March 03 2010

Dáil Debates

• Priority Questions: People with an intellectual disability in psychiatric institutions

Parliamentary Questions

• Part 2 of Disability Act & Assessment of Need
• Adequacy of Respite Care
• Respite in Co. Kildare
• Full complement of speech and Language Therapists in Co. Kildare

DÁIL DEBATES

• Priority Questions: People with an intellectual disability in psychiatric institutions

Deputy James Reilly (FG): asked the Minister for Health and Children her views on the fact that vulnerable patients with psychiatric or intellectual disabilities continue to be housed in archaic institutions in which they fail to receive adequate care and treatment;

Minister of State at the Department of the Health and Children (Deputy Áine Brady): Our current model of mental health care is largely institution-based, and 15 Victorian and older asylums are still in use. However, A Vision for Change, the report of the expert group on mental health policy, provides a framework for action to develop a modern, high-quality mental health service over a seven to ten year period and recommends that the remaining psychiatric hospitals should close and that patients should be relocated to more appropriate communitybased settings. The mental health capital programme will provide the infrastructure necessary for the patient-centred, flexible community-based service envisioned in A Vision for Change and will facilitate closure of the remaining hospitals. In this regard, Budget 2010 provided for a multiannual programme of capital investment to be funded from the proceeds of the sale of lands. In 2010, the HSE will dispose of surplus assets and reinvest an initial sum of €50 million in developing the new mental health infrastructure. Projects which will be progressed in 2010 include the development of an acute unit at Beaumont to replace the acute unit at St. Ita’s, Portrane; the construction of a community nursing unit in Clonmel which will enable St. Luke’s Hospital to close later this year; and the construction of a community nursing unit in Mullingar to facilitate the closure of St. Lomans’s Hospital. Approximately 300 patients with an intellectual disability are placed in psychiatric hospitals. Their needs, which relate to their disability rather than a mental health concern, will be addressed by the HSE in the context of the closure of the hospitals.

In addition to those inappropriately placed in psychiatric hospitals, it is estimated that approximately 4,000 people with disabilities reside in institutions or congregated settings. This includes a cohort of approximately 460 patients with an intellectual disability who are accommodated in specialised units which were formerly designated as psychiatric hospitals. Their needs will be addressed in the context of the review of congregated settings which is nearing completion. Congregated settings are defined as living arrangements where ten or more people share a single living unit or where the living arrangements are campus-based. The review will inform policy development on services for people with disabilities and specify a framework to guide the transfer of identified individuals from congregated settings to the community.

Deputy James Reilly: In 2004, planning permission was sought and granted for a new psychiatric unit at Beaumont and, as far as I know, it was put out to tender in 2005. However, nothing happened thereafter, funding having been withdrawn or evaporated. The new collocated private hospital at Beaumont, which has yet to have a sod turned, a brick put in place or a bed delivered, is impinging on that site and the psychiatric unit must move elsewhere. Today, we are told again by the Minister of State that it is in the pipeline. We have been waiting for 20 or 25 years and it is just not good enough.

An Leas-Cheann Comhairle: A question to the Minister of State.

Deputy James Reilly: Will the Minister of State provide a definite timeline for this unit? Why do children continue to be admitted to adult centres? In 2009, 155 children were admitted to adult centres. Suicide rates have increased and 1,200 seriously ill patients continue to be admitted to inappropriate institutions. Will the Minister of State provide a list of assets sold to date and the revenue raised for same; a list of assets due to be sold and the estimated revenue that will be raised for same; the timescale for investment; and the details of where the 1,200 patients will be placed? With regard to those with intellectual disabilities, our mental health

services were described by the inspector as crumbling institutions unfit for human habitation with residents wandering around aimlessly, cramped dormitories, the presence of dirt, the stench of urine, poor sanitation, broken furniture and the absence of constructive daily activities.

