Dan Neville (Limerick West, Fine Gael)
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I congratulate the Minister of State at the Department of Health and Children, Deputy Barry Andrews, on his appointment. We will lose him from one of our committees, which he chaired expertly. I wish him well. I hoped this matter would have been deemed important enough for the Minister for Health and Children to attend, but she decided not to do so.

The dispute involving the psychiatric nurses is serious and it affects the most vulnerable people, namely the psychiatric patients in hospital and in the community. Any diminution of service has an effect and the diminution in question is considerable. It is feared that the trend will continue. We urge the Minister, the HSE and the unions to make every effort tomorrow with the Labour Relations Commission to find a solution to the crisis affecting psychiatric services.

Assaults of varying degrees have been a fact of life for psychiatric nurses for a long time. In 2002 the Psychiatric Nurses Association, PNA, carried out research on the number of assaults on psychiatric nurses in 2001 and found that 857 had been injured by assault. On making this finding, the PNA wrote to the then Minister for Health and Children, Deputy Martin, stating that the frequency of the assaults in psychiatric services can, in most instances, be attributed to the mental health of the patients. The letter states that the perpetrator of the assault is, quite often, suffering from an illness such that, if charged with a serious criminal offence, there would be a finding of insanity or diminished responsibility. There was no response by the Minister and the PNA balloted members on industrial action. However, on the eve of the action, the Minister intervened and set up a taskforce on assaults on psychiatric nurses. The Minister gave a written assurance that the findings and recommendations of the taskforce would be accepted and progressed within an agreed timeframe.

The taskforce reported in April 2003 and the report contained a recommendation for the establishment of a no-fault, non-statutory compensation scheme for nurses working in mental health services who suffer serious injury as a result of an assault. It defined "injury" as "any serious impairment of the person's physical or mental condition". It provided for retrospective compensation for nurses previously injured by assault. The PNA accepted the recommendations of the taskforce but, despite several demands, there was no sign of the scheme being implemented by the Minister.

The Government considered the matter at its Cabinet meeting on 13 July 2005. The then Tánaiste and Minister for Health and Children, Deputy Harney, met the PNA that evening and said that, despite the Government's previous undertakings, the Government had decided not to implement the scheme. She stated she was asking the State Claims Agency to consider the introduction of a fixed redress scheme along the lines of the PIAB scheme that would expressly prohibit any compensation for psychological trauma and would not cover any injuries incurred before the introduction of the scheme. This was contrary to the recommendations of the taskforce and to the undertaking of the Minister's predecessor, Deputy Martin.

The PNA was adamant that psychological trauma and retrospection should be part of the scheme. However, it decided it would be prudent to allow the Government to approve the scheme as the principle of no-fault compensation at least would be established. The Government subsequently approved the scheme at a Cabinet meeting on 17 January 2007. The PNA immediately referred the matter to the Labour Court and sourced legal and medical expert opinion. The Labour Court in its recommendation upheld the PNA claim. It stated:

The Court accordingly recommends that an insurance-based scheme be put in place to take effect from the date of this Recommendation, which should include an element of compensation for psychological trauma, where relevant, and where it arises directly from the effects of an assault on a nurse while at work.

The Labour Court's understanding is that there are approximately 40 such claims already lodged in the system. In the case of these claims and no other, the court recommended that the terms of the proposed new scheme be extended to embrace those claimants on a once-off basis. Following the recommendation from the court, the Department went back to the various Departments involved, particularly the Department of Finance and the Office of the Attorney General for advice.

Following repeated requests to the Department of Health and Children, the HSE and HSE-Employers Agency, the union was informed that the Department of Health and Children had completed its consultations early this year and that a revised scheme to incorporate the findings of the Labour Court was presented to the Minister for Health and Children, Deputy Harney on 3 January 2008. The PNA issued a press release describing the scheme as being "Yellow pack in the extreme".

As of yesterday evening the delivery of services has been upset to a considerable degree. Various problems have arisen in County Kildare and the Central Mental Hospital, Dundrum, where there has been a proposal that soldiers and gardaí should take over nursing duties. While I hope this was never considered, a newspaper reported that this was the case. A staffing crisis that arose before noon in County Kildare was averted until 5 p.m. Problems exist in St. Ita's, Portrane, Tallaght hospital and in the mental health services in Clonmel and counties Clare, Monaghan and Cavan.

