Wednesday, 6 December 2006
Yesterday, I raised the issue of the remarks made by the Minister of State, Deputy Tim O'Malley, who has responsibility for mental health. The Taoiseach replied that the Minister of State does his job to the best of his ability. One must consider that 3,000 children are waiting for assessments, never mind treatment. This waiting list was dismissed as something with which to beat up the Department or a creation of power-hungry psychiatrists. Does the Taoiseach believe professional psychiatrists deliberately lengthen their waiting lists to put themselves in a position to use their power and influence, as the Minister of State, Deputy Tim O'Malley, stated?
I recall that in February of this year, the Minister of State, Deputy Tim O'Malley, told the Dáil the constant reiteration and repetition of problems in the mental health services was becoming a bit tiresome. This Minister of State has responsibility for mental health and he regards it as a bit tiresome. He regards a waiting list of 3,000 as being deliberately created by psychiatrists who want to use their power and influence.
Plans to build seven specialised units date back to when the Minister, Deputy Hanafin, was a Minister of State. The agency to which the Minister of State, Deputy Tim O'Malley, works, namely, the HSE, is clearly hanging him out to dry. He states we will have four units by the end of next year. The HSE states it will be 2008 or 2009. In his earlier report to the Seanad, he stated these four units will be operational by the end of 2006. It is another example of not being able to translate the words of Government into practice.
Yesterday, the Taoiseach stated with regard to these extremely vulnerable people that the Minister of State is doing the job to the best of his ability. I happened to see some of the programme last night where one psychiatrist stated that the Minister of State, Deputy Tim O'Malley, should go to a group meeting where they can only deal with people who either inflict self-harm or are clearly suicidal.
The Government has taken in €8 billion more than was projected during the past number of years. Surely, without any thought, the area of mental health, where the budget percentage declined from 11% to 7%, should be a priority. The person in charge, a Progressive Democrats Minister of State, backs up the Tánaiste and leader of that party who stated inequality is good for Irish society.
The Taoiseach is standing over the competency and statements of a Minister of State who stated it is all a bit tiresome. Does the Taoiseach believe it is a bit tiresome? Does he believe psychiatrists deliberately lengthen waiting lists to use their power and influence? What will he do about the Minister of State, Deputy Tim O'Malley's half-hearted statement of regret? It was not an apology. It was regret he was caught out.
Yesterday, Deputy Kenny also asked the Minister for State, Deputy Tim O'Malley, to clarify his remarks. He did so. The Minister of State congratulated and complimented the programme, most of which I saw last night. In the programme, he outlined the details of what he stated last January and March, that harrowing cases existed where families were subjected to inordinate delays in getting assessment and treatment. He fully accepted that waiting lists are real and many people wait too long for psychiatric services. He also acknowledged the work done by the psychiatric services — so do I — as they work hard. As I stated yesterday, that is why during the past number of years we have trebled the staff resources of consultant psychiatrists.
We accepted the report of the expert group on mental health policy launched at the beginning of this year covering adults and children on the basis of future development and what we should do for mental health. The report has been broadly welcomed by representatives and psychiatrists. The independent monitoring group established in March by the Minister of State, Deputy Tim O'Malley, is working on it. It set out what we are required to do over the coming years, building on what was done over the past number of years.
Last night, I had an opportunity to see where the service was before I became Taoiseach, but I will not give the litany of the sad stories of what it was then.
More staff have been put into the service during my time as Taoiseach than were put in since the foundation of the State. I am the first Taoiseach since the foundation of the State to substantially change and take this issue seriously.
Deputy Kenny asked about additional child and adolescent teams. Eight additional child and adolescent teams were put in place and recruitment is under way. We resourced them this year. We also included resources for additional teams for next year in the Book of Estimates published a few weeks ago. The report clearly points out that, between now and 2011, we must increase and resource the teams. Currently, 45 child and adolescent teams are in place. The report states we require an additional 40 child and adolescent mental health teams. We have recruited eight teams this year and must recruit approximately eight teams per year to get this service up to what would be considered adequate by this report. The report accepted that this could not be done in a short period of time. Looking at the recommendations last night, the need to put in additional resources was highlighted, and we did that this year. We took on 400 additional staff to build up mental health services. We need to get up to approximately 1,800 new posts, together with a non-capital investment of €150 million. Again, we have put in a substantial amount of the non-capital programme.
We have dramatically increased the numbers in the past few years but we must further increase them. That is where we must get to in respect of the teams. That is the plan with the HSE. We recruited approximately 400 staff this year, which shows the substantive effort to do that. It will not be easy to recruit staff, as has been pointed out by the professionals. This is why the professionals are under pressure in their work, but they know we are committed to doing it, and we will do so.
