Maire Devine (Sinn Fein)
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I will share a minute of my time with Senator-----

Denis O'Donovan (Fianna Fail)
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Three and one?

Maire Devine (Sinn Fein)
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Yes.

Denis O'Donovan (Fianna Fail)
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I will remind the Senator.

Maire Devine (Sinn Fein)
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I welcome the Minister of State to our new abode. I am not sure how it will pan out but we will do our best to behave ourselves. I want to raise the issue of Roscommon Mental Health Services and the report published a few days ago. The report reveals secrecy, poor standards and, quite frankly, negativity within Roscommon Mental Health Services. It also shows that moneys were given back by Roscommon Mental Health Services to the tune of almost €18 million - €18 million that is so desperately needed. In a reply dated 18 September to a parliamentary question by my colleague, Deputy Buckley, the HSE said that no unallocated spend and no moneys were given back. They have been given back. This report is quite shocking and saddens me as a former mental health nurse. There was a significant reduction in nursing levels and there was a massive reduction in the filling of medical posts. We recognise that there is a problem there, are working on it and have solutions.

When we spoke previously about Linn Dara, I told the Minister of State that there are solutions within my organisational body, which is the PNA, Psychiatric Nurses Association. The association has reviewed the Roscommon report and has no confidence in what is to become an implementation group established to give effect to this review's recommendations. Senior management was referenced in the review. How can we have confidence in the implementation group when the report clearly states that leadership at a number of levels appears to be ineffective?The PNA is demanding that the proposed implementation group be independently chaired, not include the senior managers who were in place during the period of the review and include representatives of on-the-ground workers. I am gobsmacked that €18 million was sent back. The review focused excessively on financial matters to the detriment of the staff's working conditions and safety, as well as patient care.

We need to abide by the recommendations made. We know that there will be no comfort if the implementation group is led by those who were found in the review to be totally ineffective. Why would we put them in charge? At times it is a little like what is going on in the Garda. Why would the Minister of State continue with it when we know that it is broken? He needs to fix it. Mental health services need to be managed well and the Minister of State has been tasked with that responsibility.

Trevor Ó Clochartaigh (Sinn Fein)
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Cuirim fáilte roimh an Aire Stáit. Tá alltacht orm agus mé ag cloisteáil inniu go bhfuil €18 milliún do na seirbhísí seo curtha ar ais as Ros Comáin.

As the Minister of State might know, Galway and Roscommon are linked in the provision of mental health services. I attended presentations a number of years ago at which we were told that the model to be used in the Galway-Roscommon mental health service would be exemplary in terms of best practice, but it is absolutely not.

I attended a joint policing committee, JPC, meeting yesterday. I am concerned about an increase in the numbers of burglaries, assaults, etc., and told by senior gardaí that many of them are alcohol and drug-fuelled. In Galway we are way behind when it comes to the provision of addiction counselling and mental health services. It is, therefore, disgraceful to find out that €18 million has been sent back. This issue has to be addressed. When one makes a comparison, there are far more counsellors in Waterford and Tralee than in Galway city and county, Mayo and Roscommon. We certainly need those moneys to be put back into the services in the region in order that we can deal with the very serious issues mentioned at a grassroots level.

Jim Daly (Cork South West, Fine Gael)
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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.

Maire Devine (Sinn Fein)
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The Minister of State referenced A Vision for Change. It is an excellent document, but its sell-by date is last year. Some 73% of it has not been implemented. In this instance one can rightly call the Roscommon-Galway report, Aversion to Change. It is stuck in the past and stuck in the old ways.

I have two things to ask of the Minister of State. The first is that the implementation group is not peopled by those who were implicated in this report. That is of utmost need. To give trust and respect to this implementation group, we cannot have those named in the report as being inefficient, if that is the polite word. The second thing I ask is for is on behalf of the people and services of Galway and Roscommon. We want our money back. We want the €8 million back and ask the Minister of State to please provide a cheque as soon as possible.

Denis O'Donovan (Fianna Fail)
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I think the Senator has outlined her response sufficiently. Is there anything the Minister of State wants to add briefly?

Jim Daly (Cork South West, Fine Gael)
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I assure the Senators that I have taken on board their concerns. I have met with the Psychiatric Nurses Association, PNA, on this matter and discussed this and a number of matters. I have met with it and heard its concerns previous to today. I gave it an assurance that I will take on board its concerns about the composition of the implementation group and who it consists of, and I will be monitoring it closely. I will also be visiting the region myself to have a look first-hand. There is a body of work to be done and a group has been tasked to do that work. I want to let some of that work get under way before I get involved directly, hands-on, but I assure the Senators that I intend to do that. I thank them for their concern about this important matter.

Maire Devine (Sinn Fein)
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What about the cheque?

Jim Daly (Cork South West, Fine Gael)
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I do not issue cheques, Senator. That is a matter for the HSE.

Denis O'Donovan (Fianna Fail)
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I am sure we will hear about this again.