Wednesday, 27 September 2017
Topical Issue Debate
Mental Health Services Provision
We are here specifically to discuss the report on Roscommon. The big question here apart from the need to address specifically the localised issues in this report is to determine just how localised they are. Is Roscommon an exception or the rule, especially when it comes to funding? Some €18 million was returned from mental health funding from 2012 to 2014. We have heard a lot from the Government about its strides in increasing mental health funding from the low base that it was at for many years, but how much of that money is being spent on an annual basis and how much is being returned? A total of €16 million for just one area is huge and particularly when that area is not providing quality care according to the report or at the least is failing in a number of regards.
In response to a recent parliamentary question, the HSE advised that all money for 2017 was allocated and would be used. Can we be sure of that until next year, given the findings here? Are other CHOs returning moneys on this level on a regular basis? Is the Government aware of the problem and, if so, what has been done or is it benefiting from announcing spending figures which do not materialise and recycling that money? Last year the Government announced a measly €15 million increase in mental health funding. Was this decided on the basis that the underspend from 2016 was providing for it?
I am very conscious that many service users in Roscommon and their families have experienced huge problems in accessing services and in the level of service they get.
Generally, the reason given, or the excuse, for all of that, as the Minister of State is well aware, is that we do not have the resources or the funds. Now we find that significant funding was sent back. There were also scandals in some of the services in the area. People are wondering what on earth is going on. For many years the mental health service has been the poor relation in the health service. It has a bit of stigma attached to it and people do not ask too many questions or probe too much. It is time to end that and to probe into the issue to find out exactly what is going on because there is clearly a serious problem given the amount of money that is being returned. As my colleague, Deputy Pat Buckley, asked, is it a reflection of what is happening in other areas around the country? If it is, there are serious questions to be answered in respect of this issue.
I reiterate the points made by my two Oireachtas colleagues this afternoon. I come here with a very heavy heart. As Deputy Martin Kenny is aware, I lost a very close friend. This morning, the Taoiseach said on Leaders' Questions that many people have been affected by suicide. As the two previous Deputies have said, this report is damning in every respect. A total of €17.67 million was returned, €4.57 million in 2012, some €6.91 million in 2013 and €6.19 million in 2014. This report was carried out by three very eminent people from the Northern Ireland health care sector, namely, Mr. Brendan Mullen, Dr. Nial Quigley and Mr. Don Bradley. I am sure the Minister of State has read the report. The language in it is appalling. There are 27 recommendations. I know the Minister of State is a genuine man. The big worry and concern now is whether those recommendations will be implemented. They must be, as it is absolutely necessary that they are. I will have an opportunity to say a few more words in due course.
I thank the Deputies who have raised the matter and continue to keep the focus on this important issue in what is a very disturbing period for all of us.
The HSE is committed to ensuring that all aspects of mental health services are delivered in a consistent and timely fashion. In 2015, the mental health division of the executive determined that it was necessary to conduct an independent review of the quality, safety and governance of Roscommon mental health services to support achieving the goals set out in A Vision for Change and other relevant national policies.
Within a short period of being commissioned, it became evident that the initial timeframe proposed to conduct the review was insufficient and the review team requested, and received, extra time to complete its work. I welcome the recently published comprehensive report, which makes 27 recommendations for local service improvement. The report indicates that the review team was impressed by the majority of staff it met or interviewed, and was struck by their commitment to see services improve for service users in Roscommon. The overriding concern of the majority of those interviewed - staff, service users and carers - was that patients and families in Roscommon were not receiving services in line with current best practice that would meet required quality and safety of care standards.
Multidisciplinary team working - the linchpin of modern mental health services - was severely eroded in Roscommon, with fractured relationships within the area management team, within the Roscommon teams and between a number of professionals and key consultant medical staff. Throughout, there were poor line management arrangements. Leadership at a number of levels appeared to be ineffective. The majority of nursing staff interviewed believed, and the team agrees, that the senior nursing leadership critical to representing the professional views of nurses at the executive level was missing. It is the team's view that, in some instances, relationships appear to have broken down irreparably.
Managers in any organisation have a difficult balancing role and they should be allowed to manage without undue interference. However, that can only occur in a working environment that is conducive to mutual respect and understanding. There was clear evidence that this was absent in this instance. The review team pointed to the need for effective application of change management principles as a new entity attempts to merge disparate parts of hitherto separate organisations. The team believes that preparatory work to support the area management team should have been in place, as it embarked on creating a new culture. The team concluded also that there was disproportionate focus, even at a time of straitened financial circumstances, on achieving budget savings at the cost of an adequately staffed and safe service.
