Dáil Éireann debate -
Wednesday, 29 Jan 2003

Vol. 560 No. 1

Hospital Staffing.

Caoimhghín Ó Caoláin

The Minister for Health and Children must act as a matter of urgency to address the severe staffing shortage at St. Mary's residential care facility at Drumcar, County Louth, and to ensure that the residents at the centre have all the personnel and other resources they need to live with dignity and safety. As I speak, thousands of people, including the families of over 250 people with physical and intellectual disabilities resident at Drumcar, are sick with worry about the welfare and safety of their loved ones. The consultants' report published yesterday highlights the unacceptable conditions which exist for many residents in Drumcar as a direct result of understaffing. Understaffing leads to inadequate supervision, inappropriate mixing of residents with very different abilities and disabilities, including very aggressive individ uals with passive and introverted individuals, the overuse of restraints in some cases, the leaving of some residents locked up and unattended at night, and increased risk of mortality from fire.

We can only imagine the distress to the people concerned, the residents of Drumcar, because they cannot articulate it. However, we are aware of the distress to their relatives and friends. This afternoon I was contacted by two sisters from County Cavan, in my constituency, whose brother is a resident in Drumcar. Their aged parents are infirm and in their twilight years, yet they have again been visited with the deep anxiety which never leaves the parents of people with severe disabilities, but which is alleviated by the care and concern shown in facilities such as that in Drumcar, when they have the proper resources to provide that care.

My brother, Dermot, who has Down's syndrome, spent many years as a resident at St. Mary's and our family has great appreciation and admiration for the religious and secular staff of dedicated carers. I emphasise that in raising this matter I am in no way critical of the staff and management of St. Mary's – quite the opposite. They are a dedicated, hard working, committed and well trained staff, eager to deliver an excellent service to the residents. However, they are prevented from exercising their skills to the full because staff shortages often mean they can only carry out essential duties.

The joint report of 1066 Consultancy and Healthcare Consultancy identifies clearly that the problem in Drumcar is caused by inadequate levels of staffing. Fr. Fintan Brennan-Whitmore of St. Mary's has accepted the findings of the report. I ask the Minister if he in turn accepts the recommendations of the report and the crying need for additional staff, and if he will act on them. When will the resources be provided to allow St. Mary's to engage the 30 additional staff for night duty necessary to deal with the serious and dangerous situation at night time? When will the 64 extra staff required for St. Mary's be provided to ensure a safe environment during the day?

I must point out that the Department of Health and Children approved the engagement of the independent consultants who produced the report. These consultants have an international reputation and were engaged by the Minister for Health and Children last year to advise on the nursing crisis in the accident and emergency services.

I am informed that for the past two years the St. John of God order has contracted the whole time equivalent of 23 nursing staff over and above their approved compliment in an effort to maintain the service, even at present levels. The commitment of the Order of St. John of God, the hospital order, is undoubted. It is my hope and that of the thousands of people I have referred to that the Minister will advise this House that he has, as Fr. Brennan Whitmore has, accepted the recommendations of this report, which the Minister sought. I hope the Minister will confirm that he will provide the necessary resources to see these recommendations implemented with the urgency that is clearly required.

Mr. Neville

I thank the Ceann Comhairle for allowing me the opportunity to raise this issue. The treatment of 250 mentally and physically handicapped patients at St. Mary's, Drumcar, County Louth, is a disgrace and should not be meted in a civilised society. Like the previous speaker, I complement the staff at St. Mary's and its head, Fr. Fintan Brennan Whitmore, for their initiative in commissioning this report to assist them in making their case to the Minister.

The Minister should immediately sanction 100 extra staff, including 30 night nurses. It is not acceptable that patients are locked up and left unattended at night while staff deal with others, leaving epileptic and other high risk patients open to danger. As the consultancy report on the St. John of God-run home stated, in the event of a fire the mortality rate would inevitably be high and the organisation culpable. The chief fire officer for County Louth should examine the situation with regard to the fire hazards in the home.

In St. Mary's, some of the patients are epileptic, some have IQ levels of less than 20, some are prone to injure themselves, some are autistic, some are schizophrenic, some in their 40s already have Alzheimer's disease and some are very aggressive. There is a need for fundamental change in the home. It is not acceptable and is inhuman that strait-jackets are used to restrain patients and that they are locked in rooms. That practice should have finished long ago but staff are forced to engage in it due to staff shortages. There is also a risk of harm to patients and staff due to lack of supervision. The Minister must address the situation where currently whole wings are left unattended, particularly at night, while staff struggle to cope with demand elsewhere, leaving residents at risk, particularly those with epilepsy and with the potential to self-harm.