It is like the Taoiseach's comment about sitting close to President Bush — one would need to get very close to be really assured here. This is an important day in the life of any Government, particularly for the Minister for Finance. Obviously, the economic circumstances are very different from those on the last occasion when the former Minister for Finance, Deputy Quinn, presented the first budgetary surplus in 27 years, which was £11 million.
My problem is that the Taoiseach has not answered the two questions I asked, which relate to accountability on the part of the Government. I will bring him back to a couple of fundamental issues. The Mental Health Commission reported earlier this year that there is no fully functioning multidisciplinary facility in the country 22 years after it made that recommendation. The problem is that the Minister of State, Deputy Tim O'Malley, issued a half-hearted regret at being found out not so much for the words he uttered but for his complete incomprehension of the scale of what he is dealing with. Mental health is the only area with which he must deal.
A total of 3,000 people are on the waiting list and 300 children are in adult psychiatric units, which is disgraceful, while the Taoiseach talks about the moneys that have been allocated. The Taoiseach referred to some of the questions I raised yesterday. I will ask him two questions that I already put to him this morning but which he did not answer. He knows the answers to these questions because they are either "yes" or "no". We are dealing with Leaders' Questions and the Taoiseach is the leader of the Government.
My first question is very clear. Does the Taoiseach believe that professional psychiatrists in this country deliberately maintain long waiting lists to exert power and influence — yes or no? Second, does the Taoiseach believe that the continuous repetition and mention of problems in the mental health area is tiresome — yes or no? I ask the Taoiseach to answer as leader of the Government and not to associate himself with the incomprehension, incompetence and lack of accountability of the Minister of State, who represents a party that supports inequality in Irish society.
——highlights what has happened in recent years and we should take full account of that. A commitment to what we must do in the period to 2011 was made in A Vision for Change by the expert group and it has been implemented. This year alone, the HSE will recruit 400 staff to build up mental health services. That is a very strong resource. We have trebled the amount of resources, which effectively all relate to staff.
We have put a significant amount of resources into the teams, all of which is due to the service and work of the Minister of State, Deputy Tim O'Malley. The only point he made was that child mental health services in Kildare reduced their waiting times following the appointment of an advanced nurse practitioner who worked in close collaboration with what Deputy Kenny said we should have, namely, a multidisciplinary team to improve access services. The Minister of State said he would urge the HSE to evaluate the model and extend it to other areas. That was not an unreasonable thing for the Minister of State with responsibility for that area and for the massively extended budget in this area to say.
The Government knows and has identified in A Vision of Change what it needs to do over the coming years. By and large, that involves recruiting additional staff. Extra money is required for that and in our Estimates for next year, and for the next three years——
At the foundation of the State, there were 200 psychiatrists, but in a very short period of time, we have increased that number to 300. The Deputy should not refer to next year. This is what we have done this year. We have done an enormous amount of work in this area. We are endeavouring to implement that programme and put in the resources, which are staff resources, so that the expert group on mental health policy, which was launched this year, can build on what has happened in recent years. I believe that can be successfully done. Deputy Kenny is correct in that, because of the good management of the economy, we have far more resources to put into services, which is why we are doing so.
I will deal with the Taoiseach's last point about resources. The budgetary provision for mental health services, as a proportion of the health budget, was 8.96% in 1997. The figure was 8.6% in 1998, 8.21% in 1999, 7.73% in 2000, 7.09% in 2001, 6.9% in 2002, 6.8% in 2003 and so on. The fact in black and white is that the proportion of the health budget spent on mental health services is declining.
The Taoiseach seems to think, having seen the programme, that it is all right to come in here and rhyme off statistics with no concept of the hurt that is felt by parents who cannot access services where they exist and who cannot get assessments where they do not exist. Having listened to the Taoiseach's reply, it seems that it is not only the Minister of State, Deputy Tim O'Malley, who is weary of this problem, the Taoiseach seems to be weary of it. If he admits to having watched the programme last night on tape and seen the plight of those parents, how can he come in here and defend it in terms of the millions the Government has spent?
There is not a Deputy on any side of this House who has not met some of these parents whose child manifests signs of psychiatric illness, suffers from Asperger's syndrome, may be autistic or suffers from a behavioural disorder, and have to wait up to four years and four months in this best of all possible worlds, with the most of all possible money, before they can even get an assessment.
