Denis Naughten (Roscommon-South Leitrim, Independent)
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I welcome the opportunity to speak on this and I thank the Ceann Comhairle for accepting this Topical Issue. I also thank the Minister, Deputy Reilly, for being present to respond on this important issue.

A litany of failures was identified in an internal health and safety audit of the acute psychiatric unit of University Hospital Galway which was carried out on 4 June last. It is clear from reading the report that the unit is an accident waiting to happen. The report points out that one-fifth of the staff are not complying with mandatory training in aggression and violence, and that as a result of recent cost containment, not all staff have attended, or been given the opportunity to attend, the mandatory training. The report also highlights problems with conditions in the facility, including the perennial problem with leaks in the roof which led to a water mark close to electrical connections at one location. It further highlights that a bed has been removed in another part of the unit because of the leaking roof.

However, it is not just one bed. A number of beds have been moved over the last six months due to the ongoing problem with the leaking roof. One of these beds is in the women's ward and it is known as the bed with a bucket. Patients use towels and sheets on the floor to soak up the water rather than have to listen to the continuous drip, drip, drip into a bucket. If that were happening in Guantanamo Bay it would not be acceptable, yet it is happening in an acute psychiatric unit in this country. The patients must ask the other patients in the ward for their towels to try to soak up the perennial flood of water coming through the roof. On one occasion, a patient occupying that bed moved it away from the leak, but then it was partially blocking the door into one of the two toilets on the women's ward, which are there to accommodate 16 women.

The issue is not only the quality of the facilities but also the lack of facilities, particularly for activities within the unit to help to prevent patient boredom. One patient put it to me that there is nothing to do but sit around waiting for medication. The only two options are to stay in one's bed or go for a cigarette. The staff are run off their feet, particularly dealing with specials - that is, patients who require one-to-one care because they are a risk either to themselves or to others. Due to the lack of staff support in the unit, many patients are being forced into remaining in the unit involuntarily. While the national average for involuntary patients as a proportion of all patients is approximately 11%, in the acute unit in Galway at present it is closer to 50%. That alone should set off alarms.

I spoke to a patient who had spent a period of time in the high-risk ward. They told me they spent two to three days without speaking with a nurse. This was in a high-risk ward. The nurses were too busy dealing with patients who required one-to-one care, including one forensic patient in the acute ward who should not have been accommodated in an acute psychiatric ward. Due to the lack of available staff to monitor that patient, the individual was occasionally able to roam freely through the unit.

The unit does not have adequate staff. That, combined with a building that is totally inadequate and the reports of boredom among patients, is a recipe for a serious accident in the unit.

James Reilly (Dublin North, Fine Gael)
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I am replying on behalf of the Minister of State, Deputy Kathleen Lynch, who is indisposed. I thank the Deputy for raising this important issue and giving me the opportunity to update the House on the matter.

The Health Service Executive, HSE, is proceeding to modernise and reform mental health services across the HSE West region, including in the Galway-Roscommon area. 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 recommendations in "A Vision for Change'', allied to a corresponding under-development of community-based mental health services, where I believe all of us would wish to see the service. In this context, an implementation plan to reconfigure mental health services across the Galway-Roscommon administrative area was put in place, culminating in the closure of the psychiatric ward in St. Brigid's, Ballinasloe, and the transfer of beds from there, on a phased basis, to the acute psychiatric unit in University Hospital Galway. Since February, a bed capacity level of 45 psychiatric beds has been operational in UHG. The HSE indicates that at no time since February has this bed occupancy level been exceeded and that there is no pressure on physical bed occupancy at present in UHG.

Along with the increase in bed capacity, the local HSE has also improved clinical governance, putting in place two assistant directors of nursing and an additional two 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 on staffing requirements to ensure the safest possible service at all times. 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. Following a recent Health and Safety Authority inspection, an action plan has been finalised by the HSE. The majority of the recommendations have already been implemented, and the remainder are being completed. For example, the safety statement has been reviewed and updated and improvements are under way in respect of relevant aspects of staff training.

I assure the House that the Department of Health and the HSE are fully committed to improving quality and safety throughout all mental health services and that this goal will remain the highest priority as regards both patients and staff. This objective is reflected in the major reconfiguration of mental health services in Galway-Roscommon, with approval for an additional 44 permanent staff at a cost of approximately €2.6 million and the coming on stream of a new 50-bed acute unit in Galway towards the end of next year.

