John Gilroy (Labour) | Oireachtas source

I welcome the Minister to the Chamber. I recognise the constraints that limit our potential to deliver the services that are required in this country. A great deal of good news and good stuff is contained in the national service plan. The real increase in the budget of €115 million, when last year's commitments are met, certainly has to be welcomed. The decision to enable general practitioners to access ultrasound will make a significant difference to the way we deliver primary care services. I recognise the improvement in the framework for the provision of cancer services, which is a model for how we would like the entire service to be. I intend to devote the greater part of my contribution to mental health services. I welcome the provision of 12 extra beds for people who are suffering from eating disorders. This area is under-catered for in the health service at the moment.

Are there plans to provide an enhanced role for non-medical professionals, particularly in our accident and emergency departments? I say this in the context of a visit I paid with a young fellow who was playing football and injured his knee. We waited a while to see the triage nurse and then waited again to see a doctor, waited again to get an X-ray, waited to have the X-ray results read, and then waited for a prescription or treatment. If we had somebody like an advanced nurse practitioner in triage who could have referred the patient directly to X-ray, it could have saved at least three or four hours. That is one example. I understand that medical professionals jealously guard their own jurisdictions, and that might be one of the blocking points to resolving the problems we are facing in the accident and emergency departments.

The mental health service budget is €756 million, and an additional €35 million has been approved again this year. That is welcome. There is a real concern among people working in the mental health services that the €35 million that has been provided to implement the recommendations of A Vision for Change and to recruit more staff is not being used to recruit any more net staff, or very few net staff, into system. It is suggested that the €35 million is being used to promote or create very important jobs from within the existing cohort of staff. The wages for the post that is being promoted remain with the HSE and the only difference the €35 million makes is the difference between the existing post and the promoted post. I would like the Minister's comments on that. Is he concerned about this?

My colleague and friend, Senator MacSharry, during his - I have to say - ill-informed contribution, referred to what the Minister of State, Deputy Lynch, said about the crisis she feels might be developing in staffing in the mental health services. There is a danger that 1,000 staff might be leaving the system this year. It is an ongoing yearly concern that has not just arisen this year. Every year it is the same, and it looks like the structure of career paths for psychiatric nurses leads people to take retirement earlier than other professionals might. A Vision for Change recommends we employ 12,240 staff and the service plan acknowledges that at the moment there are only 9,000 whole-time equivalents within the system. To implement the recommendations of A Vision for Change fully, we are 25% short-staffed already, before the imminent and worrying retirement of other staff. It seems to me that this is a legacy issue of not training psychiatric nursing staff and failing to provide proper career paths for staff who are being trained. I would like to see some statistics of the number of graduate nurses leaving the education system who do not enter into the mental health services and who go abroad. Anecdotally, it seems the numbers are quite high.

We might say it is a problem of pay or career path, but private providers of mental health services are also experiencing difficulties in recruiting staff and are using a lot of agency staff. If we view it merely as a problem with the career paths in the simplest sense, we are not really seeing the main problem. What is the Minister's opinion on that?

It is 31 years since I entered Our Lady's Hospital in Cork as a student psychiatric nurse, and in that same year a document called Planning for the Future was published - two momentous events. It seemed to me then, and seems to me and a lot of my colleagues now, that we are always just one step or one action away from delivering the perfect mental health services that we need. A Vision for Change stands with the very best policy documents in the world. Some years ago I was involved in a literature review of mental health documents in seven English-speaking countries, and A Vision for Change was certainly well up there, possibly even the best policy document. However, it has been acknowledged everywhere, even probably by the Minister, that we are not doing as much as we should to implement A Vision for Change, and even after four years of our Government trying to implement it, it seems that we are moving backwards rather than forwards in many areas.

The service plan mentions the establishment of different offices, one of them being an office of service user engagement. The language is amazing. The jargon we use in the health services is just perplexing. It also says we want to appoint service user members onto each panel of mental health management teams. While that seems to be a good idea, I am not sure how we can do it. How would the people who are going to serve on these management teams be selected? Would they be -again - insiders from the HSE or would there be open competition? While it is very important that we aspire towards things like this, the actual delivery of them at HSE level will probably not live up to the potential.

It is worrying to see that we are only now in the process of appointing clinical leads to the three clinical programmes. Is the position of director of mental health services still vacant? Is the director still seconded from that position? Is any consideration being given to driving forward in very real terms the recommendations of A Vision for Change? By that I mean we should perhaps try to appoint somebody similar to the Canadian doctor who was appointed to oversee the development of cancer services in the country. While there was a lot of opposition to what he wanted to do at the time, we can now acknowledge and agree that the outcomes provided in cancer services are second to none. Has the Minister given any thought to appointing a similar mental health czar to drive change in the area of mental health?

I cannot let the opportunity pass without referring to the ongoing crisis which is developing regarding the retention fee for nurses and the Nursing and Midwifery Board of Ireland. I spoke about this on the Order on Business and I am very concerned about it. There are 70,000 active nurses on the file. The trade union movement and staff bodies are recommending that they do not pay the new enhanced registration fee. I am inclined to agree. I was not in agreement until I heard a spokesperson for the Nursing and Midwifery Board of Ireland on the "Drivetime" radio show yesterday saying that a lot of this money will go towards servicing an impaired loan. Bad property speculation decisions by a previous board should certainly not be a factor in 70,000 nurses not being able to work in this country. The Minister needs to step in and bang some heads together - not nurses' heads but maybe some nursing board heads - and ask what is happening. It is very worrying. Only last week, he himself called for nurses and other health professionals to step up and go the extra mile to deal with the crisis in our accident and emergency departments. The nurses did that - they do it every day - but they went the extra mile only to find that their regulatory body is saying if they do not pay their registration fees in the next two months, they will not be working in our hospitals. It is incongruous for the Minister to be saying one thing while the regulatory body is saying another.

I will not mention my final point as I am just out of time, but I will take it up with the Minister in person later on.