Averil Power (Fianna Fail) | Oireachtas source

I move amendment No. 2:

In page 4, to delete lines 24 to 27.

I welcome the Minister to the House. My colleague, Senator Marc MacSharry, spokesperson on health, will give the Fianna Fáil position on the Bill as a whole and propose a range of amendments to improve it. I want to speak to my amendments which seek to ensure greater accountability within the health service for mental health, in particular, and I have proposed a number of amendments from that perspective.

The amendments as a whole are designed to ensure the Bill puts in place the leadership and accountability structures needed to ensure implementation of A Vision for Change and delivers real improvements in mental health services. I do not need to tell the Minister that mental health problems have huge social and economic costs. The social costs are immeasurable on families when people go through mental health problems unsupported. Even at a time of limited resources and priorities within the health service, we cannot turn a blind eye to the fact that there is a huge cost for individuals, employers and the State as a whole.

Unfortunately, we do not have a good history of prioritising mental health services. They have long been the poor relation of the health service as a whole. In 2010, just 5.3% of health spending went on mental health compared with 12% in England, 18% in Scotland and 20% or more in other EU member states. It is clear we are starting from a low base and much progress has been made in recent years, as acknowledged by the previous speaker, but we have a long way to go. The particular weaknesses have been highlighted by groups such as Mental Health Reform, that our approach to mental health focuses purely on a medical model, that there is limited access to supports other than medication, an over-reliance on inpatient services, inconsistent support across the country and there are large gaps in geographic areas for particular groups, such as children and adolescents. A Vision for Change set out the roadmap to improve the position and has widespread support from a broad coalition of groups who want it implemented.

The reason I have tabled the amendments is that A Vision for Change has not moved on and is not where we had hoped it would be at this point. There have been consistent and widespread concerns about the HSE's lack of accountability for delivering on A Vision for Change. That has been attributed by Mental Health Reform, in its constituent groups, in large part to the absence of empowered leadership within the HSE and gaps in structures of accountability that lead to a lack of planning and a lack of separate reporting on mental health services. The Bill presents an opportunity to put in place the structures in A Vision for Change which called for the establishment of a national mental health services directorate and that it would be one of the main drivers of implementation of the policy. It is not clear from the Bill that will be achieved on the current wording. It is not specific about who the directors will be. There are other flaws that I will point out later.

I welcome the fact that the section strengthens the Minister's control over the HSE's activities and provides that written directions can be given by the Minister to the HSE "concerning the implementation of any policy or objective of the Minister or the Government which relates to a function of the Executive, where the Minister is of the opinion that the Executive is not having sufficient regard to such policy or objective in the performance of its functions." That appears to be an improvement on the current position. However, I am concerned, as is Mental Health Reform, about the limitation that the Minister can only give a direction on policy implementation where he or she is of the opinion that the Executive is not having sufficient regard to that objective in its performance. It indicates that the Minister must wait until there is a failure before he or she can give a directive. We propose an amendment that provides that the Minister shall be empowered to give a direction on policy implementation at any time, without limitation, not waiting for a problem but ensuring that clear directives are given in the first place.

Amendment No. 3 is designed to increase public accountability of the mental health services and the role of the HSE in that respect. The section, as drafted, increases the HSE's accountability to the Minister for implementation compared with the present position, by saying that the HSE should report to the Minister on its compliance with any ministerial direction. Clearly that is positive. We are proposing that to ensure greater public accountability, any such report by the HSE, concerning its compliance with ministerial directives, should be published.

In recent days we have witnessed instances of concerns about lack of accountability and an unwillingness on the part of HSE officials to answer questions at parliamentary committees in order that there could be greater public scrutiny, more of which is needed in the current context. The amendment seeks to ensure there is nothing to hide and that the HSE should be happy to publish reports on compliance and making clear what it have been asked to do by the Minister and whether it is performing its function.

They are two simple amendments, the purpose of which is to improve accountability and transparency,