Deputy Áine Brady: In 2010, the HSE will dispose of surplus assets and reinvest the initial sum of €50 million. The HSE has already identified properties and has already received €15 million. It is in the process of selling other lands which will realise €50 million this year. The mental health capital programme will provide a range of facilities throughout the entire spectrum of mental health care facilities, including acute psychiatric units, day hospitals, community nursing units and high-support hostels, which will provide the infrastructure necessary to enable its modernisation into a patient-centred flexible community-based mental health service. The acute unit at Beaumont is prioritised as one of the projects to be funded in 2010. Acute admissions will be moved from St. Ita’s to a new unit at Beaumont.

Deputy James Reilly: There are still 23 men and 23 women sharing open wards with a block of three toilets, one shower and one bathroom. This is a disgrace in modern Ireland. Why has the 60-bedded unit at St. Ita’s sat idle for the past seven months while intellectually disabled people live with paint peeling off the walls and the dirty conditions I described? What percentage of child and adult community mental health teams are not fully staffed? The Minister of State should have that information.

Deputy Áine Brady: The Minister of State, Deputy John Moloney, was quite clear as to where he wants to go with A Vision for Change and he has three main items on his agenda: the appointment of an assistant national director with sole responsibility for mental health; to get the capital ringfenced; and to protect the human resources, which are affected by the moratorium. Deputy Reilly was present when the Minister of State indicated that he is working with the Minister for Finance to develop a mechanism whereby the human resources in certain mental health services can be supported and reconfigured where vacancies arise elsewhere and in the overall employment control framework of the HSE.

Deputy James Reilly: What is the percentage of child and adult community mental health teams that are not fully staffed? The Minister of State should have that information.

Deputy Áine Brady: That is the same issue.

Deputy James Reilly: How many? Name them.

An Leas-Cheann Comhairle: Perhaps the Minister of State will revert to the Deputy.

Deputy Áine Brady: The answer is that I do not know.

Deputy James Reilly: A Vision for Change was published in 2005. It is a disgrace.

PARLIAMENTARY QUESTIONS

• Part 2 of Disability Act & Assessment of Need

Deputy David Stanton (FG): asked the Minister for Health and Children the discussions she has had with the Health Service Executive and the Department of Education and Science in relation to the commencement of Part 2 of the Disability Act, 2005 which relates to assessment of need since the decision was taken in October 2008 to postpone its proposed implementation dates of 2010 for children aged six to 18 years and 2011 for adults; if future timescales have been proposed or developed regarding when Part 2 will be fully implemented;

Minister of State at the Department of Health and Children (Deputy John Moloney): Part 2 of the Disability Act 2005 was commenced on 1 June 2007 in respect of children aged under 5. In October 2008 the Government decided, in the light of financial circumstances, to defer further implementation of the Act and the Education for Persons with Special Educational Needs (EPSEN) Act 2004. No alternative timescales for full implementation of Part 2 of the Act have been developed to date.

• Adequacy of Respite Care

Deputy Bernard J. Durkan (FG): asked the Minister for Health and Children if she is satisfied regarding the adequacy of respite care for parents and carers of children and adults with special needs throughout the country;

Minister for Health and Children (Deputy Mary Harney): As the Deputy’s question relates to service matters, I have arranged for the question to be referred to the Health Service Executive for direct reply.

• Respite in Co. Kildare

Deputy Bernard J. Durkan (FG): asked the Minister for Health and Children the number of respite beds available in County Kildare; the number required; her plans to expand this service;

Minister of State at the Department of the Health and Children (Deputy Áine Brady): The information requested by the Deputy cannot be supplied at the moment due to industrial action by the Civil & Public Services Union (CPSU) and the Public Service Executive Union (PSEU).

• Full complement of speech and Language Therapists in Co. Kildare

Deputy Bernard J. Durkan (FG): asked the Minister for Health and Children when it is intended to provide the full complement of speech and language therapists throughout County Kildare; if the full requirement has been identified; and if she will give an indication as to when such requirements are likely to be met;

Minister for Health and Children (Deputy Mary Harney): Subject to overall parameters set by Government, the Health Service Executive has the responsibility for determining the composition of its staffing complement. In that regard, it is a matter for the Executive to manage and deploy its human resources to best meet the requirements of its Annual Service Plan for the delivery of health and personal social services to the public. With regard to the provision of speech and language therapy services, as this is a service matter it has been referred to the HSE for direct reply.

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