Seanad debates
Wednesday, 20 January 2010
Hospital Services
8:00 pm
Phil Prendergast (Labour)
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I thank the Minister of State, Deputy Moloney, for attending the House to take this matter. I sought this debate to register the anger of Tipperary people at a plan that was announced last week to close the county's only acute mental health facility. I am talking about the entire county, comprising both the North and South Ridings. It is the only county in Ireland which is so divided.
There are countless reasons why this plan is neither feasible nor reasonable. In the limited time available I will outline some of them to the House. I draw the Minister of State's attention to the conduct of HSE South officials in this matter, who I believe are acting outside their powers in formulating this plan. Last week, lead clinicians at St. Michael's were stunned when they were told at a regular meeting of HSE officials that the 49-bed unit would be shut by the end of the year. A media release to this effect was later issued by HSE South confirming that acute services were to move to Kilkenny. This decision is completely at odds with practice and procedure in reconfiguring health services. It is not in keeping with the recommendations of the Mental Health Commission's report on services in South Tipperary, which was published last April. I think the Minister of State had some knowledge of that. It is not compliant either with A Vision for Change, nor the many other HSE documents that were published concerning reconfiguring mental health services, both regionally and nationally.
The aforementioned HSE South's media release contained a litany of bogus claims, none more so than the statement that a process of consultation had taken place with stakeholders. That was a blatant lie, actually.
Phil Prendergast (Labour)
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Well it is an untruth in this regard.
Fiona O'Malley (Independent)
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Thank you. I am glad the Senator has withdrawn that. I will take it as having been withdrawn.
Phil Prendergast (Labour)
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Staff, management, patients and their families were unaware that a plan to close St. Michael's had been drawn up. In fact, discussions on the future of acute mental health services in Tipperary could barely be described as being at a preliminary stage. This plan is a direct contradiction of what the Minister, Deputy Harney, told a meeting of Oireachtas Members for South Tipperary last December. She said no decisions would be made about any aspect of our health services without notice and without consultation first taking place with Oireachtas Members, stakeholders and other interested parties both in South and North Tipperary. That means that HSE South has broken the Minister's promise by formulating and announcing this plan. It means that regional officials have decided to go over the Minister's head to try to press ahead with their plan without ministerial approval.
The reorganisation of health services in County Tipperary looks like it is being run by a faction of HSE officials who believe they are not accountable to anyone, including Ministers. I am demanding that these people within the HSE be made accountable for their actions. Their motives should be unmasked. It is obvious that those behind this plan are using it as a means to downgrade South Tipperary General Hospital also because those 49 acute beds are factored in with the general hospital's complement. Taking 49 acute beds from that complement is a de facto downgrading. That is because a lower number of beds would attract a different banding, which attracts different funding as the Minister of State knows. It has implications for the reconfiguration process currently going on within HSE South concerning the four acute hospitals in the south east.
There is a growing suspicion that the reconfiguration of health services in South Tipperary is being driven by a group of people whose personal interests in centralising services in Kilkenny are being put ahead of patient welfare. I am calling on the Minister of State to suspend the plan to axe St. Michael's. He should call to account the promoters of this shocking disregard for the Minister, for proper procedure and, most importantly, for patient welfare. If this does not happen it means we have in our democracy a group of self-appointed decision makers with powers that exceed those of the Minister and the Minister of State. Did the Minister of State, Deputy Moloney, or the Minister, Deputy Harney, know of this plan before it was announced?
There was almost a complete lack of consultation with stakeholders before announcing the closure of an acute inpatient mental health service unit in County Tipperary that had operated for more than 150 years. It was an undemocratic decision made by faceless people. There was no chance for any of the people in the county involved at the coalface to make submissions. There was a lack of logic in pre-empting overall configuration decisions for the south east which might include the removal of some services from Kilkenny. I am assured St. Canice's is located in a very old building and so happens to be in the grounds of Lacken House, the HSE head office for the region.
