at the end of October last year. They fundamentally believe that not one red cent of this money will be spread across the mental health budget. The Minister needs to confirm if this is so and to provide an explanation for it.

At the end of September 2013, some 413 children were more than a year on a waiting list for a first appointment. This means that 413 children in some level of mental distress were waiting more than a year to be seen. The demand on child and adolescent mental health services is running at 13% above the anticipated level. At the same time, research published this year by the Royal College of Surgeons in Ireland shows that the rate of children and young people with a mental disorder in Ireland is higher than anywhere else in Europe or the USA. There are individual and collective tragedies waiting to happen. This issue needs to be addressed urgently by whoever is running the Department of Health.

I believe the issues arising in the mental health service area, and in the health service generally, are the result of two key but related causes. First, the Department of Health is weak, unable to properly manage the budgetary process, suffering from a lack of confidence and support from Cabinet and lacking the ability to manage and control spending. The back-of-an-envelope approach taken to the budget and the HSE service plan has severely undermined public confidence in the service. The farcical nature of the so-called probity measures targeting savings from the medical card scheme, the reduction from €113 million to €23 million, and the miraculous appearance of €108 million in unspecified other savings from payroll are but examples from a catalogue of many in this regard. Second, and most significant, we do not know to whom the Minister is listening. He is not, given the creative editing of the commentary of the director general of the HSE, Mr. O'Brien, listening to him. To be fair to Mr O'Brien, he appears to have that rare gift for telling it as it is. He bluntly told the Cabinet: "It will not be possible in 2014 to fully meet all of the growing demands placed on the health services." However, as someone decided that this might alarm the public, when the service plan was published the next day, this had been changed to, "It will be very challenging in 2014 to fully meet all of the growing demands."

It is important the Minister listens to those on the front line. Observations or complaints from medical professionals, their unions and professional bodies, are, at best, being ignored and, at worst, the messenger is being attacked. It is not enough to send departmental officials to nod, smile and empathise with staff on the front line; we need to see action. However, this is not happening. The Minister, who I know is a listening man, needs to listen to what patients and service users are saying. I call on officials to demonstrate confidence in HSE management and the Minister by way of a process of engagement.

Morale within the health service is poor. This will eventually affect the quality and delivery of service and the patient. It is not good enough to only listen to people. We need action. It is essential in the public interest that the Minister engages properly with the service plan production and that we work together to ensure we achieve outcomes in the interests in the citizens of this country.

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