The Government is out by almost €8 billion in its projections in terms of budgetary forecast. We will be boasting later today about how much money we have, yet there are parents at their wits end trying to find respite care or an assessment service for their children in these circumstances. The Taoiseach seems to think it is fine that the Minister of State, Deputy Tim O'Malley, comes in here and tells us he has apologised to the psychiatrists. What about the parents? Did he apologise to them? The Taoiseach comes in here and says the Minister of State is doing the job to the best of his ability, but is that not the problem? The man may be eminently well suited to some other aspect of Government, but it is transparently the case that he has no feel for this area, that he does not understand it and does not empathise with it.
Any man who would say the professionals are manipulating the waiting lists to encourage their sense of self-belief and power, thus leaving parents in the aforementioned circumstances, is not suited to be charge of this area. All the Taoiseach is doing is standing up to defend the indefensible. Once more he is demonstrating no accountability. Will he deal with this problem or turn a blind eye to it and tell the people and parents that there are committees sitting, task force reports imminent and so forth? The circumstances are far more grave than the Taoiseach seems to appreciate.
Unfortunately Deputy Rabbitte's mind was elsewhere when I was answering Deputy Kenny. I answered the question on what the Minister of State, Deputy Tim O'Malley, said. If Deputy Rabbitte had bothered to listen to what he said last night, he would realise he empathised fully with the parents. If he had watched the programme with other than a political mindset, he would have seen the Minister of State was very supportive of them.
Deputy Rabbitte said we are talking about implementation groups and reports. I am not talking about these but about policies that are being implemented which provide that one in every five primary school teachers deals with special needs and autism and 8,000 special needs assistants are employed every day in schools. We have taken on 400 staff this year and trebled the staffing resources. We are doing this to help staff in the field. We provided 400 staff to help the psychiatrists and trebled the number of consultant psychiatrists, not so much because it was a good idea but because it was necessary. These are not matters we are merely talking about. Deputy Rabbitte has just heard about this issue in the past few days and knows nothing about the subject.
Regardless of whether it is intellectual, physical or sensory disability, autism or mental health, we have been investing considerable resources this year and for the past number of years. These resources have been put into revenue, buildings and staff and we have been improving dramatically the services that exist.
We have provided several hundred new residential places this year for persons with intellectual disability and autism, in addition to new respite and day places. We have continued to transfer persons from psychiatric hospitals and other appropriate places——
I am not going to reply to the Taoiseach in kind. I regret very much that he does not regard this as an appropriate subject to talk about. If he talks to parents, including some of those who appeared on the programme, he will understand why the issue is appropriate for the House to debate. He will also understand that all the professionals have concluded that early intervention is the key.
That is exactly the issue in question, even if the Taoiseach cannot understand it. The facts to which I refer are attributable to the HSE and not to me. The Minister for the Environment, Heritage and Local Government, Deputy Roche, should stay out of it — he is only trying to divert the Taoiseach. Let the Taoiseach think for himself.
Is Deputy Roche finished? According to the HSE, 3,000 children await assessment, bearing in mind that early intervention is the key.
Consider the provision of inpatient child and adolescent beds. It is said that 236 are required while there are 20 available.
The areas of greatest need are the areas of least staffing. If this is not an appropriate subject to raise in this House, I do not know what is. If, in two days, the Taoiseach is to accept the resignation or retirement of one of his Ministers of State, could anything be more appropriate than his acceptance, in two days, of the resignation or retirement of two of his Ministers of State? The Minister of State at the Department of Health and Children, Deputy Tim O'Malley, is entirely unsuited to this particular post.
He is making public statements that anger parents and leave them in despair. They are at their wits' ends trying to manage the domestic situation. They do not know where to go for help and are told they must wait for psychological and psychiatric assessment for their children in the knowledge that they are most at risk of becoming chronically mentally ill if there is no such assessment——
I agree with one point Deputy Rabbitte made, namely, that this is a very important issue to be discussing. That is why we are so determined to continue to implement and resource the A Vision for Change programme, which was agreed for this year, and not to talk about it. As I stated, regardless of all the staff we provided over recent years, we provided 400 for mental health services this year alone. We provided eight extra teams and identified, over recent years, what we need to do. The comments of the Minister of State, Deputy Tim O'Malley, in March outlined what we need to do over the next five years. In this regard, he set up the independent monitoring group, which we have resourced for the coming years.
I totally agree with what is stated in A Vision for Change. Deputy Rabbitte is repeating this and it is Government policy. I obviously agree with him that we need to deal with people early. This is why all primary and post-primary schools have access to psychological assessments for their pupils.
