Tuesday, 5 December 2006
The Government does not like to be kept waiting but look at how the Government has kept people waiting. People with cancer or aneurysms must wait for surgery, brain surgeons wait for equipment that works, women who have been raped must wait days for a doctor to attend, the elderly must suffer and wait for the nursing home to be inspected and 3,000 children must wait four years for an assessment but not treatment. Last year 3,000 children waited in adult psychiatric institutions. Does the Taoiseach realise how much humanity and sanity is lost because so many people are forced to wait because of Government inaction?
Today, a little boy named Jordan Kelly is waiting. His parents, Sharon and Martin, say he is angry, aggressive and out of control. He has spoken of suicide. Sharon tried to get help for Jordan when he was three years old. He was placed on a three year waiting list and nobody called in three years. The Taoiseach knows the joy of being a parent and sometimes the pain of being a Dad. Yesterday Martin Kelly told "Prime Time Investigates" that it is as if their little boy is hanging over a cliff and they are trying to hang on to him. He is slipping and eventually they know he will go but they do not know how it will happen. What has the Taoiseach, on behalf of the Fianna Fáil-Progressive Democrats Government, done about this? We do not need the reflex response, the BSE response — billions expended or blame somebody else. That would be terrible; somebody should do something about it. That person is the Taoiseach, with his Minister for Health and Children and her Minister of State. Action has not been taken, despite being in power for ten years. In ten budgets there has been money to do so much, but in spending one has gone astray. Last week, in the Taoiseach's absence, we had a vision of a slumped Tánaiste who was unable to answer any question or utter the word "neurosurgery". I hope the Taoiseach will do better with respect to psychiatric and mental illness, and do what the Government has not been able to do in ten years. He might like to express his thoughts on the issue.
The Deputy has raised a large number of issues but under Standing Orders, I can reply to only one. He concluded on the mental health issue. The Government and the HSE have made it clear a number of times that we are concerned about the length of waiting times for child psychiatry services. The Minister of State, Deputy Tim O'Malley, has expressed these concerns.
He is supporting new management actions to reduce waiting times, with substantial funds being provided this year and next. That is the only way to resolve these problems. More has been done in the mental health area in recent years than in any other period.
The HSE is carrying out an exercise to assess what must be changed in particular areas to reduce waiting times. It has confirmed that child mental health services in County Kildare succeeded in greatly reducing waiting times following the appointment of an advanced nurse practitioner who worked in close collaboration with a local multidisciplinary team to improve service access. The HSE is evaluating this model with a view to extending it to other areas, as it has been shown to work.
The HSE has 45 child and adolescent mental health teams and funding was provided this year for an additional eight. Recruitment is under way. Implementation of A Vision for Change requires the recruitment of an additional 40 child and adolescent mental health teams. This will be provided for on a phased basis, as planned, over a number of years. The provision of the eight teams required an additional allocation of €26 million for further development of mental health services. Although the money was provided, all the staff have not yet been recruited, as it is not easy to find qualified staff in these areas.
The provision of funding will be prioritised next year to increase the number of child and adolescent mental health teams and provide additional beds. The inpatient services at St. Anne's in Galway and Warrenstown are being expanded, while four new units are being developed in Dublin, Cork, Limerick and Galway, each of which will have approximately 20 beds which will help substantially in dealing with the problem. Interim arrangements have been made by the HSE, pending the provision of additional child and adolescent beds. All children in adult units will be treated on a one-to-one basis and additional training will be provided for staff. The Mental Health Act is in full operation since 1 November. It provides additional safeguards for children and for the first time recognises 16-year-olds and 17-year-olds as children. The Mental Health Commission has issued a code of practice for the admission of children under the Mental Health Act.
We must provide up to 40 additional teams. As I understand, it will take a few years to recruit the necessary staff. Eight new teams were put in place this year which means 45 are already in service. Therefore, we must put 32 more in place before we fulfil the requirements of A Vision for Change.
Deputy Neville has done more than any other politician in recent years to ratchet up the political priority given to tackling the inadequacies in treating mental health problems and psychiatric illness. The Mental Health Act does not provide for the provision of treatment, which is only provided when necessary.
The first report of the working group on child and adolescent psychiatric services, set up by Deputy Martin when Minister for Health and Children, states: "It is recommended that a total of seven child and adolescent in-patient units for children ranging from 6-16 should be developed throughout the country". This recommendation was made almost six years ago in February 2001. In the intervening six years — a time when the Government has collected a record level in taxes, €8 billion more than it stated it needed — the public's money has been squandered on PPARS, electronic voting machines and a range of other issues when children needing psychiatric help cannot get it.
