Thursday, 9 November 2017
Mental Health Services Provision
On the matter I have raised today, I am speaking for my mental health nurse colleagues and their patients, as well as being a member of the Joint Committee on the Future of Mental Health Care and a member of the Psychiatric Nurses Association, PNA. The high-dependency psychiatric unit at Tallaght Hospital has six beds. It has been rumoured that it will close due to staff shortages. It is my understanding that there are 43 nursing vacancies in this service, which is posing serious difficulties for any recruitment or retention of nursing staff. This has been going on for a considerable number of years.
In an overwhelming ballot last week of PNA members, 85% voted for industrial action should this unit close. In 1999, the admission unit in Tallaght was opened with two beds and no high-dependency observation unit. It involved a prescribed method of taking care of patients who are extremely volatile, vulnerable and unwell. It could be a one-to-one, where one nurse would sit with the patient on a 24-7 basis, or a two-to-one, dependent on the level of risk.They demanded at the time, as did University Hospital Galway, that a high dependency observation unit be opened, in the interests of the patients' dignity and for the safety of staff and patients. It took industrial action to do this. When it was opened, there was a significant decrease in one-to-one, two-to-one or sometimes three-to-one nursing specials was glaringly obvious. The high dependency unit did not need one-to-one, two-to-one or in some cases three-to-one nursing specials for patients, which would deprive them of their liberty.
There is also the matter of seclusion. Seclusion is something we all think of as being like "One Flew Over the Cuckoo's Nest". Seclusion is down and it is used very rarely now. It is also an issue of human rights and personal freedom. However, seclusion in the so-called padded cell, or whatever one wants to call it, is significantly down because of high dependency units.
I am aghast that the Minister of State with responsibility for mental health has proposed closing this high dependency unit leaving patients, staff and visitors to the unit very vulnerable. It is a retrograde step. It is going back to the Victorian practice of taking away people's liberty to move around without somebody following them, even into the toilet or shower, so that they can continue the prescribed one-to-one observation. Could the Minister of State please respond and put nurses' and patients' minds at ease? Go raibh maith agat.
I thank Senator Máire Devine for raising this very important issue. I am well aware of her track record on mental health and with the Pyschiatric Nurses Association, PNA. I thank and commend her for her work in the past on those particular issues. I know the concerns she raises today are totally genuine. Our objective is to ensure that all patients and the staff who work with them are given priority.
Mental health remains a key programme priority for this Government, underscored by the fact that the HSE's mental health budget increased from €836 million in 2016 to approximately €851 million this year, and will further increase to approximately €910 million next year. This new investment will help to expand and modernise all aspects of the particular services.
Nationally, and in Dublin South-Central in particular, the HSE has encountered significant issues in the past few years in recruiting and retaining registered psychiatric nurses. This is a recognised issue for all nursing disciplines in the Dublin area, and was a factor in the previous industrial action by the PNA in 2016. The HSE has been attempting to maintain a full level of inpatient and community services in the face of this staffing challenge. This has contributed to a significant level of both agency use and nursing overtime. However, in trying to alleviate such pressures, the HSE has an ongoing recruitment campaign for psychiatric nurses in Dublin South-Central, alongside panels already in existence at the HSE national recruitment service in Manorhamilton. The acute mental health admission unit at Tallaght Hospital is endeavouring to provide a safe and secure environment to treat patients for the acute phase of their illnesses. The management of the service has become increasingly concerned about the high dependency on the use of agency staff and the inability to adhere to provisions of the working time directive.
The lack of staff continuity in shifts, together with the over-reliance on agency staff, are significant risks to patient safety. We accept that. The HSE is considering several options, and while no decision has yet been made, consideration has been given to closing the six-bed ward known as the Aspen ward. This ward was originally opened as a high-observation ward in 2003. Due to the limitations in design, it has not operated as a high-observation ward for some years. It now serves generally as a low-stimulus environment for selected patients. The closure of Aspen, if it proceeds, may reduce the bed capacity of the acute admission unit from 52 to 48 beds. A concerted effort is under way to reduce the cohort of patients on the unit whose acute phase of treatment has now been completed in order to ensure that bed availability for acute admissions is optimised. The management of the service continues to engage with staff representatives to explore all options to reduce the impact of nursing vacancies in the service. This service is currently running a nursing vacancy rate of 20%, against a complement of approximately 200 qualified nursing staff. That is a very difficult position.
Any measure taken to relieve this problem by the HSE is taken with a view to minimal impact on front-line services, and will be reviewed regularly for the impact on patient care. Subject to the availability of appropriate additional staffing, it is intended that any bed reduction will be temporary in nature.
I thank the Minister of State. I am delighted, as is everyone in the health service, that the Child and Adolescent Mental Health Services, CAMHS, beds have been reopened in Ballyfermot. It is a good news story and I am delighted that it has happened.
I refer to converting the agency staff to permanent posts. In regard to the design of buildings, we have had these problems before. The design needs to be led by service users, including the staff and patients, saying how they want their building to look. That needs to be done in all establishments in all parts of the health service.
We are again going to throw vulnerable patients out onto the street with no community services. Will the diagnosis and a risk assessment be done? We are downgrading the beds but nothing is replacing the service in the community, so we are just throwing them to the wolves. Will the Minister of State get in touch with the general secretary of the PNA, Mr. Peter Hughes, who has solutions to this and prevent the industrial action which nurses are unfortunately forced to take because of the loss of services to our patients?
I thank Senator Devine for her contribution and welcome her comments on the CAMHS facility in Ballyfermot. That is a good news story. To go back to the original debate, we have a major problem with staffing and I share the Senator's concerns in that regard. I met with Mr. Paul Bell from SIPTU yesterday in regard to care staff and the disability services. There is an issue there about recruiting staff. I accept that point. That is an issue the HSE has to do something about. We are 20% down and that is the reality. My problem is that we are increasing the funding for mental health to €910 million next year but seem to have a problem getting the staff. My argument, which I am sure is made by a number of Ministers, is that when we bring in agency staff costs are increased and the stability of the service is taken away, which is needed.
I will bring the Senator's concerns back to the Minister. We should listen to the PNA and the contributions from people on the ground. The Senator knows from her own experience, and I know as a former branch secretary in the Irish National Teachers' Organisation, INTO, that people on the ground will give an insight to management on the way services are run every, and their voices should always be listened to.
The Senator mentioned the important issue of designing the buildings, and involving patients and service staff directly in that process. I will bring the Senator's concerns back to the senior Minister and the HSE. We have to do something about the shortage of nursing staff and prevent the closure of wards.