In the ten months to the end of October this year, there were 3,500 assessments. Bearing in mind the number of schools, the service providers try to deal with the issue we need to deal with, as identified correctly by Deputy Rabbitte. It was pointed out in the report and in the statements made by the Minister of State, Deputy Tim O'Malley, this year, as will be clear to anyone who was listening to what he was saying, that the schools served directly by the educational psychologist programme comprise half the picture. We must remember all the other schools access assessments through the NEPS.
I am happy to report the number of psychologists has trebled in a very short period since we set up the service. There are 127 psychologists in the scheme, four assigned to national behaviour support services which are badly needed, six are being recruited and in addition we will increase the staff for the fifth time for next year. That will allow further expansion of the number of psychologists next year. The actual number of extra staff will be worked out shortly. As well as recruiting more psychologists in the educational psychologist system we have taken steps to reduce the need for assessments through the introduction of a general allocation model for providing resource teachers in primary schools. One in five of our teachers is a resource teacher, 8,000 work as assistants in our schools.
Since last year all schools have been allocated resource teaching hours, based on their enrolment figures to support children with a high incidence of special needs and learning difficulties, dyslexia and other issues. This means that the individual assessment is no longer needed in each and every case. That frees up the psychologists for children with low incidence needs such as autism, and allows more individual assessment. More than 600 additional teachers were put in place under the model introduced this year.
Since we established the scheme, not so long ago, we have trebled the number of psychologists in the service, and funded in the region of 3,500 private assessments so far this year. We are committed to expanding the coverage of the service. We are recruiting extra staff and plan to hire more in 2007. We have agreed and are committed to a programme under A Vision for Change. Most of it is in the multi-annual programme so to say that I, or the Minister of State at the Department of Health and Children, Deputy Tim O'Malley, or anyone in this Government is not paying total attention to mental health services is wrong.
The Minister of State, Deputy Tim O'Malley, has stated that he was making a point about a scheme and he intended no offence to parents or staff. He has made that position clear and the point should not be repeated.
It is incredible to hear the Taoiseach say that everything is fine, no worries, the Government is in charge, everything is under control. When one hears the Taoiseach say that the Minister of State, Deputy Tim O'Malley, is working to the best of his abilities and we should leave him alone I wonder whether the Taoiseach understand the degree of shortfall, and the problems and trauma it creates for people with intellectual disabilities and their families?
He need only look at his national intellectual disability database which states the problem in black and white. Apart from the absence of standards, a serious problem with which we must deal, 1,906 people with intellectual disabilities will need places for residential services in the coming year. In 2006 only 255 places were given out. Is the Taoiseach telling the rest of those people that there is no problem? That is the impression he gives us. Is he telling the 1,877 people who are looking for respite services or residential support services that they will get places in the coming year? That has not been their experience in previous years. Will the 264 people looking for day services get places next year? These are the answers we need.
Is the Taoiseach able to tell those aging parents, who are worried sick that if they do not survive the year their children will be left without care or services, that they will get residential places? What will the Taoiseach say to those looking for places who do not have places and who on past experience will not be able to get places?
To be specific, in an area with a fast-growing population, my area in north Dublin, which the Taoiseach knows, the number of residential places sought——
This is my final point but it is important to state the reality so that the Taoiseach can say whether it will be addressed. A total of 115 people sought residential places in areas 6,7 and 8 of the Health Service Executive in the past year. Of those 32 got places. Is the Taoiseach saying that everything is under control or will he tell admit there are serious problems and tell us he will deal with them in the year ahead, before the general election? That is what people want to know.
I apologise if I am repeating myself but I said yesterday and this morning that A Vision for Change spells out the difficulty and the areas where there are insufficient staff. It points out where we need additional teams and resources. That is why the Minister of State, Deputy Tim O'Malley, and his colleagues in the Department of Health and Children, produced the report of the expert group on mental health this year in January which covers adults and children. It is the blueprint for the next few years, built on what has been done in recent years.
Deputy Sargent is right, that report shows that we have a five year programme to bring the service up to what it requires. We are into year two. The Health Service Executive, HSE, says that it has 45 child and adolescent mental health teams and needs 40 more. Until we get that 40 we will not have satisfied the requirement. It is not a question of saying that everything is right. That is what the report highlights. That is why we put the resources into it and why the expenditure has risen so much. Apart from the requirement for €150 million to finish the closure of the old hospitals as recommended in the 1984 report, Mental Health Planning for the Future, all of that expenditure goes on staff. We spent an additional €26 million on the eight teams set up this year.