What is different? Did the Tánaiste speak to the Taoiseach before the Minister of State at the Department of Health and Children, Deputy Tim O'Malley, made his callous and heartless outburst about this matter some time ago? The Tánaiste has stated he supports inequality in Irish society. He sees what he sees and knows what he knows. The Minister of State has now backed it up by stating very few people make representations to him, that the waiting list should be queried and, worse still, that psychiatrists deliberately keep waiting lists long in order to exert power and influence.
What kind of Minister of State has the Taoiseach in charge of psychiatric and mental health services? Did the Tánaiste speak to the Taoiseach before this heartless outburst?
Does the Taoiseach have confidence in the Minister of State? Does he think a Minister of State making such comments about people with a mental and psychiatric illness deserves to be in office? Does he intend to look for his dismissal or speak to the Tánaiste about the matter this evening? He should have no further confidence in the Minister of State.
For Deputy Kenny's information, the mental health tribunal is up and running and there are inspections. I have given impressive figures relating to teams. The Deputy has correctly stated we are in a better financial position and that we have trebled the resources available for mental health services. We have an additional 98 consultant posts, with the number moving from 210 to 308, a significant increase.
A Vision for Change, the report of the expert group on mental health, was only launched 11 months ago and covers both adults and children. It was accepted by the Government as a basis for the development of mental health policy and has been broadly welcomed by representatives of the mental health professions which asked us to take action. An independent monitoring group was established eight months ago by the Minister of State, Deputy Tim O'Malley, to monitor progress in implementation of the report. The HSE has established an implementation group to ensure its recommendations are realised in a timely and co-ordinated manner. Allowing for assimilation of the significant number of existing posts, the report estimates that over 1,800 new posts, together with total non-capital investment of €150 million per annum, will be required in the next seven to ten years. An enormous demand has been outlined to be met by the health service. The report estimates that approximately €800 million in capital investment will be required. It recommends "that steps be taken to bring about the closure of all mental hospitals and to reinvest the resources released by these closures in the mental health service". That is the reason we have put so much money into mental health services. We increased the mental health budget from approximately €300 million to close to €900 million. Obviously, there will be resources in the budget for mental health.
Regarding the point Deputy Kenny mentioned at the start, the HSE has 49 child and adolescent mental health teams. This year we provided funding for an additional eight. I am not saying we have reached the full position as we need 40 additional teams but even if we were to look for them tomorrow we would not get them. The report A Vision for Change stated we must keep doing that every year. It will not take us too long to reach the recommended level but it will not be done in one go.
Like many issues, resources for staff and buildings are required and we are dealing with that. This year alone, the HSE will recruit 400 new staff in mental health services. I do not think people can say that is not an adequate response to a report published at the start of this year. In 2007, we must do the same and, as I stated, we must do the same for a number of years to reach the total of 1,800 additional people in the health service. Forgetting about the money for a minute, hiring those people will take a considerable effort because a large portion will come from outside the country. However, we must hire them and in 2007 we will continue as we did in recent years.
The Taoiseach stated it will not take too long. What about the parents in Kerry who waited four years and four months for their child to get an assessment? Did the Taoiseach see the programme last night? If so, was he ashamed? Was it one of these programmes he feigns not to have seen?
Does anybody in the Government ever own up to accountability? Is there any accountability in the Taoiseach's Government? How could he have watched the harrowing images on the screen last night? How could he have watched parents at the end of their tether trying to deal with children with chronic disorders? We then had the image of the Minister of State responsible smugly proclaiming that the psychiatric profession is responsible and despicably passing the buck. Has the Taoiseach ever seen a more gauche unfortunate declaration of ignorance by a Minister of State responsible for any aspect of Government policy?
In reply to Deputy Kenny, the Taoiseach put his head down and muttered into his chest that his Government is trying to improve mental health. It will not improve mental health with a man who clearly has no empathy with the plight of families who are left waiting for psychological assessment for the same period which that family in Kerry waited.
In 1999, the then Minister with responsibility for education, Deputy Woods, stated that all national schools would have direct access to educational psychologists by 2004. According to the survey and the INTO, only 50% of primary schools have such access. The Taoiseach stated that he provides the resources, but in 1997 11% of the health budget was spent on mental health services — the current figure is 7.3%. The tax yield is €3.8 billion higher than expected and there is an Exchequer surplus of €5.89 billion as against a forecast Exchequer deficit of €2.9 billion. There is almost €9 billion to boast about in terms of resources at the disposal of the Government.
