Adjournment Debate.

Mental Health Services.

Mr. Neville

I thank the Ceann Comhairle for allowing me to bring to the attention of the House the death in Limerick Regional Hospital at 1.30 p.m. on 20 September 2002 of a 21 year old student who was found hanging by her dressing gown belt from a shower curtain support in a bathroom of the acute psychiatric unit in the Mid-Western Regional Hospital, Limerick.

I express our deep sympathy to the parents and brother of the patient who died and know that whatever reports are carried out will not bring back their beloved daughter and sister.

The patient suffered from severe depression from age 18 and on two occasions, one of which was the day following her 21st birthday, the patient attempted suicide. On 13 September 2002 she was admitted to St. Patrick's Hospital in Dublin without a full check by the hospital of her VHI cover, and it was found that the VHI did not cover her treatment. This forced the family to terminate the private treatment and to transfer her back to Limerick Mid-Western Regional Hospital. This should not have happened andher private insurance status should have been identified by the hospital prior to heradmission.

Despite the patient showing serious suicide risk, she was discharged into her parent's care, who travelled by train. If the patient was suffering from a serious general medical condition, the transfer would have been arranged by ambulance with medical back-up.

The consultant psychiatrist at St. Patrick's informed the clinical director of the Limerick Mental Health Services that there were concerns in relation to the patient's risk of suicide and that she was in a special care unit with 15 minute nursing observations. However, the treating consultant at the Mid-Western Health Board hospital had not been advised of a significant suicide risk. It is clear that communications regarding the patient between the consultants was insufficient, indirect and lacking in detail.

In his ward round on the morning of 20 September, the treating consultant failed to notice the hand-written letter to him from St. Patrick's Hospital, which contained concerns about the patient's current mental state and registered unease about the risk of self-harm, including details about medication that had ameliorated the patient's agitation and attendant subjective distress. The patient's life was at risk as a result.

The psychiatric nurse in ward 5B brought to the attention of the treating consultant that the collapsible curtain rails had become detached, but this was regarded as insignificant.

The report drew attention to the fact that the treatment plan was based on the clinical examination and opinion of two junior doctors without direct consultant assessment. The transfer material failed to outline the settings in which the patient was treated and the level of nursing intervention applying in St. Patrick's Hospital.

Serious concern is expressed regarding the trainee psychiatrist who admitted the patient. His psychiatry experience commenced two months previously in child and adult psychiatry but he had on-call duties for adult mental health. The report expressly states that a doctor of such limited training should not be rostered on a general adult psychiatry duty rota.

The documentation from St. Patrick's Hospital failed to identify that the patient had been cared for in a special care unit. The documentation was misaligned and in the case of some of the documents foolscap-sized material had been photocopied on to A4 sized paper with the loss of information including the letters CU appearing instead of SCU, which stands for special care unit. This would have alerted admitting staff to the patient's serious condition. The initial nursing assessment failed to read through the detailed clinical information forwarded from St. Patrick's, although these notes were available.

The absence of a high-observation area in ward 5B and a dedicated child and adolescent unit is identified as a serious deficiency in the facilities of the ward. Such facilities, if available, will contribute to the more efficient observation of patients in danger. The observation of Anne in her ward created difficulty for severely over-stretched nursing staff. At midday, two student nurses who had been detailed to observe her went off duty and a nurse detailed to observe another patient was asked to take over. She advised she was unable to do so. However, she was misinformed by another nurse who presumed that she had seen Anne in the dining room. It was not Anne, who, at approximately 1.30 p.m., was discovered missing and found hanging from a shower railing.

Minister of State at the Department of Health and Children (Mr. B. Lenihan)

I thank Deputy Neville for raising this matter on the Adjournment. The case to which he referred is tragic and I extend my condolences to the family concerned. Every sudden death of a patient in psychiatric care, from whatever cause, is most regrettable.

In accordance with section 272 of the Mental Treatment Act 1945, the Office of the Inspector of Mental Health Services was informed of the death of the individual at the Mid-Western Regional Hospital in September 2002. The Mid-Western Health Board indicated at that time that it was conducting its own investigation into the circumstances of the case. Following completion of that investigation, it decided to establish an independent review committee to carry out an independent clinical review and audit regarding the care and treatment of the person concerned.

The committee was established by the Mid-Western Health Board in October 2003 and its final report was presented to the board on 28 June 2004. A copy of the report was also made available to the family of the deceased and to my Department. It would be inappropriate for me to comment in detail on the content of that report. However, I am informed by the Mid-Western Health Board that the Limerick Mental Health Service has considered the report and welcomes its recommendations as a means to guide continuous improvements within the service. The board has agreed a process to achieve implementation of these recommendations. The process includes converting the recommendations into detailed and specific action plans and the establishment of a working group to carry out and implement the actions identified. Implementation will be monitored, reviewed and directly supported by the executive of Limerick Mental Health Service.

