Thursday, 8 October 2015
Mental Health Services
Cuirim céad fáilte roimh an Aire Stáit. Táim thar a bheith buíoch di as teacht isteach ar an gceist seo.
I hope the Minister of State is aware of the current crisis in the psychiatric services in Galway. I know she is aware of the issue that arose at that hospital last May, which led to nurses taking industrial action in relation to health and safety and staffing levels at the acute psychiatric unit. Following that incident an implementation group was set up to try to resolve the issues. Commitments were given in regard to staffing levels and the opening of a new unit that is available but is currently lying empty. I am told that those commitments have not been met.
I understand there was chaos in the acute psychiatric unit in University Hospital Galway last weekend because there were insufficient staff to manage the unit. I also understand that worker representatives spent the weekend trying to contact management who were responsible for the staffing of that unit but that they were not available or would not make themselves available to resolve the issues. I am further told that the issues should have been resolved mid-week while people were in their offices and that staffing at the time of the chaos was at a level which raised huge concerns among staff in terms of their safety and that of patients. This is not acceptable.
This issue forms part of the broader picture of psychiatric services in the west, particularly the Galway-Roscommon area. I am told by people who work in those services that the closure of the service in Ballinasloe has put added pressure on the psychiatric unit in UHG. When that service was closed a commitment was given that a community psychiatric group, made up of approximately ten to 12 nurses who would work in the community, would be established to meet additional demand following the closure of the Ballinasloe units. However, that group has not yet been established.
I am aware that there are serious concerns about some of the homes in Roscommon, which are managed by the Galway-Roscommon PCCC. It has raised huge concerns about the incidents that have occurred there, which issues I have raised in this House previously. I understand there has been a reshuffle of management in the psychiatric and mental health services in Galway. Mental health and psychiatric services in Galway are chaotic. Something must be done immediately because, according to worker representatives, staff and family members of patients at the unit, lives at being put in danger. Their concern in this regard is real and genuine. Recently a patient admitted to the psychiatric unit in Galway somehow got out and was found some days later having hanged himself. The family concerned is distraught over that incident.This is another disaster waiting to happen. It is a serious issue that must be grasped and sorted out very quickly. The review of the mental health services in Roscommon should be extended to Galway-Roscommon because the services there were managed by the same group of people and all those services were being exchanged and staff moved between the areas. If it is a question of resources, they need to be made available immediately to make sure, particularly in acute psychiatric situations, that there are enough staff and nurses to ensure the patients, doctors and other staff are safe.
The Senator may think this is patronising but I do not mean it to be but the reason I like taking Commencement matters in the Seanad – although I would prefer if I did not have to do them so often – is that there is always that extra bit of time to flesh out the question posed. When anyone dies by suicide, it is a tragedy. I can only imagine the distress the family feels, especially when they thought their loved one was somewhere but then discovered he was not. Equally, someone admitted to an acute unit in the psychiatric services is very distressed and these things will happen. It is very unfortunate and I can only imagine the distress of families and the chaos that suicide leaves behind and that is why I am very committed to the new strategy. It is an awful thing for any family to have to experience. I pray that none of us experiences it but that is not the reality as it does happen.
The reorganisation of the service in Galway-Roscommon is a priority of mine. If anything I read out here, because I asked for a detailed response, is in conflict with the facts, I would very much appreciate if the Senator would tell me that at some stage. I hope the answer will be satisfactory. It is a service in transition and it needs time to bed down but people’s safety should be paramount in that process.
It is widely recognised that this Government has prioritised development of all aspects of mental health policy. The explanation for that is the psychiatric service is different from the mental health services, which cover community-based and attitudinal problems. Despite severe financial pressures overall, we have provided significant additional funding of €125 million since 2012 to enable the HSE implement the long overdue modernisation of our mental health services, in line with A Vision for Change. Key to modernising services in line with current and future demand, and best international practice, is reorientation from a hospital and bed-based focus to developing structures and processes required for enhanced community-based provision. In line with the national approach, Galway-Roscommon mental health services are committed to full implementation of A Vision for Change. The HSE appointed an expert group to review community mental health services in the region, Galway-Roscommon, which reported in June 2014. The group recommended a broad reconfiguration across the area, with a focus on enhanced community care through residential and other community settings and a reallocation of resources across both counties. The HSE in the Galway-Roscommon administrative area provides an inpatient and community mental health service for a population of 314,000. It is well advanced in implementing A Vision for Change, including adopting the recommended population sectors of 50,000, appointing team co-ordinators, and developing an overarching clinical governance model. The number of acute beds is well within the recommendations of A Vision for Change, which indicates 50 beds per 300,000 people. Galway and Roscommon has 67 beds in total, 45 in Galway and 22 in Roscommon, for a population of 314,000. This will increase by a further five beds in Galway with the opening of the new acute unit there in early 2017.
