Colm Keaveney (Galway East, Fianna Fail)
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Last week I felt compelled to write to the Mental Health Commission and the Inspectorate of Mental Health Services asking them to carry out an urgent inspection of the psychiatric unit at University Hospital Galway. I was prompted to do so after being contacted by staff and families of patients in the unit. That week the local press in Galway described the unit has being like a war zone. Last week a person in the Health and Safety Authority provided me with a copy of a letter sent to it on behalf of the staff in the unit. It makes for alarming reading and states the ongoing dangerously low staffing levels at the unit continue on a daily basis and on more than one occasion there has been no clinical nurse managers to manage the ward. One clinical nurse manager was recently assigned elsewhere in the community.

Last week, there was a tragic situation when the absence of any security meant a patient was able to abscond from the ward and complete suicide. There was also a very near miss last week when a highly suicidal patient absconded from the ward and was found in the community inflicting self harm. The activities area in the unit was closed last week and remains so. This denies patients access to an area which is part of their holistic recovery plan. Risk assessments submitted to management appear to be ignored. Disclaimers submitted by staff outlining unacceptably short staffing levels also appear to be ignored.

There appears to be no agreement on minimum staffing levels. Morale among the staff appears to be at an all-time low and there is an exceptionally high level of sick leave owing to stress in that location.

The staff to whom I have spoken believe the above factors have been identified since the closure of St. Brigid's Hospital in Ballinasloe. They have been warning about this arrangement and pointed out that this has been an accident waiting to happen. I compliment the staff who have spoken out. Like the Garda whistleblowers, in the face of incredible pressure from senior management and the HSE, they have done a wonderful job in highlighting the consequences of the reconfiguration of the service.

This has happened as a direct result of the closure of the St. Brigid's psychiatric unit and the failure to fill key front-line posts in the region. Since last year some 40% of the posts provided for under A Vision for Change have not been filled under the HSE service plan. Without adequate mental health staff levels in University Hospital Galway and across the community, the unit is simply not fit for purpose. However, in this House earlier this year the Minister of State with responsibility for mental health services made a robust defence in the provision of that service. Is the Minister of State aware of the consequences of these cuts to mental health services in Galway? Is he aware that the House has been warned about them? We were unequivocally advised, however, that this would not happen. Is the Minister of State aware that there is a €3.2 million brand new, ligature-free facility lying idle in Ballinasloe? Despite this, service users in the psychiatric unit have no access to a recreational area, which inhibits them from securing better outcomes in their own recovery.

I appeal to the Minister of State to urgently reconsider reinstating temporarily services at St. Brigid's Hospital in Ballinasloe which would allow us to deal with the overflow. Before I came to the House, staff informed me that they were gravely concerned about the prospect of an intake over the course of a bank holiday weekend in the light of the chronic staffing levels. I appeal to the Minister of State to consider positively the temporary opening of the brand new facility that lies idle in St. Brigid's Hospital in Ballinasloe to deal with the overflow of patients at University Hospital Galway.

Alex White (Dublin South, Labour)
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I am taking this important matter on behalf of the Minister of State, Deputy Kathleen Lynch. I thank the Deputy for raising it.

The HSE is proceeding to modernise and reform mental health services across HSE West, including the Galway and Roscommon areas. A key factor in this reform was the recognition that the previous overall stock of 79 psychiatric beds across Galway and Roscommon was too high, based on the recommendations in A Vision for Change, allied with a corresponding underdevelopment of community-based mental health services. In this context, an implementation plan to reconfigure mental health services across the Galway and Roscommon administrative area was put in place, culminating in the closure of the psychiatric ward in St. Brigid's Hospital, Ballinasloe, and the transfer of beds from Ballinasloe on a phased basis to the existing acute psychiatric unit in University Hospital Galway. Since February, a bed capacity level of 45 psychiatric beds has been operational in University Hospital Galway. I have been informed by the HSE that at no time since February has this bed occupancy level been exceeded. The latest information from it is that there were ten vacant beds in the unit this morning. Therefore, there is no pressure on physical bed occupancy in University Hospital Galway.

With the increase in bed capacity, the local HSE has also improved clinical governance, putting in place two assistant directors of nursing and two additional senior nurse managers. This is in addition to a range of new staff and services, including the redeployment of nurses from Ballinasloe. The HSE points out that the clinical director, together with the nurse managers, conduct daily assessments of staffing requirements to ensure a safe service at all times. Representatives of the Mental Health Commission also regularly visit the service. Staff in the acute unit at University Hospital Galway are confident that they can meet the needs of current inpatients and the needs of those referred for assessments.

The HSE acknowledges the tragic death of a service user recently. This has been reported to the Mental Health Commission and internally in line with HSE protocols. An internal review is under way.

My Department and the HSE are committed to quality in mental health services and patient safety and will continue to strive to ensure patients receive the best care possible when they need to access health and social care services. Improving the safety and quality of that care, be it mental health, acute care, services for older people and other areas, should be and will be our highest priority.

Colm Keaveney (Galway East, Fianna Fail)
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This issue is not about bed capacity, despite the fact that 30% of the beds in the administrative area of Galway and Roscommon have been removed. The infrastructure has not been put in place for community-led multidisciplinary teams. Some 40% of posts in the community are unfilled. It is not, therefore, an issue of bed capacity but of not having the staff to deal with whatever capacity is available in the system today. It is an unsafe unit. A brand new €3.2 million facility in Ballinasloe has never even been opened and the appeal was to consider opening it temporarily.

I do not know why the HSE is advising the Minister of State that there is no issue with bed capacity. We have previously received these guarantees from the Minister of State with responsibility for mental health services and they are not being honoured. In Galway in the past 12 days there have been 11 deaths by suicide. I do not know what the unit's discharge policy is, but the staffing levels are inconsistent with the HSE's advice. The Minister of State is not listening to those on the front line who are clearly stating there is an ongoing dangerously low staffing level in the unit. I have advised the Minister of State with responsibility for mental health services that she fails to listen to front-line staff. I am, therefore, asking the Minister of State to listen to front-line staff, not to some corporate individual in a pinstripe suit based in the HSE in Merlin Park who is talking to the Department about bed capacity. This is not an issue about bed capacity but about outcomes for patient-centred delivery of an acceptable mental health service.

This location is inappropriate and absolutely unacceptable. I ask the Minister of State to consider opening temporarily a modern public service, not some 1960s or 1970s decrepit unit. The HSE cannot even open up an amenities area that is central to the recovery of vulnerable patients. Staff have clearly stated the patients detained in the unit are not being detained by legal means because the detention does not meet the requirements of the Mental Treatment Act. The HSE has closed a holistic environment where there is supposed to be socialisation and engagement with other service users. The unit is inappropriate and I am asking the Minister of State to open temporarily the facility in Ballinasloe that lies idle.

Alex White (Dublin South, Labour)
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I do not propose to add very much to what I said in my initial response. From what I have been told, I understand there was a visit last Thursday by the Health and Safety Authority of relevance to this issue. A meeting between the HSA and senior management took place on Friday and some immediate issues were addressed, including updating certain policies. It was agreed that the HSE would submit a full action plan to address outstanding issues and that there would be intensive consultation between staff and management. There has been and will continue to be intensive consultation between staff and management which has been ongoing since last week to complete the action plan. It was anticipated that the completed action plan would issue to the HSA today. I understand it includes the recruitment of additional nursing staff to eliminate the requirement for agency staff. I will certainly communicate the issues the Deputy has raised to the Minister of State, Deputy Kathleen Lynch, who is aware of the issues he has raised and has dealt with them in the House previously.