Children who are acknowledged to be at risk of chronic mental disorder are left in those circumstances because the disorder is unattended or not assessed, no early intervention occurs and no psychologists are available because the tax breaks of the former Minister for Finance, Deputy McCreevy, drove them into private practice. Parents must do the best they can.
The Taoiseach will not even admit that the man who is responsible is not fit to hold this office. I do not speak about him personally, I speak about his political ability to do a job and empathise with and understand the area for which he is responsible. For once in his life, will the Taoiseach state that his Government will have accountability when a Minister of State is manifestly incapable of doing his job?
If Deputy Rabbitte wants me to deal with the issue of mental health by stating that because the Minister of State does not have all the resources or staff required, he has an inability, I will not do so. The Minister of State, Deputy Tim O'Malley, does the job to the best of his ability and effort. Jumping on what he stated in an interview as against what he did in recent years is totally unfair.
For Deputy Rabbitte's information, I was in London last night and I did not see the programme. However, this morning I received a full report on the programme and I heard the Minister of State, Deputy Tim O'Malley, on the radio.
Previously, mental health was not referred to because people spoke about cancer, maternity and cardiac services. It did not receive resources. In the mid-1980s Professor Ivor Browne initiated changes in the area of mental health and the report on mental health in 1984-85 started a campaign to improve mental health services. Great strides were made during the past 20 years, but the matter came from a low base in that it did not have the resources of other areas. Deputy Rabbitte made much play on the percentage. The report asked for it to be brought to 8%. Stating what it was on a far lower budget is not the position.
I outlined that in recent years, mental health received substantial improvements in resources, including more than 400 staff in this year alone. As I pointed out, the report estimates we need 1,800 posts altogether, which leaves another 1,400 with a non-capital investment of €150 million. This year we invested €26 million and for 2007 there will be additional money in the Estimates. The report estimates €800 million in capital investment. Mental health will receive an increasingly bigger share but it will not receive the entire share.
I will not state because a programme was broadcast last night that the report A Vision for Change will be implemented tomorrow. It will not happen. The report of the expert group on mental health, which was launched 11 months ago, outlines what we should do over the coming years. The plan will take until 2011. We have 45 of the centres up and running, with eight additional centres open this year. I am told, even with the resources available since this time last year, they still do not have all the staff required. We will continue to invest resources next year.
We filled consultant psychiatrist posts. I cannot state whether every post approved will be filled but substantial resources have been provided. The mental health tribunal has been established, as have inspections. Everyone would feel sorry for anyone on the list and people must show compassion and understanding. However, it is no good standing up and stating it will all be solved tomorrow. The HSE, the Department of Health and Children and the Minister have a clear policy initiative to invest in resources and there is a monitoring group to deal with the matter. We must consistently follow this through so we can reach the total of 1,800 people as outlined in the report and have a proper national service in this area.
As we did in maternity where we have one of the best services in the world, in cardiac where we eliminated the problem and in cancer where we radically improved the situation, we must do in mental health services.
The Taoiseach says he cannot do this tomorrow. I understand this, but he has been there for nine and a half years. I accept his statement that he did not get the opportunity to watch the programme. However, I ask him to take time out, leave off one of the pub openings or other commitments and watch the programme to see what it is like to be a parent responsible for a child with a chronic behavioural disorder, attention deficit disorder or autism and yet be unable to even get a psychological assessment.
After nine and a half years, the HSE's own assessment is that 3,000 children are awaiting an assessment. The former Minister for Education and Science, Deputy Woods promised in 1999 that all primary schools would have this access by 2004 so this issue is not new. Can the Taoiseach tell us whether some of the vacancies in the service are due to the embargo? If they are, will he assure the House that the embargo will not apply to posts in this particular area?
If this situation arises because of tax relief introduced for care from the private sector, why do parents in the most difficult situations not have access to the National Treatment Purchase Fund?
If a person has a chronic illness in another area, he or she has access to the National Treatment Purchase Fund. Why does this not apply here? Why do the parents we saw last night not have some prospect of relief? Why can they not access the National Treatment Purchase Fund?
It is not good enough for the Taoiseach to come in here and say that he does not want to deal with the responsibility of his Minister of State. The Minister of State told the suffering parents last night that it is because some people in the psychiatric profession want to make themselves feel powerful that they exaggerate the waiting lists and like to keep people waiting because it confers this sense of power on them. Can one imagine any other EU member state leaving a man who uttered these sentiments responsible for this sensitive area?