The staff have not all been recruited, not because anybody was sitting on his or her hands, but because it is hard to get them. The HSE is committed to doing that. Next year it needs the same until we reach the 40 teams, 32 of which are still outstanding. That will deal with the assessments and the increase in consultant posts, from 200 to 300 posts, which we have begun and will continue.
Deputy Sargent also mentioned the campaign by St. Michael's House and others to deal with the residential waiting lists for the people of various ages who depend mainly on their parents. This will enable them to feel secure in their old age that there will be proper residential accommodation for their children. Over the past few years we have invested substantial resources in the bricks and mortar required. Most of these organisations, of which there are several around the country, such as St. Michael's House in Deputy Sargent's area, are building new houses and renovating houses to make them suitable for the staff to work with groups of between four and six elderly or young people to protect them for the future.
They have quite long waiting lists, which are growing even though we have invested and they acknowledge that we have done so. Due to the age profile, they have problems and made the case this year for additional resources which they received. Funding must be provided every year. They can do only so much each year but they have built up a waiting list which the Minister for Health and Children and the Minister for Finance, Deputy Cowen, who started this programme when he was Minister for Health and Children, require further resources to address in order to have more units in 2007. They have made their case and the Minister is dealing with it.
That is only the residential part of the work. Many other areas are being dealt with, apart from those discussed this morning, for example the national strategy action on suicide prevention, Reach Out, the work on the central mental hospital, and many other areas with which we must deal. Everything is not perfect but at least we have an action programme which we are resourcing and staffing and which is making a significant difference and must continue to do so until we get on top of this problem.
Members should acknowledge the major increase in staff this year whereby we have employed 98 consultant psychiatrists in recent years. This year alone we have taken on 400 additional staff but we have some way to go to reach the figure of 1,800 outlined in the report last January.
The Taoiseach is right, there is some way to go. Listening to him, one would think it is somebody's else's problem, such as those in St. Michael's House. I was talking about national figures and Government responsibility. The Taoiseach will be familiar with the saying to the effect that the greatness of a nation is to be judged on the way it treats its most vulnerable. By that yardstick, this Government is appalling. I refer also to standards. Surely lessons have been learned. The former Minister, Deputy Woods, certainly knows a thing or two about failing to keep an eye on residential institutions in the past. The Leas Cross report tells us a thing or two about not having sufficient inspection in nursing homes. Where are the standards, the inspections and the yardsticks for people in residential care with an intellectual disability? The national standards for disability services report which dates back to 2004 has not been implemented. We have no uniform costs——
——no standards or inspections to uphold any standards, yet the Taoiseach stated more resources have been invested. How is that being checked? How are the people working in those institutions to measure the standards and what is expected of them, other than the standards they set for themselves? Does the Taoiseach not believe there is a need to refocus Government policy so that by the time he leaves office, he will not just be issuing press releases stating, "We did our best", he will be able to say, "We met needs". Currently, needs are not being met and it is being left to voluntary bodies to make up for that.
They do excellent fund raising. The Mental Health Act is considered to be one of the most advanced of its kind. The final part of it only came into operation on 1 November last. That is where the powers are set out.
A total of €2.4 billion has been invested in the area of intellectual, physical and sensory autism. Practically all that money has been spent on staff. The money is used to employ professionals. It is not a case of billions of euro being thrown around the place. Staff are employed to help the needs of these people on a daily basis. It is right that we invest this money in services for people with intellectual disability. This year 255 residential respite places have been provided for people with autism. A total of 535 day care places have also been provided. The expenditure is being made and a vast amount of money has been invested in this area. I am glad——
The State is investing in these areas. As I pointed out several times this morning, we need to do more in this area. We need to increase staffing levels to the 1,800 posts that were set out in the action programme. We also need to spend €150 million dealing with it in the coming years.
I meant to pick up on a point made by Deputy Rabbitte earlier on the figures he gave. He is aware that those figures relate to a number of different areas. The figures for mental health come from the Departments of Health and Children and Education and Science. The percentage figures are far higher than those quoted by the Deputy because they are not all in one subhead.
We are currently spending €850 million on special needs in the education system. It is right that we do that at an early stage. Previously, we did not do that, as we had no money. When I first became Taoiseach there was probably a handful of people in the education system dealing with special needs, now there are thousands. It is right that we have done that. In less than a decade we have moved to a position where 20% of primary teachers, not to mind thousands of special needs assistants in schools and the thousands of other people in the community, are working in this area. The fact is we are investing significant resources, but, as the report outlines, we will have to continue to increase these numbers over the next five years.