Sharon Keogan (Independent) | Oireachtas source

As I sat down to think about what matters needed to be raised here this afternoon, I wondered what it is about health, mental health and child and teenage care that has not been said in the past ten years. I do not think a month goes by without this issue being raised in this Chamber, and I support that. It is certainly an issue of national importance and deserving of our attention but our proclamations or statements are worth nothing if they do not lead to action that will make a difference for people on the ground.

I tend to see very little evidence that disproves the impression that many people have of the HSE, that it is an unchangeable monolith, bloated by middle management and mired in bureaucracy. Last week, Professor Martin Curley, the appointed head of digital transformation in the HSE, said that the executive had no vision for the digitalisation of the health service and efforts to change this are being impeded by bad actors. It is a perfect snapshot of the system. Efforts to grow, change for the better or, God forbid, revolutionise some aspect of the service are not met with an understanding of the need for assistance in realising change but are disrupted and blocked at every turn by senior administrators who watch Ministers come and go and who, every four years, get a new programme for Government to use as a doorstop. We are pouring more and more money in and the results are getting worse, according to Professor Curley. We are spending the equivalent of what and or Austria are spending but our performance is far poorer. We are a world-class spender on healthcare for what is certainly not a world-class service. This is not due to the people on the ground, our nurses, doctors and healthcare assistants who are giving everything they have and are being stretched to breaking point every day. It is due to fundamental flaws at operational level and to middle to high-ranking pencil pushers for whom the only change that matters is to their salary or pension.

This is the backdrop against which our statements on the provision of child and adolescent mental health services in this State are being made. It is also the answer to so many of the questions heard previously and being posed again today. Why has X not happened? Why has Y not been progressed? Why are families still having to deal with Z? It is because the health system does not work and no Minister seems to have the power to change that.

Last week we saw the publication of the interim report arising from the independent review of CAMHS. It found that across the country, children and young people accessing mental health services were open cases and had been lost to follow-up care. In many cases, children were reaching their 18th birthday with no planning, discharge or transition to adult services or any advice about medication. Others were without any appointment for two years or failed to receive any appointments for a review of prescriptions or monitoring of medication. Evidence was found that some teams were not monitoring anti-psychotic medication in accordance with international standards. Children were taking medication without appropriate blood tests and physical monitoring. The report also identifies significant staff deficits across many HSE teams and CHOs. Team members were working beyond their contracted hours, often without compensation, in order to continue to provide a service. There was evidence of stress and burnout in a significant number of team members.

We were not even supposed to see this report. The inspector, Dr. Susan Finnerty, had planned to wait until the full report was completed later this year but decided to publish the interim report due to the serious concerns and consequent risks for some patients that were found. These were not few and far between, cherry-picked examples. Four out of the five CHOs that have been examined so far require urgent and targeted action in order to address the ongoing risks relating to them. The report also found long waiting lists, wide variations in acceptance rates, unacceptable variations in care, and a lack of capacity to provide appropriate therapeutic interventions. It found absent or poor care planning, a lack of CAMHS emergency and out-of-hours services, staff shortages, a lack of clinical governance and a lack of joint working with other agencies. The report also references a lack of child-centred care and administrative support, as well as a lack of ICT systems. The good news is that on foot of the interim report, the CEO of the HSE has committed to conducting a review of all open cases in all CAMHS teams, with a particular focus on identifying and accessing open cases of children who have been lost to follow-up and physical health monitoring of their medications.

We have had our statements. Knowing what needs to be done has never really been the problem. The problem lies in the doing. If it does not get done and if these problems remain unaddressed, the consequence will not be that we report a quarterly loss or that a party takes a hit in the next opinion poll. It will be more dead children and teenagers and many broken hearts and broken families. Preventing that might be worth rattling the HSE. One thing I find absolutely unforgivable relates to the recent tragedy in Creeslough.The Government pulled out counselling supports after one month and moved it online. That is unforgivable. It was the biggest national tragedy in ten years but those people are not being provided with ongoing counselling services.

The most vulnerable children in the country are those in care. When they leave child services, they get a few sessions every year on the adult services. That is not good enough. They need more. They might get ten sessions if they are lucky but some children need ongoing therapy, possibly for many years, right up to the age of 23. The Minister of State needs to consider that. Those children when they leave child services are not getting enough counselling support through adult services.