As was clearly demonstrated in the debate on the Private Members' motion held in the Dáil last week, which was unopposed by the Government, we all agree with the fundamentals of "A Vision for Change" and wish to see services brought into the 21st century. In this context, the HSE addresses all genuine concerns, particularly quality and safety, while taking account of recommendations arising out of reviews of mental health services at local level. We will continue with this approach so that all involved have an appropriate and meaningful say in modernising services across all regions of the country. Indeed, it is now a feature that we have client engagement in respect of the new units being built around the country.

Finally, patient safety was the priority in the HSE service plan for 2014, and that applies in our mental health services as well as everywhere else.

Denis Naughten (Roscommon-South Leitrim, Independent)
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I thank the Minister for his reply. He said there was no pressure in the unit at present. The difficulty is that beds are moved out of the ward when there is serious rain and are moved back in at other times due to pressures on the physical space to provide for the 45-bed capacity of the unit. On one occasion in the last number of months, men had to be accommodated in part of the women's ward because of pressure on bed numbers.

The Minister said the clinical director and the nurse managers conducted a daily assessment of the staffing requirements.

I am told by the nursing union there that, on one particular shift three weeks ago, of the eight staff on that floor, two were pregnant and the other six had no restraint training. Does the Minister believe that is a safe situation? Two weeks ago, there were two female staff managing the men's ward, one of whom was pregnant. There was a serious incident and the alarm had to be pressed. Patients who were "specials" had to be abandoned to respond to that emergency, and these specials require one-to-one support because they are either a risk to themselves or a risk to other patients in that unit.

We were told that most of the actions in the health and safety audit had been completed. Clearly, that is not the case in regard to the incidents I have raised. The leak problem in that facility is still there. Last year, we were promised that home-based treatment teams would be put in place, but that has not happened, and we need them immediately in Roscommon and Galway city. The 50-bed unit will take another 18 months to put in place. As an interim measure, will the Minister open the state-of-the-art St. Luke's unit in Ballinasloe to take pressure off University Hospital Galway pending the completion of that new 50-bed unit?

James Reilly (Dublin North, Fine Gael)
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I again thank the Deputy for raising the matter. There is no question or doubt that, historically, the mental health services in this country have been the Cinderella of the health services. I had the pleasure of opening a new acute psychiatric unit in Beaumont Hospital last Friday, something we have waited over 25 years for. When St. Ita's was built, it was a state-of-the-art engineering feat that appeared on the front of the international engineering magazine in 1902 or thereabouts. However, I know from information gleaned from working in that institution over many years as a visiting GP that the original intention was to build the hospital on Lambay Island - out of sight, out of mind, and the further away the better. The next furthest point was the peninsula at Portrane. Thankfully, we live in much more enlightened times. The Government's policy is to remove the stigma from health care relating to mental health, and all new primary care centres now have mental health facilities associated with them. Indeed, the new unit in Beaumont is a joy and a delight for the patients, and the unit is, in fact, named after a Mr. Sheehan, who was one of the service's long-standing clients. The whole approach has become much more client-oriented.

The Deputy raised some points that he believes still apply. That being the case, I will certainly come back to him in regard to their status. It would not be acceptable that a leak was not fixed and that patients were in that scenario. It takes time to build new facilities. We are moving to a new model of care and, as I am sure the Deputy agrees, we want people kept in the community in so far as is possible, and we need to transfer staff to the community in order to do that. Community facilities are more appropriate and, although they are not necessarily more cost-effective, it is best outcomes for patients that we want. That is our focus. A lot of extra money has gone into our mental health service in this regard - rightly so - and that continues to be the case. I will certainly undertake to check the areas about which the Deputy has concerns and I will revert to him in writing.

At Beaumont I made the point that in the past we had had a terrible situation in which patients were in large rooms with paint peeling off the walls, but they were getting excellent care, and when they moved to the palatial surroundings of the likes of Leas Cross, the care was not good at all. We need to do both. I congratulate, commend and thank the staff who do such a great job looking after some of the most vulnerable people in our society.