Phil Prendergast (Labour)
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I am concluding on this point. The long, narrow Carlow-Kilkenny-south Tipperary mental health area is geographically unsuitable. There is no allowance made for new motorway systems or thought put into patient convenience or preferences. Areas in north Tipperary very close to Clonmel – for example, Thurles and Templemore - are excluded. The road to Kilkenny is unsuitable. The hospital in Kilkenny is also not suitable for servicing the needs of the people of south Tipperary. The outlay to make St. Michael's Hospital suitable to meet modern requirements would be trivial by comparison with the ultimate dangers for patients and the difficulties faced by relatives and staff. There has been a huge outcry and people are seriously concerned. I cannot underestimate that aspect of the matter.
I ask that the Minister of State suspend any decision pending detailed consultation, costings and submissions from stakeholders in County Tipperary. I spoke to the staff. I declare an interest in that-----
Fiona O'Malley (Independent)
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The time has concluded. This will have to be the Senator's final point.
Phil Prendergast (Labour)
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I am making my final point.
I have a relative who has been in front-line management in south Tipperary for many years. Therefore, I am very well acquainted with the facts, figures and realities of working within the unit and aware of the report produced last year. There was never any suggestion all acute services would be removed from Tipperary. Was the Minister of State or the Minister aware of this? Is the Minister of State willing to suspend the closure of any unit in south Tipperary until all parties have been consulted?
John Moloney (Laois-Offaly, Fianna Fail)
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I thank the Senator for what she said. I wish I had more time to respond because she raised so many issues. I do not intend to respond by way of the prepared script because many of the issues raised are not referred to therein.
I have been asked to meet a delegation including Deputy Mattie McGrath, the Minister of State at the Department of Finance, Deputy Mansergh, Senator Prendergast and Deputy Tom Hayes and I intend to do so. I do not want to be blunt or bad-mannered in my response. It is my intention to proceed as fast as possible to close down every mental hospital in the country. I am committed to doing so in three years. I have visited nearly every psychiatric hospital and have done so without media involvement. The Senator might remember I did not notify the public representatives in the areas concerned. I did so to build a belief we were serious about mental health service reform.
One of the first hospitals I visited was St. Michael's in Clonmel. I saw its condition, just as I saw the condition of so many other hospitals. I certainly made a commitment to its staff, particularly those who attended the meeting. I had some serious discussions with them and made a serious commitment to the effect that, if I secured funding for the capital programme, the mental health services in the hospital in Clonmel would be among the first to benefit from investment.
I consider this matter in the context of A Vision for Change. Everything proposed for south Tipperary is contained in that document; it is not new thinking. I ask the Senator to bear with me, as I will take another opportunity, perhaps next week, to explain my points.
The second issue is that there will be absolutely no attempt on behalf of the HSE or Department to close down St. Michael's Hospital until the investment of €20 million is made. In this regard, I am going to Tipperary within a fortnight to turn the sod on the new development. It is not sod-turning for the sake of appearing on camera but it is a sod-turning in line with all the serious commitments given by me in the past 18 months. The recommendations were not set down by me but by experts in the area of psychiatric care, including Senator Prendergast. The Senator is aware of what is occurring on the ground.
I hope what we are doing in Clonmel will happen throughout the country in the coming years. We are starting off with a commitment to provide €43 million for mental health services. We have a multi-annual programme. What is proposed for and what is happening in Tipperary was outlined four years ago in A Vision for Change. I read the local media and do not agree with the contention that the HSE is acting independently, improperly or without the imprimatur of the Government. It is carrying out exactly what was proposed for the reform of mental health services nationally. This must include St. Michael's Hospital. Patients and their families are the people about whom we are always talking. Before there is any attempt to close St. Michael's Hospital, the investment in the 40-bed nursing unit in Clonmel will be made. There will be a full team of health providers, psychiatric care providers and nurses to deal with psychiatric care issues in Tipperary.
