Private Members’ Business Dáil Éireann, Tuesday, 5 February 2008 – Speech by Minister of State for Mental Health and Disability Services, Dr Jimmy Devins, T.D.

I welcome the opportunity to respond on behalf of the Government and my colleague, the Minister for Health, to this motion. It is an opportunity to debate our health services, the policies we are implementing, and the progress our country is making on the basis of facts about our health services.

If our debates are not informed by facts and a recognition of progress that has been and is being made, then we have no rational basis on which to map out what needs to be done next, to make clear what our priorities should be, how to allocate funding, and how to build sustained improvements and higher performance.

This is the only basis on which those of us involved in doing, rather than commentating, can act. It’s only by recognising real progress that we can address real issues.

I do not want to rehearse a long list of general statistics, and I do want to address particular aspects of the debate this evening. But it is the truth, for example, that

•life expectancy has increased rapidly in Ireland in the last two decades, at one of the fastest rates in the developed world, and especially since 1999
•our cardiac and cancer services are improving constantly and are far improved from where they were, only ten years ago
•waiting times for common operations have been cut from years to months
•the number of people with medical cards is now rising again since 2004 and more people can now visit the doctor free of charge than in any time since the early 1990s
•our hospital services are expanding in range, depth and volume with many hundreds more consultants and specialist staff treating tens of thousands more people
•we now have Home Care for 10,000 older people where we had none a few years ago;
•we now have Breast cancer screening where we had none and we will soon start cervical and colorectal screening.

These are facts. This is ‘where we are at’ now. It is real progress and we are determined to build on this reality. We are not where we want to be, yet. But we are getting there.

Cystic Fibrosis Services

I would like now to turn to some specific aspects of the debate. The improvement of services to persons with cystic fibrosis has been a priority for the Government and for my colleague, Minister Mary Harney. We are as concerned as anyone in this House to improve services and facilities for people with cystic fibrosis. We understand the frustration of patients and their families while new facilities are yet to open.

However, we have begun to make progress in services.  Following publication of the Pollock Report in 2005, the Health Service Executive established a Working Group to undertake a detailed review of cystic fibrosis services. The Group, which was multi-disciplinary in its composition and included representation from the Department of Health and Children, was asked to review the current configuration and delivery of services to persons with cystic fibrosis in Ireland. The Group identified a range of service improvements required for persons with Cystic Fibrosis, including the need to increase the level of clinical, nursing and allied health professional staffing in Cystic Fibrosis units around the country.

Arising from the Pollock Report and the emerging recommendations of the Working Group, the Minister for Health allocated additional revenue funding of €6.78 million to the Health Service Executive (HSE) in 2006 and 2007. This funding helped in the appointment of 44 additional staff, covering both adult and paediatric services across a number of hospitals, throughout the country. The necessary funding is available to facilitate the recruitment of a further 37 staff nationally.

The HSE was asked to place a particular focus on the development of services at the National Adult Tertiary Referral Centre at St. Vincent’s Hospital. A number of capital projects have recently been completed at the hospital and have helped to improve facilities. These include a new ambulatory care centre, the refurbishment of St. Camillus Ward, and a new Accident and Emergency Department which includes single room accommodation.

However, it is accepted that these developments do not address the immediate needs of patients. For that reason, the HSE is currently fast-tracking the re-development of a ward which is adjacent to the main cystic fibrosis treatment area. The project is to commence within the next few weeks and will provide six single rooms. On completion, additional work will begin to provide a further eight single rooms. This will result in a total of fourteen single rooms for cystic fibrosis patients by the end of the summer.

In the longer term, a new ward block is to be built and will include 120 replacement beds in single en-suite accommodation, including accommodation for cystic fibrosis patients. Planning permission has been obtained, financial provision has been included in the HSE Capital Plan and the contract is to be awarded this year. It will be a condition of the contract that the design build period is to be not more than 24 months from the date of contract award.

Beaumont Hospital operates as a regional centre in providing services to adults with cystic fibrosis. In the 2008 Budget a special allocation of €2.5m capital funding was provided to enable Beaumont Hospital to provide out patient facilities for cystic fibrosis patients.

An independent registry for cystic fibrosis has been established. As yet, the data is not available to fully inform analysis relating to median survival in this country. When it is available, the data from the Registry will allow for benchmarking against comparable countries around the world to measure the performance of our healthcare system.

Mental Health services

I would like to turn now to the area of my Ministerial responsibility, mental health services. ‘A Vision for Change’ the Report of the Expert Group on Mental Health Policy, which was published in January 2006, sets out a comprehensive policy framework for our mental health services over a 7-10 year period. The Report proposes a holistic view of mental illness and recommends an integrated, multidisciplinary approach to addressing the biological, psychological and social factors that contribute to mental health problems. Special emphasis is given to the need to involve service users and their families and carers at every level of service provision.