The overuse of mechanical restraints to subdue difficult patients during the day and particularly at night is likely to be in violation of European human rights directives. There is evidence that some staff more than others use restraint in the form of all-in-one suits as a matter of routine. The report also draws attention to the mixing of violent and aggressive residents with more passive and introverted patients, which puts the latter at a disadvantage as staff spend a greater percentage of their time with the demanding residents. It is unacceptable that those who are mentally retarded, passive and introverted are intimidated by more aggressive residents. Their quality of life is severely damaged because of this. Arrangements should immediately be put in place so that people live with those of similar disabilities and abilities.

The report also draws attention to the lack of stimulation available to patients which is causing serious problems. As a consequence, their behav iour becomes more aggressive, destructive and violent. At night many of these residents are locked or shut in their rooms and unable to open the door unaided.

Reading details of the report, the institution is more like a prison than an institution of support for the physically and mentally handicapped, and custodial practice has become the normal routine. Staff should ensure that they support the residents to lead a life that is as fulfilling as possible, including their physical, psychological, social and spiritual needs. This seems to be largely absent in this institution due to the lack of resources available to the Order of St. John of God.

I ask the Minister to immediately sanction 30 whole time equivalent nursing staff to cover the night shift as a matter of urgency to ensure that the staffing levels do not put residents' safety at risk. The institution heavily relies on seasonal workers and is short of nursing staff and there is a lack of evident space for a clinical nurse specialist. The result is that practice is out of date, the care is custodial, restraint is common practice and residents' needs are not always met.

The head of St. Mary's, Fr. Fintan Brennan-Whitmore, has conceded that it is a very difficult place for staff to work, that as patients get older their needs are greater. The Minister must immediately ensure that the conditions for these most vulnerable people are addressed by ensuring that Fr. Brennan-Whitmore and his staff have the necessary resources available.

Mr. T. O'Malley

I thank Deputies Ó Caoláin and Neville for raising this matter and giving me the opportunity to outline the position concerning the issue. St. Mary's, Drumcar, is a specialist residential facility for people with an intellectual disability. There are 246 residents living in 28 separate units, with a wide range of problems from moderate to profound disabilities and an age range of 19 to 60.

The Government has made a significant level of additional funding available to services for persons with an intellectual disability and autism. In 2003 additional funding of €13.3 million has been allocated to these services. This funding is in addition to the very significant revenue investment, amounting to €188 million, which has been made since 1997 and which is built into the ongoing budget base. The figures are as follows, to the nearest million: €15 million in 1997; €14 million in 1998; €23 million in 1999; €49 million in 2000; €48 million in 2001; and €39 million in 2002. Additional capital funding of €139 million has been made available since 1997. The additional funding provided between 1997 and 2002 was used to put in place about 1,700 new residential, 470 respite and 3,000 day places.

Despite this very significant and unprecedented investment, demographic factors are contributing to growing waiting lists for residential services in particular, even though the number of people in receipt of services, including full-time residential services, continues to increase. The increased birth rate in the 1960s and 1970s has resulted in large numbers of adults in their late 20s and 30s requiring full-time residential services. In addition, people with an intellectual disability are living longer than previously, adding to the need for services compared to previous generations. This has also been the international experience in service provision to this population.

Due to the changing profile of those who have been in services for many years there is a need to review issues such as staffing levels and skills mix. For example, an increased need for additional night cover has arisen in many agencies because of the more dependent profile of the residents, due to old age, illness or behavioural issues. An ongoing review process has been under way for a number of years with the health boards and the voluntary agencies, with funding allocated annually over recent years to meet these identified needs.

The overall economic position in 2003 has had implications for all aspects of public investment and this is reflected in the Estimates and budget adopted by the Government for 2003. Within this overall framework, however, two thirds of the additional funding available for non-capital investment in services has been allocated to the health services.

Responsibility for the provision of funding for organisations providing services for people with an intellectual disability or autism in the north-eastern region is a matter, in the first instance, for the North-Eastern Health Board. The situation in Drumcar will be discussed at a meeting between my Department and representatives of the health board on Tuesday, 4 February in the context of the board's service plan for 2003. A meeting between my Department, the health board and representatives of the St. John of God order is also scheduled for the following day. Within the resources available to the North-Eastern Health Board this year, I am hopeful that progress can be made at these meetings on the most pressing problems facing St. Mary's at present.

The Dáil adjourned at 9.05 p.m. until 10.30 a.m. on Thursday, 30 January 2003.