It is not good enough for the Taoiseach to say that he did not see the programme and that he wishes to talk about the substantive issue, rather than the Minister of State responsible. This is not the first time we have seen this. A week ago, this same man said he thought people in the country suffering from depression were simply experiencing a condition of life. How can the Taoiseach leave this man in this position and say that he will address mental health services? They are incapable of being renovated under a Minister of State with this deficit of understanding, to put it at its mildest.
The National Treatment Purchase Fund normally deals with a waiting list issue where there is no follow on and is not involved in assessment where it is continuing on with a programme. If there is a quicker way of doing it, there is obviously no difficulty opening this up.
I cannot let Deputy Rabbitte's first question, which stated that we have been here for ten years but that nothing has happened, go. I will not remind him of what used to happen in the mental health area ten years ago, but he knows this budget has dramatically increased every year. It is nothing other than the increase in staff. This year, 400 additional staff were hired. The area is not bound by the embargo so this will not affect teams. They have had to work hard this year to increase the 45 teams by a further eight simply to fill the posts and get professional staff to deal with these issues. It is not a money issue.
A total of €500 million in the health programme goes towards the building programme but they cannot build everything. As is outlined in the A Vision for Change report, they must deal with closing the remaining mental hospitals and reinvesting the resources realised as a consequence in the health services, as recommended, and building up staff.
In respect of what the former Minister for Education, Deputy Woods, said many years ago, I am informed that all primary and post-primary schools have access to psychological assessments for their pupils directly——
Deputy Rabbitte asked a question about the service and I would like to give the answer. He said he was concerned about the parents, who I agree are unfortunate and want to know if the service is there. When I give the answer, his colleagues shout me down. I will repeat for the third time that I am informed by the Department of Education and Science that all primary and post-primary schools have access to psychological assessments for their pupils, either directly through educational psychologists or through the scheme for commissioning psychological assessments administered by NEPS.
Will the Opposition listen to the answer and then disagree with it, rather than disagreeing with it before I say anything? Schools which do not have NEPS psychologists assigned to them avail of the scheme and have assessments carried out by a member of the panel of private psychologists approved and paid for by NEPS. In the ten months to the end of October 2006, over €1.25 million was spent on approximately 3,500 of these assessments. The number of schools which are directly served by NEPS is only half the picture. One must remember that all the other schools can access assessments paid for by NEPS through the scheme. As I understand it, this important and fundamental point was missed in last night's programme, but I will wait until I see it. It was missed in the programme.
There are currently 127 psychologists in NEPS and four psychologists have been assigned to the national behavioural support service. A total of six psychologists are in the process of being recruited. On top of this, there has been a one fifth increase in funding for NEPS in the Estimates for next year, which have already been published. It allowed for 400 additional posts last year, including eight teams.
I accept that there is a plan outlined to 2011 which means that we must get up to 1,800 posts. The plan was published last January. A total of 400 of these people have been taken on this year. We must establish eight additional teams this year. We know there are service inadequacies. It is not true that these have not been set out. They are being published in a report. The tribunal was only set up on 1 November and the inspections programme was established in November. When we are dealing with issues, we should at least look at the full facts.
Hundreds of decent people from County Monaghan again braved the cold and inconvenience to make yet another trek to Leinster House to ask the Government to maintain crucial services at Monaghan General Hospital. Deputy Connolly has championed the community in County Monaghan time and again on this issue, to great effect. We want the Taoiseach to clarify exactly where the Government stands on the hospital's services because there is, on the face of it, a total contradiction between what the Tánaiste says will happen in the next two years and what was said today by representatives of the Taoiseach's party. The Tánaiste is promising that within two years the high care unit in the hospital will be closed, in addition to the medical services ward, which is open 24 hours per day, seven days per week. It was promised that the opening hours of the accident and emergency unit which has operated 24 hours a day, seven days per week, would be pared back to 12 hours per day and that there would be a similar paring back of X-ray facilities.
A Fianna Fáil Senator said to the people of County Monaghan outside the gates of Leinster House today that the Taoiseach was in full agreement with him that all current services should be maintained at the hospital.
The Teamwork report, commissioned by the HSE, is supposed to be driving this process but it states no services should be removed from local hospitals until better services are in their place. However, the downgrading of Monaghan General Hospital within two years will mean acute patients will be pushed off to the hospitals in Cavan and Drogheda which currently account for 20% of the national trolley count and are already overwhelmed according to the stated evidence of their dedicated staff.
