Psychological Service.

The Minister of State may understandably feel beleaguered today given that the House has already discussed the dispute of public health doctors, a Private Members' motion on the equality of cancer care services and I am now raising the position of psychological services within the health service. This is currently subject to an intensive lobby of all public representatives by psychologists in all areas of the country.

The arguments are both basic and valid. They describe how staff shortages are impacting on service delivery throughout the country. Vulnerable adults and children are not receiving an adequate range of services. Children entrusted to health board care are not receiving adequate psychological services. Health boards are storing up a medium and long-term financial burden because of a failure to deliver these psychological services.

The Minister for Health and Children has earned a reputation of initiating a number of reports and reviews. While on the surface the need to inform and find out the circumstances that exist in the health service is necessary, the amount of reports and reviews undertaken and the failure to act on them is an indictment of the failure of the Minister, the Ministers of State and the Department.

The state of the psychological services is a good example of this. In 1994, those involved in psychological services lobbied for a review to be undertaken, this was agreed to in 1995 and the review was finally put in place in 1999. The grounds for such a review were: difficulties in recruiting and retaining qualified psychologists; staff shortages were seriously impacting on service delivery; a number of existing posts were inadequate to meet the need and range of psychological services for vulnerable adults and children; and that children entrusted to the care of health boards were, in many cases, not receiving any psychological service at all. As the terms of reference for the review, these are also the criticisms that can be levelled at the Government today for its failure to properly resource psychological services within the health service.

The main difficulty is the 40% shortage of psychologists in the country. This can vary from region to region. My colleague, Deputy Gogarty, tells me that the shortage is 64% in the Eastern Regional Health Authority area and it is higher again in the South-Western Area Health Board. I have seen how real these difficulties are in the Southern Health Board area and how the Government's promise of 50 training places annually was met by providing only two last year.

The final report of the review on psychological services within the health service was delivered in March 2002. It made a number of recommendations that the Government has not implemented 13 months later, nor has it put in place any mechanisms that would allow them to be implemented.

I will cite a number of the recommendations and ask the Minister of State how the Government intends to respond to this real need. The recommendations included: the commitment to bring the number of training places to 50 per year; the need to allow clinical psychologists to be clinicians, rather than administrators, in assessing people; the establishment of the post of director for clinical psychologist in each health board; and the need to establish principal posts in each community care area. Given the shortfalls in the training system and the numbers that need to take up those places, what are the Government's medium and short-term plans to meet and seek to reduce the number of vacant posts in the psychological services?

I am sure the Minister of State will agree that this cannot continue. For many of the people in need of these services, it means we are intensifying problems that could be easily solved by the required political will.

I thank the Deputy for raising this matter and I would like to outline to the House the good progress that has already been made in implementing key recommendations of the report of the joint review group on psychological services in the health services. Following the publication of the report of the joint review group in March 2002, a major priority for the Department of Health and Children was to promote an integrated and co-ordinated approach by the health boards to its implementation over time. This applied in particular to the major recommendations of the report relating to the organisation and management of psychology services, entailing substantial increases in the number of principal and director level clinical psychologist posts.

Given the key role of the Health Boards Executive in fostering collective working and progressing organisational change and development in the health service, the Department secured the agreement of the executive to work with the directors of human resources in the health boards towards the implementation of the recommendations of the report. The present position is that the directors of human resources are in the process of individually considering the recommendations contained in the report and how the boards might propose to proceed with the implementation process in due course. This work is being undertaken in light of service imperatives, funding priorities and the budget 2003 announcement on public service numbers.

In this context, it is important to bear in mind that the overall budgetary and economic position in 2003 has had important implications for all aspects of public spending. This is reflected in the Estimates and budget adopted by Government for 2003. Given these constraints the Department, together with the directors of human resources in the health boards, is prioritising support for the implementation of a key recommendation of the joint review report relating to human resource planning. This is being secured through the continued provision of a substantial number of additional postgraduate training places in clinical psychology. This has resulted in a threefold increase since end-1999, from 26 to 83, in the number of student clinical psychologists employed in the health services. This development, in enhancing graduate output, will help maintain an improved balance between demand and supply in human resource and service provision.

The Department remains committed to working on an ongoing basis with health agencies, educational providers and the education authorities to ensure adequate provision of training places, consistent with the medium-term human resource requirements of the health services as detailed in the joint review group's report.

A particular priority is to secure the best return in terms of graduate output on the very significant financial resources currently invested in psychology training. In this context, the Department has recently initiated a review, to be completed in the coming months, with a sub-group of the directors of the human resources group of the current training model for postgraduate psychology training. The main objective of the review is to underpin the maintenance and development of training provision on a planned and sustainable basis into the future.

In light of the foregoing, the House will note that good progress is being achieved in addressing the range of recommendations contained in the joint review group report.

The Dáil adjourned at 10.50 p.m. until 10.30 a.m. on Wednesday, 16 April 2003.