The fact that the brothers in the order commissioned an independent report into St. Mary's highlights their great concern for those for whom they care. That they should make it public demonstrates how serious are the problems outlined in the report. It is to their great credit that they have informed all of us. I am worried that this is not the first report commissioned by them and, while the previous reports did not receive such public attention, they have been forwarded to the Department of Health and Children. Their difficulties have been highlighted in the past and I am at a loss to understand the reason the Department did not address their concerns previously.

The main thrust of the report is that there is a severe shortage of staff. The independent investigators who examined the organisation of St. Mary's stated there was a shortage of approximately 100 people in the home. This had led to a lack of stimulation of inmates during the day which meant the main problems arose at night when it was more difficult to deal with them. The investigators also stated excessive restraint was used on patients, particularly through the use of straitjackets. Some patients were restrained in all-in-one suits. There were specific problems at night also because there was an even greater shortage of staff. Members of staff pointed out that consultants always prescribed the restraint but I am sure they only did so because they believed it was the last measure they could prescribe.

Caring for patients such as those in St. Mary's is extremely difficult. I am a member of the board of Peamount Hospital where there are such patients but they are not as severely disabled as those in St. Mary's. It is often difficult to prevent them from harming themselves or others, the reason physical restraint must be sometimes used. The only alternative is to sedate patients in order that at night they are not in a position to move and cause damage to themselves or others. Many of the patients are in wheelchairs or bedridden.

Is the shortage of staff due to a lack of interest in filling these difficult positions or a lack of funding? Money is not allocated to institutions such as St. Mary's by the Department directly but by the health boards. However, the Department is ultimately responsible for what goes on at the home. Fantastic work is done by the staff with the patients. Is it difficult to recruit staff to fill the vacancies or is not enough money getting through to hire staff, as I believe to be the case?

The superior of the order must have been desperate to have made the position public. Other hospitals have similar difficulties but they have not publicised them. Therefore, I commend those in St. Mary's for making their problems known. There is no inspectorate for the approximate 200 facilities which cater for those who are intellectually and-or physically impaired. During the years these institutions have been declassified because it has been agreed by the inspector for mental hospitals that the people concerned are not mentally ill, although, regrettably, in time some of them become mentally ill. The inspector supervises and inspects only those institutions which house the mentally ill. The occasional institution comes under the remit of the inspector, for example, St. Joseph's, Portrane.

The Government has invested significantly in this area over the past three years to improve conditions in units and provide more facilities but, by the Department of Health and Children's own admission, there are still people who are not being catered for. According to the Department's waiting lists, 1,711 are seeking residential places while 800 need day care and 1,000 respite care. Some of those who care for patients at home are well into their seventies and eighties and their great concern is what will happen to the patients, who are aged between 40 and 60 years in some cases.

This situation will get worse, not better because such patients are living longer and there is an improved survival rate among babies born prematurely but who have a high morbidity rate and babies with congenital and genetic defects. Older people become most difficult to deal with because they become bedridden. There is a major problem in this area and I hope the Minister of State's reply will not outline all the Government has done. I recognise what has been done as the Government has made a significant effort but I am concerned about the report on St. Mary's. The administrators must have been at the point of despair to have released it. Is there a shortage of money or, worse still, can staff not be recruited to work in such institutions? Is it not essential that an inspectorate for these institutions should be established immediately?

Despite this significant and unprecedented investment, demographic factors are contributing to growing waiting lists for residential services, in particular, even though the number in receipt of services, including full-time residential services, continues to increase. The increased birth rate in the 1960s and 1970s has resulted in large numbers of adults in their late twenties and early thirties requiring full-time residential services. In addition, people with an intellectual disability are living longer than previously, adding to the need for services compared to previous generations. This has also been the international experience in service provision to this population.

Due to the changing profile of those who have been in services for many years, there is a need to review issues such as staffing levels and skill mix. For example, an increased need for additional night cover has arisen in many agencies because of the more dependent profile of the residents due to old age, illness or behavioural issues. An ongoing review process has been under way for a number of years with the health boards and voluntary agencies, with funding allocated annually in recent years to meet these identified needs.

The overall economic position in 2003 has had implications for all aspects of public investment, which is reflected in the Estimates and budget adopted by the Government for 2003. Within this overall framework, however, some two thirds of the additional funding available for non-capital investment in services has been allocated to the health service.

Responsibility for the provision of funding for organisations providing services for people with an intellectual disability or autism in the north-eastern region rests, in the first instance, with the North Eastern Health Board. The situation at Drumcar will be discussed at a meeting between the Department of Health and Children and health board representatives on Tuesday, 4 February in the context of the board's service plan for 2003. A meeting between the Department of Health and Children, the health board and St. John of God's representatives is also scheduled for the following day. Within the resources available to the health board this year, the Minister is hopeful progress can be made at these meetings on the most pressing problems facing Drumcar.