Rónán Mullen (Independent)

Cuirim fáilte roimh an Aire Stáit. Tréaslaím leis as ucht a chuid dea-oibre. Déanaim comhbhrón leis nach ball den Rialtas anocht é, ach ní fada go dtarlóidh sé sin.

When A Vision for Change was published in January 2006 it was greeted with near-universal approval. No one doubted that mental health services badly needed a substantial overhaul and A Vision for Change was seen as containing a credible blueprint for that to happen by 2016. Since its publication the credibility of the proposed mental health services blueprint has remained a constant. What has changed, unfortunately, is the optimism which greeted its publication. Scepticism as to the implementation of A Vision for Change is largely down to a lack of political will and, in particular, a failure to commit Government finances to the project means that many of its proposals and recommendations remain in limbo. The Government should publically and unequivocally commit to implementing A Vision for Change fully no later than 2016, the original due date. Ease of access was to be a hallmark of a system where the involvement of service users, their families and carers would be encouraged and facilitated as regards the development of services and their delivery. The establishment of highly professional community mental health teams to offer multidisciplinary home-based and outreach care would signal a much needed shift away from the old "battery hen" paradigm of mental health services. The new model would see formal links between mental health services, primary care services and voluntary groups. It would operate along updated geo-demographic trends and within catchment areas of between 250,000 and 400,000. To make room for these changes A Vision for Change recommended the closure of the existing mental hospitals with a view to selling off these capital assets to fund the implementation of the recommendations.

It sounded fantastic, but bureaucracy and lethargy have stymied momentum. Three successive reports in 2007, 2008 and 2009 by the independent monitoring group established to monitor progress in implementing A Vision for Change, criticised the HSE for its delay in implementing key recommendations of the document. The first report took issue with "the lack of a systematic approach to implementation and the lack of clarity in responsibility for implementation in the HSE". The lack of real leadership and a comprehensive implementation plan was noted in all three reports. Though the 2009 report recognised that progress was being made with regard to the provision of child and adolescent services, and also engagement with service users and mental health information systems, it warned "that the recommendations of A Vision for Changecannot be implemented effectively without a National Mental Health Service Directorate". It said the absence of a dedicated leader at senior, national level had impeded progress in the implementation of A Vision for Change and might be contributing to continuing poor facilities and standards of care in some areas and an inconsistent approach to embedding the recovery ethos in services. Two of the key tenets of A Vision for Change have not yet been properly addressed: catchment areas have not yet been put in place, while the resourcing of community mental health teams has not been sufficiently prioritised.

What adds to the disappointment is the insistence on behalf of the HSE that they have in fact released a comprehensive implementation plan. This document is however aspirational in tone and largely uncosted, ambiguous and lacking in a rigorously defined timescale. Indeed, Dr. Siobhán Barry, co-author of a 2009 report by the College of Psychiatry of Ireland which encompassed issues relevant to mental health services, has claimed that at "the current rate of staff recruitment it will take 40 years to implement" A Vision for Change. Her report, entitled A Gloomy View,found that 53% of the services surveyed across the HSE had consistently low levels of recruitment of the promised multidisciplinary team members, with only 16% receiving the resources which they had been promised. It is not as if this shortfall in resources and commitment was unforeseen. In welcoming A Vision for Change upon its publication the Irish college of psychiatrists added the caveat: "We would be concerned that the necessary funding to drive the recommendations will not be made available over the seven years." This was prescient. It pointed out that mental health services in this country have historically suffered from "an acute lack of funding". The college further highlighted that even if all went according to plan the percentage of health monies allocated to mental health would rise from 6.8% to 8.24% - still a considerable distance off the 12% to 14% it recommends. The Department of Health and Children has admitted that while from 2006-09 the HSE was provided with €51.2 million to implement A Vision for Change, €24 million of this was used to meet "overriding obligations of the HSE to live within its approved allocation".

In 2009 the Centre for Ageing Research and Development in Ireland produced a report on the progress of A Vision for Change. It acknowledged the Minister of State's total commitment to the project, as I do here. However, the centre highlighted several areas where implementation was severely behind schedule: the selling off of old psychiatric hospitals to raise the €796 million needed for the new project; the appointment of a director for mental health services in the HSE; and the establishment of community mental health teams to specialise in different areas such as adult mental health, child and adolescent services, the psychiatry of old age and intellectual disability.