I read one of the comments made at the meeting. It is implied there was an attempt to punish the patients by sending them to Kilkenny. This could not be further from the truth. Every aspect and every geographical area has been dealt with in A Vision for Change. The document was not put together by politicians but by service users, their families and experts in the field. Every proposal made therein will be implemented.
I read in the media that somebody emerged from a meeting and leaked something that was being hopped on by the HSE, but the reality is that the HSE was explaining what A Vision for Change was about. That is exactly why I went to Tipperary some months ago. I look forward to visiting again.
Let me be more specific because I know the Senator is very concerned. I heard her speak about this issue in the House in the past. I do not say this to plámás her. While the HSE has announced the closure of St. Michael's Hospital, its services will, in due course, be transferred to St. Luke's Hospital in Kilkenny. It must be stressed that this will not occur before a home-based treatment team is put in place and operating for 24 hours a day, seven days a week. This is not the system that obtains. I note from the brief that one third of referrals to St. Michael's Hospital in Tipperary occur after hours, in other words, at a time in respect of which people have not proposed or requested a separate service.
Phil Prendergast (Labour)
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Did the Minister of State say the beds would be transferred to St. Luke's Hospital in Kilkenny, not St. Canice's.
John Moloney (Laois-Offaly, Fianna Fail)
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Yes. The Senator should remember that in the general hospital in Kilkenny there are acute psychiatric services. I have visited the unit and noted it is forward-thinking. In Kilkenny, as in Sligo, there is a nurse operating in the area of psychiatric care. There is a prescribing nurse in this area also, which I welcome. All of these developments are positive.
I will not do the Senator an injustice when addressing her concerns. That is why, in spite of the fact that the matter is properly being raised today, I intend to invite her to a meeting to discuss it. This is to assure her there is nothing surreptitious, hidden, smart or cute. The only regret I have is that what is proposed should have been happening approximately ten years ago. Having visited most of the hospitals, I am aware that there is a great need. I am glad that, at long last, we have a ring-fenced budget. We are moving as fast as we possibly can.
When I was in Tipperary over 12 months ago, the commission was involved in addressing the issue concerning the facility in Clonmel. It reported that the facility certainly could not provide the mental health service required. I accept that the Senator is not saying for one minute that the building and structure are adequate. She may ask why there could not be a separate facility on the campus. I intend to take the services provided at St. Michael's Hospital off campus. Let us be clear that the issue involves selling land and property to ensure we can develop further services in the area. I am aware that the service in north Tipperary is delivered from south Tipperary.
A comprehensive €20 million programme to develop community-based mental services has been announced. The programme will be funded from the proceeds of the sale of lands and will be associated with the package of €43 million announced in the budget. I expect the project in respect of the 40-bed unit to be put out to tender in the coming weeks. I made a commitment to the Clonmel and Letterkenny facilities as they were crying out for immediate investment.
The programme will provide more appropriate mental health services with better access for users. It is all based on the recovery model of mental health treatment and the transfer from old structures to modern facilities backed up by committed mental health teams. A Vision for Change envisions a community-based mental health service with a reduced reliance on inpatient care. The decision to provide a home-based treatment team will minimise the necessity for hospital admissions. Over Christmas I refreshed my mind on this clear policy in A Vision for Change. My only regret is that we should be further up the line in this reform programme than we currently are. I intend to revisit those hospitals I visited last year to work with them on their capital programmes.
Regarding the point raised about bogus claims and lead clinicians making different assessments, I accept there is some anger in Tipperary. However, part of the reason for this anger is that people, in their minds, perceive this as a downgrading of their acute hospital services. It has nothing to do with this. I may not have done justice to all the issues raised by Senator Prendergast. However, I promise I will brief her and her Oireachtas colleagues in the next two weeks to assure her that this move is in the patients' best interest and is part of a reform programme that must be pushed.
Phil Prendergast (Labour)
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The Minister of State claims this is not a downgrading. Taking 49 beds out of the bed compliment of a general hospital means it attracts a different branding grade and is in effect a downgrading. There is a regional configuration to Kilkenny's advantage. There were no discussions with the clinicians, nursing staff or stakeholders involved prior to it being announced at an ordinary meeting three days before the national announcement.