When we started to realise that there was a difficulty there, we put a particular focus on that area. The HSE has secured significant additional new staff posts for Galway-Roscommon since 2012, including additional consultants in the areas of general adult community mental health teams, psychiatry of later life teams and rehabilitation and recovery teams. Allied staff include occupational therapists, community mental health nurses, social workers and psychologists. The service in Galway-Roscommon has a nursing complement of over 400 whole-time equivalents. It had funding of €62.3 million in 2013, €63.4 million in 2014 and an allocation of €65 million this year before receiving its share of the 2015 development funding, which was the ring-fenced funding for development posts. It should be noted that the service has mental health spending of approximately €190 per head of population which, when adjusted for deprivation indices, compares very favourably to the national average of €161. Therefore, funding is not a core problem for mental health services, either in HSE west or nationally. This is one of the few areas that had an increase in funding. There are, however, acknowledged staff recruitment and retention difficulties generally, symptomatic of the wider health system which are being addressed in this context. The problems we are experiencing now will not help that. Recruitment is becoming easier but it is still difficult. Notwithstanding such difficulties, an additional 16 staff are being recruited for the community home-based intensive treatment team, as an alternative to admission to Galway University Hospital. The Roscommon area has developed a home-based intensive treatment team, since February this year. The acute unit in Galway continues to recruit additional nursing staff. Based on a Labour Relations Commission agreement in early June 2015, this includes two clinical nurse managers, five registered psychiatric nurses, one suicide crisis assessment nurse and progressing registration for 12 post-graduate nurses. In addition, six clinical nurse managers and ten staff nurses are in the process of recruitment.
I understand that local HSE management has recently met with the Health and Safety Authority, HSA, and staff representatives, and that all concerns highlighted regarding health and safety are being addressed as constructively as possible. These things sometimes take time and they are not as straightforward as we like to think they are. Any indication that Galway mental health service is an unsafe service is unfounded and any patient or staff member requiring assistance from the service is encouraged to ask for it. I particularly mention from time to time that staff need support in this type of service, which is demanding and challenging. We always hear about the acute hospitals and yet the most challenging of all is the service delivered by our extremely qualified staff in the acute mental health units.
It should not be happening and we need to examine that another day. The one phrase in the Minister of State’s reply I take umbrage with is: “Any indication that Galway mental health service is an unsafe service is unfounded, . . .”. After a weekend like last weekend when an acute psychiatric unit was short four nurses and the nurses feel patient safety and their own safety is in question is an indication that a service is unsafe.
There are lots of promises in the reply about staff being recruited, and I appreciate there are difficulties in taking on staff. Is the Minister of State confident that next weekend and the weekend after, the situation in Galway will not be the same and the acute psychiatric unit will be four nurses short? Does she have absolute confidence that the management of Saolta University Health Care Group will have the proper complement of nurses available in the acute psychiatric unit to ensure that nurses and patients will have no health and safety problems?
The management reconfiguration is recent as the Senator knows, and I have every confidence in the management. I do not think anyone, no matter who, no matter what status, whether Taoiseach, President or Minister, can guarantee that things will not happen.Following my investigation into the matters raised by the Senator, I can tell him that there are sufficient staff to ensure the shortages we see at weekends do not happen. I do not know whether it is a management issue or whether other issues are coming into play but I will make further inquiries. I try to be as honest and open as possible as I do not believe in fudging matters but I cannot guarantee any of those things. I am not there and I am not the person micromanaging the system. When resources are an issue, I will do my best to deal with that but it is not my job to get into how something is managed at local level. I will make further inquiries but I cannot guarantee that people will not be missing next weekend. With the resources that have been put in, this should not happen
Ultimately, the buck stops on my desk but how a resource is managed is an issue for managers. If somebody comes to me and tells me they are short of ten nurses, it is my job to get the resources to deliver those nurses. Sometimes it is not possible because of issues relating to recruitment but it is my job to ensure it happens as quickly as possible. I have confidence in the management; I would not have approved this if I did not. We are dealing with acute mental health services which, by their very nature, have particular difficulties. To say the service is unsafe would unnecessarily frighten people who are not in the service but who need it. I have every confidence in the staff working in the psychiatric and mental health services, who are incredibly well trained and very dedicated. I have confidence in the safety of the service but, from time to time, things do go wrong.