The report highlights that approximately €17.6 million of mental health funding for the years 2012 to 2014 was returned by the Galway-Roscommon area, and it details the context surrounding that. The report makes a specific recommendation on the issue, to the effect that the HSE should have greater delegation of budgetary authority to promote greater accountability, better management and more effective service delivery at local level. The HSE has confirmed that funds unspent in a particular area may be reallocated elsewhere within mental health services, and that is the case here.
A team has been formed by the HSE to implement the recommendations of the report. The executive has statutory responsibility for the planning and delivery of health care services at local level, including mental health in Roscommon. Nonetheless, the Deputies can rest assured that I, and the Department of Health, will closely monitor the progress of the HSE implementation team to ensure that all the recommendations are delivered as quickly as possible to address at local or national level, as appropriate, all concerns raised by this important report.
I thank the Minister of State for his response. In the very first paragraph it stated: "The HSE is committed to ensuring that all aspects of mental health services are delivered in a consistent and timely fashion." One of the two key points I raised with An Taoiseach yesterday, which are in the report, is that there was more focus on achieving savings than providing safe and effective services. The second point concerns allegations of conspiracy. I cannot see anything in the report to suggest mental health services are being "delivered in a consistent and timely fashion". The report refers to corruption, secrecy and acceptance of poor standards. As Deputy Eugene Murphy and my party colleague, Deputy Martin Kenny, said, this is a 43-page document and it is absolutely pathetic in this day and age that we as public representatives have to come in here and fight to represent the people that are trying to use this service when everything in the system is corrupt. Some of the people concerned would not even engage in the review. That is how bad it is. The mental health services in this country upset me so much. My daughter is going to a funeral today of a 15-year old friend because of the failure of the mental health services.
Deputy Eugene Murphy mentioned a case and I am also aware of a young woman who died while in receipt of help from the mental health service in Roscommon. At the time, there was very little come-back from the service for the family or when others tried to find out what was going on and what happened. It is really because of that case that I began to ask what was going on when I saw the report. It flags it to the high heavens that something can happen to a young woman with a family who wanted to get a service and was rejected and pushed away, and ended up in the circumstances that transpired.
The Minister of State has given a response and he said he will do his best but there is a cultural problem there that needs to be addressed. My understanding is that there are people who do not do their job and when they are challenged about it, they have a hissy fit and say they are being bullied and pressurised. We all know it is a difficult balance in the workplace, no matter where one is, but especially in that type of workplace where one is dealing with very vulnerable people. Those who are charged with providing the service need to do it in a much more adequate way than has been the case to date. I accept the Minister of State is new to the job and I wish him God speed to get this issue sorted out because it needs to be sorted out in Roscommon and across the country.
Every time I look at the young family of that woman my heart aches. The family is from down the road. It is no secret. There is also a family that is known to Deputy Martin Kenny as well. In this case the woman was turned away from several hospitals over a five-week period. Her family had done everything to help her, as Deputy Martin Kenny could also confirm in the case he outlined. There was absolute and utter failure within the system. In this review, more than 60 staff were interviewed and a lot of them were very committed, dedicated people. Quite a number of them had expressed concerns to me and to other politicians over a period about what was going on.
I acknowledge the sincerity of the Minister of State. There are 27 recommendations. I do not want to be back here in six months, nine months or 12 months talking about more tragedies and trouble within the system. We need extra money and the money that was taken away from the system. I meet people every day, as do the other Deputies, who really need the services and, as things stand at the moment, the service is not there in Roscommon and we need to rebuild it. There are great staff in many sections but we must ensure we have a top class service for people.
All I can do is provide the Deputies with an assurance that I am well aware of the issue. I have spoken to a number of their colleagues in the other House and to Deputies who are not in the Chamber today. To their credit, I think every Oireachtas Member has reached out to me on the issue of Roscommon. I am travelling there on Monday and intend to meet with Tony Canavan, the chief medical officer there. I intend to get my head around what went wrong. I understand the Deputies are not looking to assign responsibility for the past but for the future, to make sure that the recommendations are adhered to. I accept that responsibility in full. As Minister of State, I have responsibility to oversee the implementation of the recommendations. That is not much but it is the very least we owe to the victims of the wrongdoings that took place. I will take that responsibility as seriously as I can to ensure there are no repetitions. I will also keep an eye to the national picture to ensure issues like this are not going under the radar in other community health care organisations or counties.