Vol. 478 No. 7
10 Mr. Cowen asked the Minister for Health if his attention has been drawn to the fact that a mother of an eight year old mentally handicapped incontinent child has been told to store up the used nappies so that the health board can check on them; the reason the five year plan for the development of mental handicap services has not been published in spite of commitments in this regard; and the plans, if any, he has in respect of mental health. [12308/97]
(Limerick East): I understand from the health boards that the needs of applicants for incontinence wear are assessed on an individual basis, taking account of each person's particular medical requirements. Supplies are provided according to need and individual needs are reviewed on a regular basis. With regard to the case to which I understand the Deputy refers I have asked my Department to seek an immediate report from the chief executive officer of the relevant health board on this matter. I will communicate further with the Deputy on receipt of the report.
With reference to the Deputy's query regarding the development of services to persons with a mental handicap, the Minister of State, Deputy O'Shea, recently published a report, Assessment of Need for Services to Persons with a Mental Handicap, 1997-2001, based on information from the national intellectual disability database. The assessment provides a comprehensive picture of the requirements for additional residential and day services for persons with a mental handicap over the period concerned. The Government is committed, under Partnership 2000, to the development of services to persons with a mental handicap.
It has been the policy of successive Governments to restructure the mental health services through the development of services located in the community as an alternative to institutionally based care. This policy is based on the recommendations of the report on the development of the mental health services, Planning for the Future, which was published in 1984.
Acute psychiatric units at general hospitals, day hospitals, day centres and community residential accommodation are now being provided to replace services previously provided in psychiatric hospitals. This shift in the provision of services from the traditional institutionally-based model of care to a community-based care setting has been extremely successful and is widely accepted as providing a more comprehensive service for patients and a much improved quality of life for persons who were former patients of psychiatric hospitals.
It is outrageous to talk about assessments of needs or five year plans when a mother has been told to store up used nappies of her eight year old incontinent son so that the health board can check them. There is an assessment of needs database and there is supposed to be a five year plan, although it has not been published yet. Is that because we are not prepared to make the resources available to deal with the problem based on the assessment of needs database to which the Minister referred?
What does the Partnership 2000 commitment mean to parents of mentally handicapped children and young adults? Does it mean there will be increased funding within the overall parameters?Will it be sufficient and over what timescale to deal with the need for more funds based on the assessment which is available for 1997-2001?
(Limerick East): I have very little information on the particular case to which the Deputy refers. After much checking I understand the case relates to the Midland Health Board and I have sought a report on it. When the question was put an official of my Department contacted Deputy Cowen's office seeking more information.Had we received more information I would be in a position to give the Deputy a better answer. I am unable to confirm whether the event occurred but I will get a report on the matter.
With regard to the database, the Deputy will be aware from his term in Government that the provision of day care and full residential places for persons with mental handicap had been neglected during the period of the Progressive Democrats-Fianna Fáil coalition Government.
Let us agree that it was neglected for years by successive Governments. The question is what we are going to do about it. Let us move away from apportioning blame.
(Limerick East): When the Labour Party and Fianna Fáil went into Government in 1992 there was a heavy investment in this sector, but it was investment against a generally perceived need without that need being quantified. However, significant progress was made. A database is now available which identifies the actual need and which, with the help of the voluntary groups and the health boards, has come up with figures necessary to meet outstanding need. The figures are precise — 1,439 residential and respite places and 1,036 day care places. For the first time the problem has been quantified. The Minister of State, Deputy O'Shea, has published the database and the information has been made public. In this year's budget the Government decided to invest to meet these needs through a multi-annual programme and allocated £12 million.
The social commitments in Partnership 2000 include a commitment to meet the unmet needs of the handicapped during the period of the programme which is 39 months from July. That is to say, there is a commitment from the Government to meet the unmet needs as identified in the database during the period of Programme 2000, which comprises five financial years, with £12 million being invested. The overall cost of providing these places is about £50 million and there is probably an extra capital investment necessary. That is the commitment.
As the Deputy is aware the commitment is made on the understanding that the resources will be available. The Deputy will also be aware that the commitments in Partnership 2000 are subject to the general condition of the availability of resources. The database has been published and it is the intention to provide the places over four to five years. The first instalment of £12 million was provided in the budget this year and is in the 1997 post-budget estimate.
We have already read that the Minister for Finance is talking about having to renegotiate Partnership 2000 after this election, should he be in a position to do so, because it is going off the rails.
The Minister indicated that the commitments are subject to overall resource constraints. Whatever the improvements made, it is clear that much more needs to be done for the mentally handicapped.Is the Minister prepared to give more priority and funds to this sector in the coming years, if he remains as Minister, than has been the case during his tenure to date? In the absence of such a commitment the National Association for the Mentally Handicapped of Ireland does not believe that the results the Minister predicts will be achieved. Given that the Minister must operate within the overall constraint of resource availability, will he give a commitment that he will increase the level of resources for this area?
(Limerick East): My predecessor, Deputy Howlin, and I have committed more funds annually and on an ongoing basis to this area than any other Minister for Health, by a factor of hundreds of percent. This year we have provided an additional £12 million and that will be repeated next year. Our commitment is to meet the unmet needs over the period of Partnership 2000. The commitment is tied into Partnership 2000 to make it stronger than a political commitment given in the House. This view is shared by the social partners and the parents of the handicapped.
Regardless of who will be in Government after the general election, if it is a commitment to deal with it in accordance with what is laid down in Partnership 2000 it will bind our successors, through the social partnerships. It is, therefore, stronger than a statement from me in the House. It is my intention that the unmet needs will be met over the period of Partnership 2000. As I said to the Mental Health Association of Ireland when I met representatives of its regional branch in Limerick, I cannot guarantee——
Will the Minister meet representatives of the national association?
(Limerick East): I have met them previously.
Not as Minister.
(Limerick East): I have.
Not according to them.
(Limerick East): I attended its annual meeting last year.
The national association?
(Limerick East): Yes. As the Deputy is aware, under a delegation order, the Minister of State, Deputy Brian O'Shea, is responsible for this area. He is unavoidably absent and I am answering on his behalf. I meet people regularly and there is no problem of access.
The Minister has not met them.
(Limerick East): The unmet needs will be met over the 39-month period of Partnership 2000.
Regarding the supply of incontinence sheets, it is not a matter of meeting demand for what is required. In many health board areas one receives a fixed amount, a maximum of one or two per day. This bears no relation to the number required. On mental handicap, there are unoccupied beds in some parts of the country in spite of the demand — as the Minister said, over 1,000 places are required. There are 40 unoccupied beds in Aras Attracta in Swinford, County Mayo. I ask the Minister to prioritise mental handicap, mental disability, learning disorders or whatever terminology one wishes to use, given that there are still over 1,000 people inappropriately placed in psychiatric hospitals. This will require the allocation of capital funding. I hope the Minister will make a start in this area.
(Limerick East): A significant start has been made during the past three years or so. I have prioritised this area. As Deputies are aware, I secured an extra £25 million in this year's budget for the development of services, of which £12 million is dedicated to the area of mental handicap.
