James Browne (Wexford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

65. To ask the Minister for Health his plans for new measures to address the shortfall in consultant psychiatrist numbers; and if he will make a statement on the matter. [43915/18]

James Browne (Wexford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

What are the Minister's plans for new measures to address the shortfall in consultant psychiatrist numbers?

Simon Harris (Wicklow, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I will answer this question on behalf of my colleague, the Minister of State, Deputy Jim Daly. Budget 2019 allocated an additional €55 million for the development of mental health services, and I acknowledge Deputy Browne's commitment to this area also. The additional funding allocated to mental health services since 2012 has provided for the recruitment of more than 1,500 posts in mental health since 2012. In the last year alone, the number of psychiatrists increased by 14.

There are 340 consultant psychiatrists in the mental health services and 83 vacancies. The HSE uses locums, short-term contracts and other arrangements to fill many of these posts to support service delivery. In addition, we have developed our capacity in primary care through the funding of 114 assistant psychologists, a new grade whose positive impact I have seen first hand, 20 psychologists and ten advanced nurse practitioners. This will help to manage the demand and improve access to psychiatry services.

A focus of funding for 2019 will be on early intervention and support services that will assist as many service users as possible in dealing with mental health challenges before they require acute or psychiatric care. The Government remains committed to increasing the consultant workforce and there is a significant need for psychiatrists. It is generally acknowledged, however, that there are difficulties in recruiting and retaining certain grades of staff, particularly specialist child and adolescent mental health services, CAMHS, staff and consultant psychiatrists. This is an issue not just in Ireland but internationally.

The HSE undertakes continuing recruitment of consultant psychiatrists. Campaigns have targeted international events involving prospective candidates. In its report published on 4 September, the PSPC identified difficulties in attracting consultant applications for many posts and acknowledged that the pay rates for new entrants had been highlighted as a factor in this. The Department of Public Expenditure and Reform has published proposals regarding mitigation of the extended salary scales for new entrants across the public service under section 4 of the PSSA. Two separate interventions will take place at the fourth and eighth points of pay scales, involving the bypassing of two scale points. This measure will apply from 1 March 2019 and will be applied to eligible new entrants as they reach the relevant scale points on their current increment date. Those between the fourth and eighth points will also benefit from the first intervention on the date of their next normal increment.

James Browne (Wexford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I welcome the opportunity to raise the worrying issue of the shortage of psychiatrists in our health system. The PSPC found there were problems, in particular, with recruitment in psychiatry, where there were 458 established posts but only 364 of them had been filled, which is approximately 79%.

However, this level is based on established posts, not on the number that should be in place under A Vision for Change, and the actual number is probably much lower than that. In June 2018, 25 unqualified non-specialist doctors, who were not on the specialist register, were acting as psychiatric consultants, a practice that the President of the High Court, Mr. Justice Peter Kelly, described as "scandalous", and reported the matter to HIQA, the Attorney General and others. It did not receive the coverage it deserved at the time due to other serious health issues in the news. It is clear that there is a serious shortage of psychiatrists, however, when the College of Psychiatrists of Ireland sought to increase the number of trainee places by 10%. This was refused and an increase of only 5% was granted. The Government says that it cannot recruit psychiatrists but, at the same time, will not train them in sufficient numbers. What will the Minister do about this?

Simon Harris (Wicklow, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Deputy for his point acknowledging that recruiting psychiatrists is a challenge but also highlighting the increase in numbers while vacancies remain. Given its analysis, the Public Service Pay Commission proposed that the parties to the public service stability agreement jointly consider what further measures could be taken to address the pay differential between pre-existing and new entrant consultants, which has increased following the settlement of the 2008 consultant contract claim.

The Departments of Public Expenditure and Reform and Health have noted the commission's views and consideration will be given to solutions that are line with public sector pay policy and available budgets.

We will now prepare the HSE service plan for 2019. A significant budget is in place for the delivery of mental health services, which will exceed €1 billion, and an additional €55 million will be available for the development of mental health services. The Minister of State, Deputy Daly, also remains eager to identify other ways of supporting mental health services. An example of this was the assistant psychology posts this year, with 111 of 114 filled successfully nationally. I accept there is much more to do but we will look to see how to further progress it in the context of the HSE service plan.

James Browne (Wexford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I appreciate that pay is a significant and important factor, but the conditions under which many consultant psychiatrists must work is also causing particular problems. They were taken out of the hospitals and put in the community, and rightly so, under A Vision for Change, but the buildings are not fit for purpose. I have been in many of them and they are often decrepit or lack proper facilities. The psychiatrists tell me that they are spending a great deal of time in these buildings that are not fit for purpose but also performing roles that are not part of their remit such as finding hospital beds, making phone calls, opening letters and so on. That is a waste of time that they should spend with clients. Will the Minister examine the conditions in which many of our mental health services are provided? They are not fit for the psychiatrists, the psychiatric nurses or other allied health professionals or for the patients who have to attend those facilities.

Simon Harris (Wicklow, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I agree that more must be done on this and I will pass on the Deputy's observations in the context of drawing up the service plan for 2019 with the HSE. In addition to the psychology posts and the benefits they bring to the service, we are also committed to increasing the number of psychiatric nurse undergraduate places by 130 annually by 2021-22. That will increase from 270 undergraduate posts to 400 a year.

On an improved seven day a week services, which returns to the Deputy's point about the level of service we are providing, the HSE is in the final stages of recruiting the staff required to deliver seven day a week mental health service cover for the areas that do not currently have a service in place. It is also expected to be delivered in early 2019.

I will take the Deputy's points on board as we prepare for the HSE service plan 2019.