Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Gabhaim buíochas don Cheann Comhairle as an deis chun na ceiste seo a phlé. In an adjournment debate on 29 January 2003 I called upon the Minister for Health and Children to act as a matter of urgency to address the severe staffing shortage at St. Mary's residential care facility at Drumcar, County Louth, and to ensure that the residents at the centre had all the personnel and other resources they needed to live with dignity and safety.

Thousands of people, including the families of more than 250 people with physical and intellectual disabilities then resident at Drumcar, were sick with worry about the welfare and safety of their loved ones. A consultant's report had just been published which highlighted the unacceptable conditions for many residents in Drumcar as a direct result of understaffing. Understaffing led to inadequate supervision, inappropriate mixing of residents with very different abilities and disabilities, including very aggressive individuals with passive and introverted individuals, the overuse of restraints in some cases, the leaving of some residents locked up and unattended at night and increased risk of mortality from fire.

The report identified the need for 94 additional staff to cater for all the needs of the residents. Following this report there was a concerted campaign for increased funding for more staff. I played a part in that lobby and I welcomed the outcome when agreement was reached with the Department of Health and Children for the appointment of 30 extra staff at St. Mary's. The extra staff commenced work in April 2003 and were specifically hired to ensure there were sufficient numbers on night duty. This was to address fire and other safety risks for residents at night. A key part of the agreement with the Department of Health and Children and the North Eastern Health Board was that the other issues would be addressed, including the provision of the remaining 64 staff required.

I will cite a note by the management of St. Mary's, which is under the auspices of the Hospitaller Order of St. John of God:

We remained hopeful that the funding for the remaining 64 staff would be approved over the following two years.

During the past two years, because of the serious risk to the safety of the clients and staff on day duty, we were left with no alternative but to take on extra staff without funding which resulted in overspends in the nursing pay area. This excess in expenditure was funded through stringent cutbacks in other areas, and vacancies in areas such as speech therapy, social work, medical registrar and administration. The planned programme of building maintenance and painting had to be suspended and this has impacted negatively on the quality of the environment for the clients, and will ultimately cost a lot more to restore in the future.

In 2004, both ourselves and the NEHB experienced substantial shortfalls in the funding to meet the extra cost of the various pay awards, and like other health agencies we had substantial value for money and other cutbacks imposed on our allocation. We have now reached the stage where we have exhausted all options internally to meet the shortfall.

The very grave situation facing the North East Services was discussed with the North Eastern Health Board on the 10 November 2004 and the Board requested us to conduct a review of the situation, and advise them of the options which we would have to consider to deal with the situation. We did this over the following weeks and informed the Board in December of the various options. The Board passed our concerns on to the Department of Health and Children and a meeting was arranged with the Health Service Executive on 1 February 2005.

Following that meeting on 1 February between the HSE Northeast and St. John of God Northeast Services it was agreed to use the existing joint partnership forum to develop a strategy on how best to continue the implementation of the Sale and Oreschnick Report to address the outstanding priority concerns regarding health and safety issues and critical staffing levels at St. Mary's Residential Services.

It is expected to complete this process within the next three weeks. In the meantime St. John of God Northeast Services has undertaken to defer the decision around the suspension of respite service provision in St. Mary's until February 28 2005.

Aware that my time has marched on, I will conclude by appealing to the Minister for Health and Children to ensure that the outcome of this process is the approval of the full staff complement, namely, the 64 staff identified more than two years ago, funding for same and the restoration of all services lost through the unacceptable delay in fulfilling commitments already given.

As the sibling of someone with Down's syndrome who has spent many years in Drumcar, I believe that it is a wonderful facility only because of the great dedication of the hospitaller order and staff at the site. It requires and deserves a wholehearted and fulsome response from the Department. The loss of respite would be a devastating blow to countless families and I do so appeal.

Seán Power (Kildare South, Fianna Fail)
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On behalf of my colleague, the Tánaiste and Minister for Health and Children, Deputy Harney, I thank the Deputy for raising the matter and giving me the opportunity to outline the position with regard to St. Mary's residential care facility, Drumcar, County Louth. I appreciate the Deputy's personal interest in the matter.

The Department has, since 1997, allocated a significant level of funding across the disability sector which has resulted in significant and unprecedented developments in the quality and quantity of the health related services being provided to people with disabilities. With regard to the matter raised by the Deputy, in June 2002 St. Mary's, Drumcar, was served with formal notice of industrial action by the Irish Nurses Organisation because of the staffing position in its residential services.

As requested by the order, the services of the Labour Relations Commission were availed of. One of the proposals to emerge from the conciliation conference was to conduct an independent review of the staffing of the residential services at St. Mary's. It was agreed that this review would be conducted by Diana Sale and Bob Oreschnick, 1066 Consultancy and Healthcare Consultancy Limited. They were commissioned by the order to undertake the work. The report was finalised on 13 November 2002.

Statutory responsibility for the provision of intellectual disability services, including the funding of the Drumcar services, lay with the then North Eastern Health Board. Following publication of the report, the board indicated that there was insufficient funding available to it to implement the recommendations contained in the report. Following discussions between the Department, the North Eastern Health Board and the St. John of God order in February 2003, agreement was reached on the provision of funding to enable the order to proceed with the immediate recruitment of 30 additional staff. The initial investment, amounting to approximately €l million, was intended to address the priority issues identified in the Sale and Oreschnick report around quality of care and health and safety.

Agreement was reached on a process by which the implementation of the recommendations contained in the report would be progressed as a matter of priority as resources permitted. As it has not been possible to provide further additional funding in 2004, both the order and the North Eastern Health Board have expressed anxiety regarding funding for the further implementation of the report, which recommended a total of 94 additional staff.

As the Deputy is aware, the Health Act 2004 provided for the Health Service Executive which was established on 1 January 2005. Under this Act, the executive is required to manage and deliver, or arrange to have delivered on its behalf, health and personal social services. Following a meeting held on 1 February 2005 between the Health Service Executive north east and St. John of God north east services, it was agreed to use the existing joint partnership forum to develop a strategy on how best to continue the implementation of the Sale and Oreschnick report to address the outstanding priority concerns regarding health and safety issues and critical staffing levels at St. Mary's residential services. It is expected to complete this process by the end of the month.

In the meantime, St. John of God north east services has undertaken to defer the decision around the suspension of respite service provision in St. Mary's until 28 February 2005. The Health Service Executive north east disability services and St. John of God north east services will arrange to keep parent representatives abreast of developments in the process. Both parties are hopeful of a positive outcome.