Some misconceptions appear to have arisen in relation to the funding requirement for the implementation of ‘A Vision for Change’ and I welcome the opportunity here this evening to correct those misconceptions. The estimated additional cost of implementation is €150 million i.e. €21.6m per year over 7 years, or €15m per year over 10 years. ‘A Vision for Change’ is clear that new funding should follow implementation, and in this regard a total of €51.2 million has been allocated since 2006.

Thus, in the first two years of a 7-10 year implementation period, one third of the overall requirement has already been allocated. In view of this very significant additional investment in 2006 and 2007, it is appropriate, and indeed prudent, in 2008 to ensure consolidation of the investment to date and to make sure that the funding delivers what is intended.

I should also explain that in addition to the extra funding required to fund service developments, the Report notes that existing resources within the mental health service, should be remodelled and reallocated. There are of course substantial resources already invested in mental health; in 2007, an estimated €1 billion was spent on these services.

The implementation of ‘A Vision for Change’ is therefore dependent to a much greater extent on the remodelling of existing resources, rather than on new funding. It is also clear that both the additional investment and the reorganisation of existing mental health services and resources must be managed in parallel.

Deputies will no doubt accept that it is necessary, in the context of the ever-increasing demands for health resources, that mental health expenditure be closely monitored to ensure that services demonstrate both effectiveness and efficiency. Before any further additional funding is provided, it is I believe essential, that the HSE is in a position to demonstrate that the funds allocated for mental health services are efficiently used and that the substantial changes in the organisation and delivery of mental health services envisaged in ‘A Vision for Change’ are progressed in a timely fashion.

The HSE has advised the Department of Health and Children that because of competing expenditure pressures and the overriding obligation to live within the approved overall allocation, some of the planned developments in mental health services in 2006 and 2007 have been delayed. While this has been disappointing to me and to all involved in mental health services, I note that some of these developments will proceed in 2008, for example,

•the provision of 8 additional Consultant Child Psychiatry teams
•the provision of 18 additional beds for children and adolescents at St, Anne’s, Galway, St. Vincent’s, Fairview and St. Stephen’s Hospital, Cork. The provision of these beds will increase the bed complement from the current provision of 12 to 30 during 2008.
•the construction of two 20 bed units for children and adolescents in Cork and Galway. Construction is expected to commence in 2008 and be completed in 2009.

In the context of the 2008 Service Plan, Minister Harney has pointed out to the HSE that there can be no question of diverting service development funds to meet expenditure pressures arising in relation to core services and expressed her concerns about the development of mental health services in line with ‘A Vision for Change’

The Minister also pointed out that she believes there is scope within the HSE’s overall allocation to deliver further service enhancements in 2008, over and above those outlined in the Service Plan, through improved performance, productivity and realignment of existing resources.

The HSE has primary responsibility for implementing the recommendations of ‘A Vision for Change’ . I understand that the HSE implementation plan has now been finalised and it is expected to be presented to the Board next week. I will meet with the HSE shortly to pursue these issues.

I am pleased to be able to reassure Deputies that this Government is committed to the provision of a high quality mental health service. The service is underpinned by the comprehensive policy framework outlined in ‘A Vision for Change’ and ‘Reach Out’- the National Strategy for Action on Suicide Prevention. Furthermore it is supported by the legislative reforms contained in the Mental Health Act 2001 and has been in receipt of unprecedented levels of funding in recent years.

‘Reach Out’ aims to prevent suicidal behaviour, including deliberate self-harm, and to increase awareness of the importance of good mental health among the general population. A key component of‘Reach Out’is to develop and implement national training programmes. The HSE’s National Office for Suicide Prevention, which oversees the implementation of the Strategy, is engaged in a significant level of training including the ASIST (Applied Suicide Intervention Skills Training) programme and has already trained 91 trainers and delivered over 200 x 2 day workshops to over 5,000 people around the country. In October last, I had the pleasure to launch the National Office for Suicide Prevention’s Mental Health Awareness Campaign. The main aim of the campaign is to influence public attitudes to mental health. The campaign is specifically designed to change negative attitudes and to promote positive attitudes to mental health. The campaign was developed by the National Office for Suicide Prevention in partnership with key voluntary and statutory agencies working in the area of mental health in Ireland.

I wish to assure you all of my personal commitment to the provision of quality care in the area of mental health, to upholding the civil and human rights of those who suffer from mental illness and to encouraging measures aimed at combating the stigma that is so often associated with such illness.   I welcome the establishment of the Office for Disability and Mental Health, announced by the Taoiseach on Wednesday 30th January 2008. The Office will support me in the exercise of my functions in relation to disability and mental health across four Government Departments. In relation to mental health, the Office will focus in particular on driving the implementation of ‘A Vision for Change’ and will, I am confident, lead to more coherent policy making and the more effective use of resources. The establishment of this Office makes the political commitment to mental health a reality.