Jim Daly (Cork South West, Fine Gael) | Oireachtas source

The HSE is committed to ensuring all aspects of mental health services are delivered in a consistent and timely fashion. In 2015 the mental health division of the HSE determined that it was necessary to conduct an independent review of the quality, safety and governance of services provided by Roscommon mental health services to support achieving the goals set out in A Vision for Change and other relevant national policies. I welcome the report which was completed in July and which makes 27 recommendations for local service improvement. Within a short period of being commissioned, it became evident that the initial timeframe proposed to conduct the review was insufficient and the review team requested and received extra time to complete its work.

The recently released report indicates that the review team was impressed by the majority of staff it met or interviewed and struck by their commitment to seeing services improve for service users in Roscommon. The overriding concern of the majority of those interviewed - staff, service users and carers - was that patients and families in Roscommon were not receiving services in line with best practice that would meet required quality and safety of care standards. The team concluded that there was a disproportionate focus, even in a time of straitened financial circumstances, on achieving budget savings at the cost of an adequately staffed and safe service.

Multi-disciplinary team working, MDT, the linchpin of modern mental health services, was severely eroded in Roscommon, with fractured relationships within the area management team, AMT, within the Roscommon teams and between a number of professionals and key consultant medical staff. Throughout, there were poor line management arrangements. Leadership at a number of levels appeared to be ineffective. The majority of nursing staff interviewed believed - the team agrees - that the senior nursing leadership critical to representing the professional views of nurses at the executive level was missing. It is the team's view that, in some instances, relationships appeared to have broken down irreparably. Managers in any organisation have a difficult balancing role and should be allowed to manage without undue interference. However, this can only occur in a working environment that is conducive to mutual respect and understanding. There was clear evidence that this was absent in this instance. Some senior medical and nursing staff maintained that the relationship difficulties impacted on their ability to bring about changes that they felt were necessary.

The review team pointed to the need for effective application of appropriate change management principles as a new entity attempted to merge disparate parts of hitherto separate organisations. The team believes preparatory work to support the area management team should have been under way as it embarked on creating a new culture.Little emphasis seems to have been placed on this, and when combined with economic constraints, less than favourable conditions then prevailed.

An implementation group has now been formed by the HSE to implement these recommendations. This House will appreciate that the HSE has statutory responsibility for the planning and delivery of health care services at local level, including mental health in Roscommon. The Senators can rest assured that the Department of Health and I will closely monitor the progress of the HSE implementation team to ensure that the recommendations of this comprehensive report are delivered as quickly as possible.