I am not suggesting that absolutely nothing has been done to implement A Vision for Change. In 2006 there were 47 community, child and adolescent mental health teams. By January 2009 this had increased to 50 teams while now there are roughly 60. All told, that is a 30% increase since 2006 and credit is due for that. Furthermore, since 2006 at least 18 adult community mental health teams have been created. Earlier this month the Minister of State announced that a total of 14 Victorian-era psychiatric hospitals were to be closed with a total of 1,200 patients to be transferred to more modern community-based facilities within three years. Some of these antiquated facilities were at various stages described as "inhuman" and "deplorable". At the announcement the Minister of State pointed out that there had been a doubling in the number of child and adolescent beds to 30, along with shorter episodes of inpatient care.

However, it would be delusional to believe the response by the HSE to A Vision for Change, thus far, has been anything other than piecemeal. The reality is that implementation is behind schedule, still lacking a truly comprehensive plan and relying on the sale of property to avoid the worst of the property collapse so as to be an adequate source of funding. The final key recommendation of A Vision for Change was that it "should be accepted and implemented as a complete plan". To date that has not happened. What is required is a renewed resolve on the part of the Government and the HSE in particular to honour this document. This resolve must be public and must be framed by a genuine commitment. Therefore I repeat my call on the Government to publicly commit to implementing fully A Vision for Changeby the original due date of 2016.

We are where we are and we all know the situation is very serious economically. I know the Minister of State will be doing as much as he can to bring about the fulfilment of A Vision for Change. However, we also know the test of a civilised society is how it treats its most vulnerable members. I reflect on the plight of those groups of people affected by the lack of modern provision for their needs, despite the fact that some may have concerned loved ones who look out for their interests and are frustrated at the lack of progress on their behalf. There are, however, groups who lack political clout and whose needs have for far too long been unaddressed. There has been a lack of imagination as regards thinking properly about the full dignity of people at all stages of their lives and taking the steps necessary. This is visible more generally in our hospital services as well. Consider the infrastructure of our hospitals and what people have to endure in situations of vulnerability and compare that with the circumstances people with money enjoy when they go to hotels. I often find it remarkable how little hospitality exists in our hospitals despite the good efforts of dedicated staff, primarily because they operate in out-of-date premises, which of course is a central theme here too. It is also a question of ongoing resources.

I had a meeting with the Irish Hospice Foundation this morning to hear about its concerns to try and make hospitals more friendly particularly in end-of-life situations. Relatively small amounts of cash injections by the State could be matched by private donations to try and fund particular projects wherein people would be treated in a more humane manner in hospitals, particularly in end-of-life situations where facilities could be developed for people to talk to a loved one in extremis, or to receive the remains of someone who has just died and so on.

It is true that the times are financially difficult, but we must never forget that this is an indication of the need to prioritise. We shall spend much time, and rightly so, talking about the need for investment in education and research and development. Last week I was among many politicians pointing to the fact that the Irish commitment to research and development has remained constant because we know that is what is needed for the economy to recover. However, we must not forget the heart of our society, which must involve the protection of its most vulnerable members. Mar achoimre beag ar an méid atá ráite, bhí ríméad ar gach éinne nuair a foilsíodh an fís seo i mí Eanáir 2006. Bhí gach éinne sásta leis an méid a bhí molta agus socruithe le déanamh. Tá a fhios ag an saol go bhfuil géarghá le athordú iomlán sa chaoi ina gcuirtear seirbhísí ar fáil dóibh siúd le fadhbanna sláinte intleachtúil ar leibhéil éagsúla. Is léir gurb é atá sa doiciméid seo ná an cur chuige ceart. Mar a dúradh, bhí sé i gceist go mbeadh sé i réim agus i bhfeidhm faoi 2016. Is léir nach dtarlóidh sé sin muna bhfuil athrú sa chaoi ina bhfuil an Rialtas agus an HSE ag tabhairt faoi agus muna gcuirfí na hacmhainní caoi ar fáil. Tá cinneadh le déanamh anois os rud é nár tharla go fóill go leor de na rudaí gur chóir dóibh a bheith tarlaithe ag an bpointe seo. Tá súil agam go dtabharfaidh an Rialtas gealtanas go gcuirfear an fís seo i bhfeidhm roimh 2016.