Dan Neville (Limerick West, Fine Gael)
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I welcome the opportunity to address the report of the independent monitoring group on A Vision for Change. The group is chaired by an eminent person, Dr. Ruth Harrington, and I note that a member of the monitoring group is the former Minister of State in the area, Mr. Tim O'Malley.

The monitoring group, in the conclusions of its first report which was published last year, recognised that 2006 was a year of significant challenge and change for mental health services and expressed the view that it expected to see accelerated action in the second and subsequent years. It is disappointing to report, by and large, that the recommendations of the first report of the independent group have not been addressed in 2007, but they have been prioritised for 2008. However, no resources have been allocated to introduce them because the Minister has suspended giving any further resources to implementing A Vision for Change.

The main concerns of the monitoring group on the implementation by the HSE include the absence of clear, identifiable leadership within the HSE to implement A Vision for Change. The monitoring group considers that the Health Service Executive was mistaken in its decision not to implement the recommendation to establish a national mental health service directorate to drive the changes recommended in the report. The monitoring group does not believe that the administrative arrangements put in place by the HSE are appropriate to the scale of the changes requires. The monitoring group notes that the HSE appointed a director of cancer services in 2007, which was mentioned earlier, to lead implementation of the cancer strategy, and the reform of the mental health services, it states, requires a similar approach. The national steering group appointed to manage the planning and implementation for A Vision for Change is not multidisciplinary and includes no service user or carer representative, as recommended. In addition, the role and relationship of the steering group to the HSE expert advisory group on mental health and the implementation group is unclear. There is a confusion of roles in that regard.

The HSE implementation plan relates to 2008 and 2009 and spans 11 chapters of A Vision for Change, and it identified six key priorities to do so. The plan is selective and vague and is mainly limited to the years 2008 and 2009. Although many of the recommendations require a longer time span for implementation, it does not address the impact of the employment control measures with the HSE on the recruitment of key staff necessary for the implementation of A Vision for Change.

The monitoring group has been informed that a comprehensive plan will be provided by the HSE before the end of 2008. The group regrets that a comprehensive plan has not been published heretofore.

The recommendations of A Vision for Change are not being addressed as a comprehensive package. The monitoring group is concerned that the HSE transformation process is taking precedence over the implementation of the recommendations.

The resourcing of multidisciplinary community health care teams is not being adequately prioritised, an issue which we have raised repeatedly over the past three years in this House. There appears to be a lack of clarity regarding the key central role of multidisciplinary teams, as envisaged in A Vision for Change. Primary care and significant aspects of specialist mental health care, including the multidisciplinary community mental health care group, are concerned about the potential for a blurring of boundaries.

The monitoring group also raises the issue, highlighted on several occasions in the House, of the use of funds. Some €24 million of the €51 million development funding allocated to the HSE for the implementation of A Vision for Change was not used as planned. It was hived off elsewhere and it is not apparent to the monitoring group who in the HSE has budgetary responsibility for mental health services or how budgetary decisions affecting mental health services are made. Will the Minister of State identify who is responsible for making these budgetary decisions? As he has come into the House with a prepared script I am sure the matter will not be addressed.

Barry Andrews (Dún Laoghaire, Fianna Fail)
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I take this Adjournment debate on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. I thank Deputy Neville for raising this issue. I warmly acknowledge that it has been inspired by a genuine commitment to ensure that persons with mental health difficulties receive the best service possible and, for that reason, I welcome the opportunity to explore this issue in the House this afternoon.

I will discuss the findings of the report, but it is important to acknowledge how far we have come in the area of mental health. I do not wish to dwell on the past, but in 1961 the rate of psychiatric beds per 1,000 of population was 7.3, which was believed to be among the highest in the world. Ireland was described as being "hospital prone". For a considerable time those in need of treatment or care had little choice but to seek it within an institution. Although there was considerable stigma attached to these institutions, they were the only places available.

I am pleased to say that since then, significant developments have taken place——

Dan Neville (Limerick West, Fine Gael)
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The community based team did not replace——

Barry Andrews (Dún Laoghaire, Fianna Fail)
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——with the full implementation of the Mental Health Act 2001 and the launch of two important strategy documents, A Vision for Change, the report of the expert group on mental health, and Reach Out, the national strategy for action on suicide prevention.

A Vision for Change, launched in January 2006, represents an action plan for the development of a quality mental health service which places the patient at the centre. It recognises both the strengths and inadequacies of existing services and a strategy for building on the innovations outlined in previous strategy documents. The Government has accepted the report as the basis for the future development of our mental health services and is firmly committed to its full implementation.

Although there have been great strides taken in the development of mental health services in Ireland, I accept that we are not where we want to be, but we are getting there. A Vision for Change is an ambitious and aspiring publication, containing 200 recommendations to be implemented over a seven to ten year timeframe. The challenge is to maximise the benefits of having such a progressive strategy to ensure that real benefits for the patient and indeed for society as a whole are realised.

The second annual report of the independent monitoring group was published on 27 June 2008. I welcome the findings and recommendations in the report. The group expressed its disappointment at the slow rate of progress in implementing A Vision for Change. We must accept that much work needs to be done and I look forward to seeing increased progress this year and in subsequent years.

The HSE recently approved its implementation plan which sets out six key priorities for 2008 and 2009. These include the provision of eight additional consultant child psychiatry teams. The HSE recently advertised an additional 12 consultant child and adolescent psychiatrists and is examining new ways of working to address waiting lists. Another priority is the provision of 18 additional beds for children and adolescents at St. Anne's Hospital in Galway, St. Vincent's Hospital in Fairview and St. Stephen's Hospital in Cork. This will increase the bed complement from the current provision of 12 to 30 during 2008, which represents a 150% increase in child and adolescent inpatient bed capacity. A third priority is the construction of two 20 bed units for children and adolescents in Cork and Galway. Construction of these units is expected to be completed in 2009.

The HSE will also expand multidisciplinary community based mental health teams and complete existing teams. It is intended to support new and existing teams to develop the multidisciplinary nature of their services and provide a more comprehensive range of medical, psychological and social therapies to service users and families. Adopting a holistic approach to developing services lies at the core of A Vision for Change.

Work is also advanced nationally on the process of replacing the remaining psychiatric hospitals with a range of modern mental health services. Closure plans for existing psychiatric hospitals will be put in place by the end of 2008 and the revenue raised from these sales will be directed towards improving mental health services.

Mental health has been in receipt of unprecedented investment in recent years which has allowed us to make real improvements to mental health services. However, it is not just funding that has made a difference. It is a completely different approach that has and will enable new mental health services to develop. We now have a much greater focus on community services, the provision of multidisciplinary teams, early intervention services and many others. The modernisation and reform of services is in line with what patients want and what they need.

I assure Deputy Neville that the Government is firmly committed to the implementation of A Vision for Change. The Government's decision to establish an office for disability and mental health reflects its ongoing commitment to developing a more coherent and integrated response to the needs of people with disabilities and mental health problems. The overall vision is to establish structures which provide greater cohesion in supporting disability and mental health across the public service. The office brings a new impetus to the implementation of A Vision for Change, working in partnership with the HSE and other stakeholders to achieve implementation of agreed targets. The HSE has undertaken to prepare a more comprehensive implementation plan for beyond 2009 by the end of this year and I reiterate the Government's commitment to the full implementation of A Vision for Change.