Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

I welcome this motion. It is important that we talk about this issue until it is resolved. We seem to have been talking about shortcomings in mental health services for time immemorial and yet it seems nothing is being done to bring them up to the standard that is expected for a modern and wealthy society. Many of the problems impacting our mental health services, especially CAMHS, are microcosms of the difficulties within the health service. Those problems include the available capacity, the recruitment of staff and workforce planning. E-health is central and we know in the context of reports of poor record-keeping how important it is. There are also problems in respect of the structure and how we organise our health service. The HSE is structured in such a way as to avoid accountability in different areas. The local manager does not have to account for how he or she provided services or failed to provide them, or explain why money was not spent properly. There needs to be that level of accountability at local level, rather than having the chief executive apologise. That often happens. The chief executive comes on the airwaves to apologise for some serious failure and promises a report that we may or may not ever see. That lack of accountability has been descriptive of the situation in CAMHS.

The other issue relating to the structure of the health service was referred to by Deputy Sherlock. We have a postcode lottery. Whether a child can get access to services within a reasonable period of time is hit and miss. Children are in many cases left waiting indefinitely. That is why we need a new structure in the HSE where resources are provided on the basis of the needs of the local population. The plan is there and it needs to be implemented urgently.

Mental health services are victims of the bigger problems and issues impacting our health services and how we deliver them. It is worth reminding ourselves of the kinds of appalling figures and data we get from CAMHS. We have seen a couple of reports in the past year or so. As of 30 November, some 4,000 children were on a waiting list for CAMHS. Almost 1,000 of those, which is 25%, had been waiting for more than nine months and almost 600 had been waiting for more than a year. We all know from experience, or can imagine, that when a child has a serious mental health difficulty, the case is urgent and the child must be seen within a reasonable period of time. There are 1,000 children waiting for more than nine months for an appointment. That is an eternity in a child's life. Almost a year of childhood is lost waiting for an appointment. What happens in the meantime? What happens to the child and his or her distraught family? Families get distraught in those circumstances. What happens the child's education? What happens the child's social connections and networks? All of that is put at risk because of these long waiting lists.

We also know, shockingly, that almost half of last year's allocated health budget was not spent. Of the €24 million allocated in 2022, €11.5 million was not spent. It is unforgivable that at a time of crisis waiting lists, half the money available was not spent. That should pose a major challenge for the Government. It should address this issue.

Why has the money not been spent? Is it because we have awful recruitment procedures within the HR section of the HSE? Regardless of whether a post is in south Kerry or north-west Donegal, and irrespective of how much priority attaches to the post in the view of local management, approval for the post must be obtained from Dublin and somebody in Dublin decides whether funding will be approved. Then there is the long rigmarole of the recruitment process, with the likelihood that no people are available to fill the post. That raises all kinds of issues about the lack of responsibility by the Government, the HSE and the Department of Health in having proper workforce planning. Increasingly, we are seeing additional money being provided which cannot be spent because we do not have the intake and the graduation from colleges, and we do not have the healthcare placements.

We also know that the interim report of the Mental Health Commission found "serious concerns and consequent risks" for some patients in four out of the five CHOs on which it reported. That is a damning figure. There is no reason to think that the remaining four CHOs that have not been reported on are any different.

One of the worst aspects of the recent report of the Mental Health Commission was the question of lost case files. The interim report highlighted open cases that were lost in the system. When children's cases are lost in the system, children are lost to follow-up care. Children can wait nine months, 12 months or more to get into a service. They get some level of care and treatment and are then lost to the service. This includes children on medication, some of whom reached their 18th birthday with no discharge or transition plan. In one team, some 140 open cases had been lost to follow-up care. Another team did not follow up with children on continuing medication for up to two years. There is negligence involved in that.

In regard to the digital infrastructure which I have referenced already, we know that the e-health strategy is eight years old. There is virtually no record-keeping in many aspects of our health service. How can a service be supervised and managed if there is no proper data collection system? We cannot monitor and keep track on what is actually happening in the services. How long are people waiting? How many people are waiting? How many staff do we have? How many vacancies are there? What length of time do children stay in the services? These are key things. I often say that what matters gets measured. If we are not measuring activity within the health service, clearly it does not matter. We have a huge problem with the lack of data collection and analysis. Services cannot be run in such circumstances.

The interim report found that five CHOs use paper-based files in this day and age. The report states that patient files were frequently disordered with little logic to the filing, and clinical notes were frequently illegible and at times were incomplete. The report concludes that without a digital patient-management system, it is difficult to see how improvements in the quality of CAMHS can occur. The business case for the Department of Public Expenditure and Reform must be a priority in this regard. Key to restructuring how we provide health services is ensuring accountability. All of this money goes in but when there is a failure in the service, who is held accountable? Nobody. We get an apology – yet another apology – and a promise of a report, and nobody is held accountable. As long as a situation prevails where there are no consequences for failures in delivering services or spending budgets, there is going to be a dysfunctional system.

It is similar in regard to allocating resources. Resources are allocated on a historic basis or on the basis of what constituency happens to have a Minister. That has to end. As part of the regional health authority structure that was recommended by Sláintecare but seems to be taking forever, not only would there be integrated care and accountability of staff but there would also be objective resource allocation. That is critical. The budget that is allocated has to reflect the level of need in the area, and not just be an ad hocmatter. So many of these problems relate to how we organise our health service, the lack of investment and the lack of priority being given to some of those big projects. The Minister and the entire Government need to get behind making our health service fit for purpose and fit for the modern day.

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