When the Minister of State was Chairman of the Joint Committee on Health and Children, he stated that any moneys realised by the sale of hospital lands should be red-circled for reinvestment in community mental health services. While the moneys, however, have been realised, they have not been reinvested in community services. A community service for south Tipperary means it is in the area. Kilkenny is not our community. Land is available on the campus of South Tipperary General Hospital. Why can a new build for St. Michael's not be accommodated on that land?
Brendan Drumm, chief executive officer of the HSE, publicly met with senior managers of south Tipperary mental health services in January 2009 and confirmed his commitment to the development of its programme as set out in its service plan for 2009 to 2010. He also commented that the type of transformation under way in south Tipperary is being replicated across mental health services in Ireland. To support this work, he stated the HSE has implemented a new national initiative where funding from the sale of mental health services' lands and properties would be set aside in a protected fund to support the development of community-based services.
Fiona O'Malley (Independent)
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I thank Senator Prendergast. The Minister of State has promised to invite her to a meeting on the matter. I do not want him to be put out.
Phil Prendergast (Labour)
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"Home care treatment teams" was a term pulled from A Vision for Change. It cannot be selectively used for south Tipperary and applied in a positive fashion to Kilkenny.
Phil Prendergast (Labour)
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We in Tipperary are very serious about our health services.
Fiona O'Malley (Independent)
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The Senator has been indulged in this matter and has been invited to a meeting.
John Moloney (Laois-Offaly, Fianna Fail)
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I know Senator Prendergast has a background in these services and I am not trying to rubbish any of her remarks. Retaining the level of competency of a hospital for the sake of the 49 beds in this case, however, is wrong. I went through all of these factors during the cancer services debates in Laois. In the case of Tipperary, an image has been created of people sitting in a room somewhere in the HSE privately deciding on the services in this hospital. Three clinicians made the media aware of the removal of these services as if it were breaking news. It was not; it is part of the whole reform programme for mental health services.
If one takes the full logic of the argument that the moneys released from the sale of mental health hospital lands should be retained for the particular area in question, then the people of north Tipperary should not receive any of it because it has no facilities.
Phil Prendergast (Labour)
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This hospital has been serving north Tipperary for 160 years.
John Moloney (Laois-Offaly, Fianna Fail)
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Some counties have no existing mental facilities to sell off to fund their mental health programmes. Tipperary is part of the 300,000 catchment area referred to in A Vision for Change. The whole process has been to ensure we deliver multidisciplinary services to these areas. We are not unravelling A Vision for Change to suit Tipperary as I am having to do the same in Portlaoise.
When I first took over this job 15 months ago, I made it clear I wanted a director for mental health services appointed to drive the reform programme. My second commitment was to secure the capital funding for the reform programme from the Government. My final commitment is to ensure a full assessment of how far A Vision for Change has been implemented on 1 March and how it will be funded for the remaining four years. I believe who ever holds this ministerial post should do this assessment every March.
This assessment will give me an opportunity to work with people in the HSE, such as Brian Gilroy, who heads the procurement programme. This year I intend to ensure the capital required will be available to deliver a modernised mental health service with priorities such as a new Central Mental Hospital site, child and adolescent services, acute psychiatric units and rehabilitation units. Much work has to be done to convince Senator Prendergast that this is consistent with the non-involvement of politicians and the full involvement of service-users, their families and service-providers. What the HSE is doing in this case has not been thought up in an ad hoc fashion, but is a clear following of the mental health services reform programme.
Fiona O'Malley (Independent)
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I thank the Minister of State and wish to clarify that I indulged him with a little more time as he was imparting real information to Members. I regret it is necessary to suspend the House for five minutes as the Minister of State, Deputy Mansergh, who is taking the next two Adjournment debates is caught in a division in the other House. I ask the Acting Leader to suspend the House for five minutes.
Denis O'Donovan (Fianna Fail)
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I propose that the House adjourn for five minutes.