The Taoiseach should not reply by stating the regional centres of medical excellence are the alternative. There is no contradiction between local hospitals, where day surgical procedures and minor and intermediate surgery are carried out, and centres of excellence for more serious procedures. More significantly, no date has ever been set for establishing centres of medical excellence. It will happen in the dim and distant future. Within two years, if the Tánaiste's writ runs, all the aforesaid services will be lost from Monaghan General Hospital. She has already in place an implementation group to try to put this into effect.
The Ceann Comhairle is very familiar with this issue. Deputy Higgins's quotation was correct in that I agree with my Senator colleague who stated we should not close any of the services in Monaghan General Hospital until we provide better services in the region. That is what he said and that is the position.
I met the Monaghan action group, the staff and some of the general practitioners from Monaghan General Hospital. They identified a number of services that they wanted to keep. The HSE representatives, whom I met recently, said they were prepared to keep them open until a better service could be agreed. I hope senior members of the HSE can agree on these issues which have been discussed backwards and forwards.
Approximately 15 patients per annum who tend to be extremely ill would be minded better and more safely in Drogheda than in the high dependency unit. There are too few patients to deal with in the latter unit. The clinicians and specialist staff have been clear on this; they have said this is the better way to deal with the issue. They made this clear at a number of meetings and I have read what they said.
On the longer term issue for the region, citizens should have available to them top quality health services that meet their needs within their own region. There is a short-term plan and a longer-term one. I have seen the papers produced by both sides and hope there will be a meeting of minds to reach agreement on the issue. An enormous effort has been made by everybody. Everybody involved means well but the HSE has set out clearly in the documents I have seen the services it will keep in Monaghan until a better service is made available elsewhere in the region.
I have talked to Professor Drumm and senior individuals in the HSE and they have said clearly and put it in writing, having attended the meetings in Monaghan, that the existing services will not be closed until a better service is available.
I know Deputy Connolly has been arguing the point for a long time. HSE officials attended meetings in Monaghan and met the Oireachtas Members. They have said they will not close any service until they provide a better one elsewhere in the region.
They have given an undertaking on foot of that position. It is only where there is an issue of safety, in respect of which I mentioned the 15 patients per annum who pass through the high dependency unit, that patients will be treated elsewhere. I honestly believe——
——that everybody, on both sides, rather than having a go at each other, albeit through legitimate protest, would be far better off if they set down to discuss what both sides are saying to try to reach agreement on the matter. The more it is talked up, the more difficulties will be created, and the problem will not be resolved. The Teamwork Management Services report, commissioned by the HSE, outlines the long-term position, but it also outlines the short-term position. It should at least be possible for those concerned to agree on what both sides are saying and the medium and long-term strategies.
The problem is that for several years the Taoiseach has backed and facilitated the extreme right-wing ideology of the Minister for Health and Children, Deputy Harney, and her party, the Progressive Democrats, in crucial areas of the health service. He has even done so by not restoring the thousands of beds ruthlessly cut from the system in the 1980s and by allowing cowboys — speculators and builders — to treat health care as a product on the market by building private hospitals.
It is very difficult to obfuscate about the situation at Monaghan General Hospital and get away with it. The Taoiseach may say with regard to mental health services for children that he cannot do the work immediately but these services exist in Monaghan County Hospital for the community of County Monaghan. Therefore it is easy to be very clear on what will happen in the next two years.
I would like the Taoiseach to state in his final reply whether in two years time the high care unit, the seven day, 24 hour medical services ward, the seven day, 24 hour accident and emergency unit and the extra facilities will be there and fully functioning to provide the service that is needed in County Monaghan. The Taoiseach could be very specific about that and clear up what is on the face of it a complete conflict between what the Minister for Health and Children is saying and what the Taoiseach was quoted as standing for at the meeting today.
It is important that the Taoiseach is clear on this matter for this community and for communities around the country because this is a pilot project. If the Minister for Health and Children gets away with what she clearly has in mind with the cutbacks, the same will come to hospitals around the country. A great deal is at stake. The Taoiseach needs to be very clear, and state in black and white the position of the Government of which he is head. He can resolve this issue in the next minute, to everybody's satisfaction.
I will be very clear. I emphasise again that no service will be changed in Monaghan before a better service replaces it and any change will be planned well in advance. The change will be for the good of the patients in Monaghan.