I am very glad to have an opportunity to speak in this debate and to refute the inaccurate statements which have been made regarding the current state of the health services. I would like to concentrate on two important areas of our health services where there have been significant achievements since this Government took office.
In Ireland we have built up a wide range of specialised services for our mentally handicapped people. The quality of our service is recognised internationally. There is no doubt that this is due, in no small part, to the magnificent contribution which the many non-statutory organisations have made. Their attitude of sharing and caring has ensured that the highest standards are afforded to our mentally handicapped people in keeping with their dignity and worth.
There are, at present, some 326 units or centres which provide 9,834 places for our mentally handicapped people. Some 5,800 of these are residential places, the remaining 3,000 are day care places. These figures exclude the 2,000 mentally handicapped people inappropriately placed in psychiatric hospitals. They also exclude the provision made by the Department of Education for the handicapped in schools and classes throughout the country. In 1986 over £100 million will be spent by the Department of Health on services for the mentally handicapped. This is about 100 per cent more than was spent in 1980.
I must say that I took grave exception to Deputy Briscoe's rather vindictive and untrue remarks made during the course of this debate in relation to the Minister's attitude to voluntary groups who look after the mentally handicapped.
The Minister for Health has, on numerous occasions, discussed the present state of the mental handicap services with representatives of the non-statutory organisations and impressed his commitment not only to maintain the existing level and high standard of our mental handicap services but to improve these. We, in Government, recognise that mentally handicapped people must have a particular priority within the health services.
Since becoming Minister for Health, the Minister has clearly demonstrated that this was no false promise. Since he came to office, projects have been completed at: Cheeverstown House; St. Michael's House, Belcamp; Swinford; Cootehill; St. Patrick's, Upton. Major improvement schemes have been completed in St. Mary's, Drumcar and funds have been given to facilitate the development of community-based services by the Brothers of Charity and the St. John of God Brothers. Expenditure on these projects amounted to £27.1 million.
In addition, between 1983 and 1985, almost £3 million was provided to enable minor improvement works to be carried out in mental handicap centres.
He has also initiated a scheme to enable a planned programme of maintenance works to be undertaken in centres for mentally handicapped people over a 3-year period. A sum of £600,000 was spent in 1985, £400,000 in 1986 and at least £400,000 for further improvements will be allocated in 1987. In addition, in 1986, the Minister has provided capital grants totalling £710,000 towards the development of community-based services.
One hundred and fifty new posts have been created in the programme which has enabled 14 new projects to be commissioned including developments at Cheeverstown House, St. Mary's, Drumcar, Pope John Paul II Centre, Galway, St. Michael's House, Dublin; Sunbeam House, Bray and Galway County Association.
Of course the Minister is conscious that much remains to be done to bridge the gaps and eliminate the weaknesses which exist in our mental handicap services. There is an urgent need, particularly in the current economic climate to evaluate existing information at our disposal and to draw up guidelines for the future development of all aspects of the mental handicap services. For this reason he has initiated a review of the mental handicap services. This task will be carried out by way of consultation with the persons and organisations involved in the provision of the service. Despite the onerous task, it is expected that the review will be completed quickly.
I would hope that from what I have said it will be perfectly clear that the Minister is determined to continue to give our services for the mentally handicapped the highest possible priority and to ensure that the present standards for the care of the mentally handicapped are maintained. He looks forward to continuing to work in partnership with the many non-statutory agencies in establishing comprehensive services throughout the country for a very special group of our people.
The Minister has also been accused of being uncaring in his approach to services provided for the mentally ill. Nothing could be further from the truth as is clearly evident in the developments which are taking place in the psychiatric services. The report Planning for the Future has pointed the way for the future organisation of our psychiatric services based on a comprehensive community-oriented service which will cater for the varying needs of people with mental illness. The components of such a service include prevention and early identification assessment, diagnostic and treatment services, in-patient care, day care, out-patient care, community-based residences together with rehabilitation and training. These facilities are being provided in the community so that they are close to where people live and work. They will provide an alternative to the largely institutional services now in existence which were planned at a time when more modern treatment methods were not available. The great advantages of this reorganised service will be that most patients will be able to continue to live in their own homes with the necessary psychiatric support being provided locally.
Each of the eight regional health boards have drawn up plans to implement the report Planning for the Future in respect of the psychiatric services in their respective functional areas. The Minister's Department is actively following up the implementation of these plans with the individual health boards and considerable progress has been made to date. The Minister has allocated considerable capital resources to enable the health boards to develop facilities in the community such as mental health centres, day facilities, supervised and unsupervised hostels, high support hostels, rehabilitation units etc. A considerable effort is being put into the reorganisation of the psychiatric services in this country which will result in significant improvements for people suffering from mental illness in so far as a comprehensive psychiatric service will be provided in a community setting without the need for admission to large psychiatric hospitals.
In my own area, the South Eastern Health Board have drawn up a comprehensive plan for the reorganisation of psychiatric services in the region based on the principles which I have already outlined. This plan provides for the organisation of the service on a sector basis which means that a comprehensive psychiatric service will be provided for a population of known size who are resident within a clearly defined district. This service will be provided by a multi-disciplinary psychiatric team with a consultant psychiatrist as its leader. The plan provides for the provision of acute psychiatric units at Kilkenny and Wexford and the upgrading of existing units in Ardkeen and Clonmel together with the development of mental health centres in Waterford, Wexford, Kilkenny, Carlow, Clonmel, Dungarvan and Enniscorthy. The services to be provided in these centres will include assessment, diagnostic and treatment clinics, nursing care, rehabilitation and activation facilities and will be the location of key sector headquarters and administrative facilities where necessary. In addition, centres for day care and clinics are being considered in association with community care facilities for smaller urban areas such as Thomastown, Clogheen, Kilmacthomas, Tipperary, New Ross, Mullinahone, Gorey, Bunclody, Carrick-on-Suir, Bagenalstown, Cashel, Castlecomer, Tullow, Lismore, Callan and Cappoquin.
In the context of the development of psychiatric services in the South Eastern Health Board area I would like to refer to the position of Carlow Psychiatric Hospital. A lot has been said about the present Carlow hospital this year, some of it mischievous.
In the plans drawn up by the South Eastern Health Board for the development of psychiatric services, it is proposed to transfer back to the Eastern Health Board the services in respect of County Kildare. These have traditionally been provided by Carlow. A new catchment area will be created which will have as its hospital base a new unit at Kilkenny General Hospital. When the Minister published the report on the psychiatric services —Planning for the Future— he said Government had accepted the recommendations. Subject to any changes as a result of discussion of the report he proposed to implement it. The report was very widely accepted and to give impetus to its implementation he chose two hospital areas in which the recommendations should be implemented without delay. He was criticised for that. No doubt he would have been criticised even more strongly if he had decided not to implement the report. He was in a no-win position. Despite a slow start, progress is now being made and I expect that that will become clear very soon. Here again, despite the pressure on resources, funds will be made available to enable the plans to be implemented.
I would like to congratulate the Minister and, indeed, the South Eastern Health Board for their enlightened approach to the care of people suffering from mental illness.
Since he was given the health portfolio, the Minister has given priority to the reorganisation and development of the psychiatric service. The development of this service along the lines which I have indicated is a further indication of the steady improvements which have taken place in the overall health services since this Government took up office.