Jim Daly (Cork South West, Fine Gael) | Oireachtas source

I thank the Deputies who have raised the matter and continue to keep the focus on this important issue in what is a very disturbing period for all of us.

The HSE is committed to ensuring that all aspects of mental health services are delivered in a consistent and timely fashion. In 2015, the mental health division of the executive determined that it was necessary to conduct an independent review of the quality, safety and governance of Roscommon mental health services to support achieving the goals set out in A Vision for Change and other relevant national policies.

Within a short period of being commissioned, it became evident that the initial timeframe proposed to conduct the review was insufficient and the review team requested, and received, extra time to complete its work. I welcome the recently published comprehensive report, which makes 27 recommendations for local service improvement. The report indicates that the review team was impressed by the majority of staff it met or interviewed, and was struck by their commitment to see services improve for service users in Roscommon. The overriding concern of the majority of those interviewed - staff, service users and carers - was that patients and families in Roscommon were not receiving services in line with current best practice that would meet required quality and safety of care standards.

Multidisciplinary team working - the linchpin of modern mental health services - was severely eroded in Roscommon, with fractured relationships within the area management team, within the Roscommon teams and between a number of professionals and key consultant medical staff. Throughout, there were poor line management arrangements. Leadership at a number of levels appeared to be ineffective. The majority of nursing staff interviewed believed, and the team agrees, that the senior nursing leadership critical to representing the professional views of nurses at the executive level was missing. It is the team's view that, in some instances, relationships appear to have broken down irreparably.

Managers in any organisation have a difficult balancing role and they should be allowed to manage without undue interference. However, that can only occur in a working environment that is conducive to mutual respect and understanding. There was clear evidence that this was absent in this instance. The review team pointed to the need for effective application of change management principles as a new entity attempts to merge disparate parts of hitherto separate organisations. The team believes that preparatory work to support the area management team should have been in place, as it embarked on creating a new culture. The team concluded also that there was disproportionate focus, even at a time of straitened financial circumstances, on achieving budget savings at the cost of an adequately staffed and safe service.

The report highlights that approximately €17.6 million of mental health funding for the years 2012 to 2014 was returned by the Galway-Roscommon area, and it details the context surrounding that. The report makes a specific recommendation on the issue, to the effect that the HSE should have greater delegation of budgetary authority to promote greater accountability, better management and more effective service delivery at local level. The HSE has confirmed that funds unspent in a particular area may be reallocated elsewhere within mental health services, and that is the case here.

A team has been formed by the HSE to implement the recommendations of the report. The executive has statutory responsibility for the planning and delivery of health care services at local level, including mental health in Roscommon. Nonetheless, the Deputies can rest assured that I, and the Department of Health, will closely monitor the progress of the HSE implementation team to ensure that all the recommendations are delivered as quickly as possible to address at local or national level, as appropriate, all concerns raised by this important report.

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