Michael McNamara (Clare, Independent) | Oireachtas source

It has been a pretty grim week for our health system, particularly our mental health services, both for those who work in them and those who rely on them. One of the grimmest aspects of it is that we are here at 7.50 p.m. on a Thursday discussing this important issue. Obviously the political agenda of the week was dominated by relatively minor electoral infractions by both sides of the House.

On Sunday night, I learned that this report was going to be in the media the following morning. I pay tribute to the main author of the report, Dr. Susan Finnerty, and the Mental Health Commission for driving that report. It is fair to say they have done the State some service. In the report, we learned of poor monitoring of medication, children waiting for days in emergency departments for psychiatric care, and children left unreviewed on antipsychotic medication for years. Deputies have said that this is completely contrary to best practice. It should not take ordinary people to know that. We are supposed to have a health service staffed by experts. The report states that staff are exhausted, overwhelmed and inadequately supervised. It states that psychiatrists are not trained to work with children, that there is poor risk management, poor clinical governance, and chaotic paper-based record-keeping. The area that I represent, Clare, is not identified in the report but it was identified inThe Irish Times. It is obviously part of the mid-west community health organisation, CHO, which covers Clare, Limerick and north Tipperary, where it was found out that there were 140 open cases. A serious risk to the safety and well-being of children accessing CAMHS was identified, including the 140 with open cases who had been lost to follow-up.

The immediate response from the HSE was, as it typically is, a defensive one. A senior psychiatrist from the HSE was on RTÉ the next morning to say that the HSE had found that out before the Mental Health Commission report, as if it was somehow a defence that the HSE had seen it a year before the Mental Health Commission identified it and reported on it, but had seemingly done nothing about it. It is beyond me how that came to pass. The part of the report that I found perhaps most depressing was the discussion of systems. I have long held the view that we have no systems anywhere in our healthcare. We have excellent people but no systems. It seems that, as a nation, we do not do planning particularly well and we certainly do not put systems in place. It might be something to do with a post-colonial legacy. I do not know but we do not do it.

The report states:

- One CHO in our review had a system that they had devised themselves which allowed generation of reports but did not provide electronic records.

- Only one CHO had electronic records; this system was provided through an independent agency which also provided the CAMHS service.

It is important to highlight that it was an independent agency. I do not highlight it with a view to suggesting that independent agencies should be providing all of the services within CAMHS, but if they can do it, surely to God the HSE can put a system in place. The report continues, "A small number of teams had independently tried to set up basic information systems within their own teams, through their own knowledge of information technology, to increase efficiency and monitor patient files and outcomes. But time spent on such matters takes away from time on patient care and national system would be the most efficient and effective manner of dealing with this." It later states that paper-based files were the norm rather than the exception, that those paper-based files were often incomplete and contained handwritten notes which were illegible. I would welcome it if the Minister spoke on that. It meant that people could not travel out of an area to receive a service but had to be provided with the service in an area.

If that was not depressing enough, on Wednesday, we woke up to learn that Professor Martin Curley, who was tasked with delivering the digitisation of health services across the entire HSE, had resigned from his position, saying there were bad actors within the HSE blocking the implementation of this. He helpfully pointed out that Ireland had been loaned €200 million from the European Investment Bank. We have one of the biggest budget surpluses in Europe and we have been loaned money from the European Investment Bank. Even then, we cannot put information systems in place. Who is blocking this? I am sick of the HSE defending this. Over Christmas, the Department defended itself and said it was the HSE's fault, while the HSE said it was the Department's fault. Frankly, I do not much care. I know the Secretary General of the Department of Health was appointed to the board of the FAI during the week. If he can bring his defensive capabilities from our health system to the FAI, we may have a team with a defence like Italy, but Italians return to a functional health system. We in Ireland have an utterly dysfunctional health system. Deputy Joan Collins pointed out how little we spend on mental health. It is quite true that it is utterly inadequate. We spend as much money on health in this State as Austria and Denmark spend per capita, but we do not get a return. The complete lack of systems is part of that.

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