John Moloney (Laois-Offaly, Fianna Fail)

I thank Senators for their contributions. I take Senator Bacik's point that miscellaneous provisions in themselves can cater for so many different issues. I will try to deal with as many as possible. I am particularly interested in the mental health provisions of the Bill.

I am aware that Members of this and the other House have expressed concerns about the possibility of rushed legislation. The reason for the rush is the High Court judgment delivered on 21 May 2009 and also because the Houses will be beginning the summer recess soon. By that I do not mean that we should rush legislation because of the recess. The judgment delivered on 21 May 2009 has given rise to particular difficulties in the Dublin area, parts of the east and Clonmel and Cork, where up to 90% of the assisted admissions are undertaken by the external agency. In order to ensure the continuation of externally provided assisted admissions, an amendment to the Mental Health Act 2001 is required. I made the point in the Lower House that the review of the Mental Health Act is due next year and we can then tease out specific issues. Lest people are of the view that the external agency does not have any qualification and there have been queries as to the protocols involved and the level of standards involved, I will deal with these specifics. There is only one agency involved. All the employees of the external agency are qualified psychiatric nurses. A qualification as a qualified psychiatric nurse is not in itself sufficient. The status of all employees is reviewed annually.

This is not a case of outsourcing and privatising the service. Protocols had not been agreed with SIPTU and the PNA and often the required staff were not available. The concern would be that people might harm themselves or others so there is a need for involuntary admissions. This is an interim measure. The external agency is working in close co-operation with the Garda Síochána. I will give Members some background in respect of the numbers. The narrow interpretation of the term "staff of an approved centre" presents a difficulty in the ongoing provision of an assisted admission service. In 2008 there were 2,004 involuntary admissions, of which 604 were assisted. A total of 42% or 250 of these assisted admissions were provided by the external agency. It is worth noting that all of the assisted admissions in the Dublin-mid-Leinster region were provided by the external agency.

The point was raised by a number of Senators, and I appreciate it, that when we are dealing with mental health issues we must be twice as cautious as with any other area. The issues raised by Senators on all sides of the House are genuinely founded and it is up to us to try to persuade Senators to realise that we are acting in patients' best interests, with safeguards provided also.

I am satisfied that the external agency has provided a professional, high quality and safe assisted admission service for both the Health Service Executive and the two private psychiatric hospitals since 2006. To date, over 600 people have been safely brought to hospital by this agency. The fact that there have been no complaints either from family, gardaí, advocates or anyone else shows that a standard has been set and that people have been safely brought to hospital by the agency. The fact that no complaints have been made is noteworthy when one considers the sensitive and potentially difficult nature of the service.

The provision of the assisted admissions by a central agency enables the development of a specialised expertise in the de-escalation of difficult situations, which is of immense value and ultimately makes the situation easier for the patient and the patient's family.

I reaffirm what was said in the opening statement by the Minister of State, Deputy Brady. Points were raised in the Dáil about the nature of the company, the company setting up its business and in terms of advertising, interviewing or whatever. The company employs only fully qualified psychiatric nurses, all of whom have received intensive specialised training, including appropriate interaction with service users and training on de-escalation and talk-down techniques.

The most important point I can make on this area, before I deal with the other issues involved, is that the company complies with all Mental Health Commission guidelines and standards in terms of its work. Guidelines and standards meet the minimum test. I appreciate that protocols or guidelines are not sufficient but on balance, and the fact that so many involuntary admissions are required each year, I stand over this measure as being safe.

The amendment proposed is necessary to ensure that the acutely mentally ill person who requires hospitalisation but refuses to go to hospital can be brought to hospital involuntarily by specially authorised persons.

On the wider miscellaneous areas, as indicated earlier, the proposals in the Bill on the integration of agencies within the Health Service Executive and the Department of Health and Children are consistent with and build upon progress to date under the overall health reform programme. I take the point raised by Senator Buttimer regarding his area but it is about recognising the mission statements of the six agencies and retaining their purposes. Unfortunately, because of the economic situation we find ourselves in this is a way of amalgamating services, while not curtailing services.

The health reform programme acknowledged that there was a need to streamline the number of health sector agencies to ensure we have a better co-ordination of services. That objective was a cornerstone of the plans announced last June on the rationalisation of State agencies generally.

On the points raised about value for money and the money that will be saved by dissolving the agencies, the primary aim in rationalising these bodies is a streamlined service delivery and to promote service integration. The proposals are consistent with and build upon progress to date on agency rationalisation within the sector under the health reform programme. However, efficiencies will derive over time from economies of scale and the elimination of duplication in areas such as recruitment procurement, payroll and ICT systems.

On the cancer strategy, while not specifically dealing with that area I accept the point made by Senator Burke on the need for a progress report. I will bring that point to the attention of the Minister, Deputy Harney. I recognise the Senator's concerns about the reform programme and the cancer strategy. I will suggest an interim report on the progress on that to the senior Minister.

On the National Cancer Screening Service, it is intended that the service will be integrated into the HSE's national cancer control programme. The National Cancer Screening Service works closely with the HSE. The Minister is confident that high quality national cancer screening programmes will continue and be expanded when the service is fully integrated into the HSE's cancer control programme. I will put that position also to the Minister.

Senators Maria Corrigan, Ivana Bacik and others raised the issue of the Crisis Pregnancy Agency. The Bill expressly provides for the transfer to the HSE of certain functions of the crisis agency in line with legal advice. It is important to state that the work of the agency will continue, and steps have been taken to ensure that happens. The Minister will expand on later Stages on the steps involved in that.

The HSE is examining how best to integrate and carry on the work of the agency. The Crisis Pregnancy Agency, the HSE and the Department have already had a number of meetings to make plans in that regard. In addition, the HSE has set up an internal group to progress and report on the matter.

Senator Twomey asked about accountability. There are well-established accountability arrangements in place. The Minister for Health and Children is accountable to the Oireachtas and the chief executive of the HSE is required to appear before Oireachtas committees. Those of us who have served on the Joint Committee on Health and Children are aware of the rigorous questioning by Oireachtas Members on foot of presentations. There is accountability in that respect.