Barry Andrews (Dún Laoghaire, Fianna Fail)
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I thank Deputy Neville for raising this issue and for his good wishes. I am taking this Adjournment debate on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

In 2002, a task force was established to investigate assaults on psychiatric nurses with a view to exploring preventive measures to reduce the incidence of assault and to provide for a compensation scheme for the nurses concerned. The task force reported in April 2003. It recommended the introduction of a no fault, non-statutory compensation scheme for those nurses working in the mental health services who are seriously injured as a result of an assault by patients during the course of their duties.

On 13 July 2005 the Government decided, in the light of advice received from the Attorney General, that it was neither feasible nor practical to proceed with the introduction of a no fault compensation scheme as recommended by the task force. The Minister for Health and Children met officials from SIPTU and the PNA on 13 July 2005 and advised both unions of the Government decision. However, the Minister confirmed that consideration would be given to the idea of a fixed and proportionate redress fund for physical injuries as an add-on to the serious physical assault scheme.

Following from this, the Labour Court recommendation dated 29 March 2007 and subsequent clarification, the HSE introduced an insurance scheme to provide compensation for nurses in the mental health services assaulted by a patient or client in the course of their employment. This insurance scheme is modelled on standard personal accident insurance cover and will provide a fixed tariff of compensation for particular physical injuries resulting from assault by a patient. It would be in addition to the existing serious physical assault scheme, which provides for enhanced sick pay and cover for medical expenses, as well as five sixths of salary for nurses permanently incapacitated as a result of a serious assault at work.

It also should be noted that premiums due for the personal injury insurance cover are paid for by the HSE and no charge is incurred by individual nurses. The policy commenced on Monday, 21 January 2008 and is in line with industry norms in respect of insurance-based schemes that are available to other sectors of the economy. Both the PNA and SIPTU have rejected the scheme and have argued that any benefit should be reflective of the Personal Injuries Assessment Board, PIAB, book of quantum. However, the cover provided is an insurance-based scheme which never was intended to compensate persons at levels equivalent to the PIAB or the courts.

The PIAB assesses claims for compensation only in circumstances in which the negligent party, whether employer or otherwise, acknowledges fault. The PIAB compensation is based on the equivalent compensation that a person could expect to be awarded by a judge of the Circuit Court or High Court.

Following 21 days' notice, the PNA and SIPTU commenced a work to rule on 30 April, which includes a ban on overtime whereby psychiatric nurses will work rostered hours only; no co-operation with assisted admission; no escorting of patients to mental health tribunals; and no attendance at non-essential meetings. The HSE invited the PNA and SIPTU to talks yesterday, 7 May, to discuss issues relating to contingency plans, continuity of service and emergency cover for the ongoing dispute. Both unions declined to attend. This non-attendance, combined with the failure to notify the HSE of their non-attendance, raises serious questions about the commitment of union leadership to patient safety.

Meanwhile, as a consequence of the ongoing PNA-SIPTU industrial action, the position in Lakeview acute mental health unit at Naas General Hospital has reached critical point. There have been significant ongoing difficulties in staffing the Lakeview unit. However, due to uncertainty regarding the ability to deliver continuity of care in a safe environment, a decision has been made to transfer immediately patients to other treatment facilities. This is a regrettable step but is unavoidable at present and has been taken in the best interest of patients.

As for claims concerning the Central Mental Hospital, the hospital remains open. Management of the HSE has met both unions locally and is managing the situation on a daily basis. It should be noted that staff from all disciplines and management have worked tirelessly to protect patient care since the dispute started last Wednesday.

The Labour Relations Commission, LRC, has formally invited the parties to the current dispute for exploratory talks on Friday at noon. This invitation is on an unconditional basis and all parties have accepted this invitation. The Minister has welcomed the initiative by the LRC. She has expressed her deep concern at the adverse impact of the dispute on the care of mental health patients and has appealed to the two nursing unions involved to suspend their industrial action to minimise hardship to service users and their families while the talks process at the LRC gets under way.