John Browne (Wexford, Fianna Fail)
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I thank the Ceann Comhairle for selecting the Topical Issue on Maryville health centre, a five-day hospital service for 60 to 70 patients in New Ross and surrounding areas.

Recently a psychiatric nurse was transferred from Maryville to another centre without a replacement, causing much concern to the patients attending the centre. A Vision for Change which was implemented in Wexford, as it was across the country, outlined the provision of a better service for people with mental health issues, including depression. A nurse who had been in Maryville for a number of years and was a key contact for the 60 to 70 patients attending the centre is no longer there. She was their first and, in many cases, only contact owing to the lack of adequate services in the New Ross area. The patients are devastated by the decision, as they had built up trust in the nurse during the years. They had formed a bond and a relationship with her.

People with mental health difficulties, including depression, find it very difficult to relate to people and trust them. Now someone they trusted has been taken away from them and they are very concerned. A number of patients told me this nurse was a friend more than a nurse. She went above and beyond the call of duty to help patients at Maryville and to be there for them. The patients are devastated and many of them told me the centre was no longer relevant to them owing to the removal of the nurse. They want her to be returned to the New Ross area and Maryville as a matter of urgency.

I received a reply from the HSE recently which contained the usual gobbledygook about the importance of A Vision for Change. It referred to the services provided at Maryville, contrary to what the patients who attend there had said. It outlined details about staffing levels. A nurse is on maternity leave and a number of staff members have retired. In Wexford mental health services a number of other nurses are on maternity leave. The decision to move the nurse from New Ross to another centre in the county was robbing Peter to pay Paul and has left a bad taste for the patients in New Ross. Naturally they would prefer to see the return of the nurse who was there and had built up a bond of friendship. She had helped them to find jobs and be part of the community. She should be returned to New Ross as a matter of urgency. A Vision for Change never envisaged a person essential to one centre being transferred to another, leaving the centre from which he or she has come lacking the people needed to provide a service.

It is important that the nurse who left Maryville return. Some of the patients attending Maryville have sent me letters indicating that it is no longer of relevance to them because of the removal of the nurse. They are trying to develop their own group, New Me ~ New Ross, totally on a voluntary basis, without any financial support. They also claim that professionals come to Maryville and hold endless meetings, with nothing coming from them. They now want the services restored to them as a matter of urgency.

Paudie Coffey (Waterford, Fine Gael)
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I thank the Deputy for raising this important matter. I am replying on behalf of the Minister for Health who is unavoidably absent and sends his apologies.

In line with national policy, Waterford and Wexford mental health services implemented the recommendations of A Vision for Change on the organisation and provision of mental health services, transforming them from a largely bed-based in-patient service towards a more community-based service. In Wexford mental health services are arranged by geographic location. There are general adult mental health teams based in Summerhill in Wexford, Carn House in Enniscorthy and Tara House in Gorey, all of which operate a seven-day service from 9 a.m. to 5 p.m., while Maryville in New Ross operates a five-day service, also from 9 a.m. to 5 p.m. If someone is feeling suicidal in County Wexford and wishes to have a consultation, he or she can be referred through his or her GP to any of these four day hospitals and be seen by a consultant psychiatrist. All general practitioners in County Wexford are aware of these day hospitals and familiar with the process for making direct referrals to these units.

A multidisciplinary mental health team based at Maryville includes a consultant psychiatrist for adults, a non-consultant hospital doctor, nursing staff, an occupational therapist, a psychologist, a social worker, a secretary, a community mental health nurse and a part-time addiction counsellor. In line with the proposed skill mix in A Vision for Change, the multidisciplinary team based at Maryville has expanded with the appointment of the aforementioned social worker and occupational therapist posts.

With regard to nurse staffing levels in Maryville, a nurse currently on maternity leave will be reassigned to the service on her return. In addition, a number of nursing staff have retired from Wexford mental health services in recent years. Aside from the nurse in Maryville, a number of other nurses are on maternity leave in Wexford mental health services generally. It is challenging to recruit candidates to fill temporary short-term positions such as maternity leave cover.

Management from the HSE's Waterford and Wexford mental health services continues to monitor staffing levels on a regular basis and explore all possible options within resources available to try to improve service provision. Given the number of nursing retirements and staff on maternity leave, at times the service needs to reallocate staff between mental health services and units to optimise services so as to meet patients' needs, as appropriate.

The overall recruitment of nursing staff is proving very challenging in Ireland generally, let alone in County Wexford. For example, all 11 recent nursing graduates from Waterford and Wexford mental health services have been offered full-time employment within the local mental health services. In addition, posts are advertised nationally and overseas. Other recruitment measures include bespoke recruitment campaigns.

Local HSE management and mental health service personnel are working closely with the national mental health division on nurse staffing issues. In addition, a national mental health workforce planning review group has been established to better plan and deliver staffing and service needs overall, including in the mental health area. I trust that clarifies the issues for the Deputy.

John Browne (Wexford, Fianna Fail)
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I thank the Minister of State, Deputy Coffey, for his reply, which I am sure has come from the Department of Health. I am aware of Summerhill, Carn House and Tara House in Gorey. They provide an excellent service throughout the county, as do the outreach nurses with whom we deal with on a regular basis. The point made by the patients and others who seek a restoration of the service in New Ross is that patients had built up a bond, trust and friendship with the nurse in question who understood them and their needs and how difficult it was for them at times to attend the services or to leave their home and be part and parcel of the community. In the reply, the Minister of State outlined that there is a nurse on maternity leave and that she will return eventually. It is the right of any person on maternity leave to be out of the workforce for a year or a year and a half. Is the HSE saying Maryville will have to survive and continue without a nurse for a period of time? Could the Minister of State, Deputy Coffey, request the Minister for Health to re-examine the situation and return the nurse who was located in Maryville and find a replacement nurse for the other service to which she has been deployed? That would be very important.

I deal regularly with Ciarán Cullen and Martin Fitzhenry and others who are outreach nurses for mental health services. They say it is very important for there to be continuity in the care provided, given the bond and trusting relationship that is built up over the years. It is important that such a level of care would continue to be provided, not in the interests of the nurses but of the patients. I urge the Minister of State to request that the Minister for Health, through the HSE, restores the services that were available in the New Ross area as quickly as possible. Wexford, Gorey and Enniscorthy have a seven day service while Maryville in New Ross only provides a five day service and it is important that the service would be adequate to serve the needs of the people. It is also important that the particular nurse who has the ear of the people suffering from mental health and depression disorders in New Ross would be returned as quickly as possible.

Paudie Coffey (Waterford, Fine Gael)
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It is acknowledged in the initial reply that HSE management has a responsibility to ensure adequate provisions in terms of staffing at each of the four units based in County Wexford, namely, the one in Wexford town, and the centres in Gorey, Enniscorthy and New Ross, which is the subject of the current debate. The recruitment of nurses in this country is proving challenging in general. I note that all of the 11 nursing graduates this year have been offered full-time employment in the mental health services in the Waterford and Wexford areas, which is to be welcomed. In addition, advertisements continue to be placed both nationally and internationally to attract some of the nurses who qualified and possibly worked in this country back here so that we can enhance services in this country. I recognise that the matter raised is of genuine concern and I will undertake to relay the concerns outlined to the Minister.