Upon receipt of a copy of the report of the independent review committee in July, my colleague, the Minister of State, Deputy TimO'Malley, referred it to the Mental Health Commission. One of the functions of the commission is to promote and foster high standards and good practices in the delivery of mental health services. The commission endorsed the recommendations of the committee and indicated that those recommendations which are applicable to all mental health service providers will be incorporated into the quality framework being developed by the commission. This framework includes the development of standards for mental health care, clinical governance and codes of practice. The inspections by the Office of the Inspector of Mental Health Services provide for the ongoing monitoring of such policies and standards by the Mental Health Commission.

I am satisfied that the circumstances surrounding the unfortunate death of the individual concerned have been fully investigated. My Department will continue to monitor developments in the Limerick mental health services to ensure that the recommendations of the independent review committee report on local services are implemented. At national level, the ongoing work of the Mental Health Commission regarding quality standards in the delivery of services will ensure that the lessons that can be learned from this tragic event are incorporated into national frameworks and guidelines for the future.

Hospital Services.

Mr. Durkan

I thank the Leas-Cheann Comhairle for exercising his good offices in allowing me raise the issue of the need to provide the extra resources and ancillary facilities required in the provision of hospital services in Naas and Peamount hospitals and the James Connolly Memorial Hospital in Blanchardstown, all of which serve the north Kildare area.

Some €42 million has been spent on reconstructing Naas Hospital. The project is excellent and state-of-the-art facilities have been incorporated. Everything is fine except for the fact that two state-of-the-art theatres are unopened because of a lack of staff and commitment on the part of the Department of Health and Children. There are 21 ICU beds unopened and two CCU beds are unopened due to a shortage of nurses. There are four unopened rooms in the radiology unit, two general rooms, an ultrasound room and a screening room. There is a capacity for 50 persons per day at the outpatients clinic, but only 21 can be dealt with daily simply because of a lack of adequate staff. The accident and emergency unit, which opened in September 2003, is operating only to the same extent as was the case in the old hospital.

I compliment the staff of Naas Hospital on their excellent work in attempting to deliver a service with their hands tied. Having regard to the initial extensive capital outlay, for which there was an obvious need, will the Minister for Health and Children consider the equally important need to provide the back-up services necessary to enable the hospital to work to its full potential?

On Peamount Hospital, with which the Minister and Minister of State will be familiar, there is a proposal to relocate the TB and respiratory sections to an unknown location. This proposal has not been well-received in the locality or catchment area. An adequate response has not been given, either in response to parliamentary questions or by the Eastern Regional Health Authority which replies to questions perhaps three months after they have been asked. This is hardly satisfactory.

Will the Minister and Minister of State examine the issues involved with a view to retaining the TB and respiratory units that are already in the hospital? They have served the community well and will continue to do so. The need for them already exists and I do not accept the notion that some mysterious way can be found to replace them. I believe the service will be discontinued.

The James Connolly Memorial Hospital in Blanchardstown, which covers the north Kildare area, also has a requirement for extra facilities. Some have been provided but not all.

Mr. B. Lenihan

All have been provided.

Mr. Durkan

There was an attempt to provide the facilities in the course of the local election campaign.

Mr. B. Lenihan

It is part of the ministerial announcement.

Mr. Durkan

The Minister of State can address these issues in his response, making reference to Naas and Peamount hospitals also. I hope his response to my queries on Naas and Peamount hospitals will be as loquacious as the one he intends to give on the James Connolly Memorial Hospital which I hope is now functioning to its full capacity. I hope people's hands are not tied behind their backs as regards accessing the necessary facilities and resources.

Mr. B. Lenihan

Overall responsibility for the provision of services at Naas General Hospital and James Connolly Memorial Hospital rests with the Eastern Regional Health Authority. Peamount Hospital is a voluntary hospital and it provides services under an arrangement with the authority.

Naas General Hospital has a 199-bed complement and provides general, medical and surgical services, acute psychiatric services and medical and social assessments for patients aged over 65 years to more than 180,000 people in the Kildare and west Wicklow catchment areas.

A major development programme, phase 2, commenced at Naas General Hospital in November 1999. In addition, phase 3A, which includes accommodation and enabling works for future phases, 3B and 3C, commenced on site in April 2002. All the departments constructed in phases 2 and 3A are in operation.

The Deputy will be aware that my Department recently approved additional revenue funding of €7.5 million to the ERHA in respect of the commissioning of additional services at Naas General Hospital. On the accident and emergency department at Naas, my Department is advised that the additional funding will be used to provide the following additional facilities: nine observation beds; two treatment rooms; two additional treatment bays; one additional resuscitation bay; a dedicated triage room for operation of 24 hour nurse-led triage; a dedicated plaster room; three additional radiology rooms, including the provision of CT service; two additional operating theatres; additional outpatient suites; pharmacy; pathology; and a geriatric day hospital.

It is anticipated that the remainder of the development, phases 3B and 3C, will be procured on a phased basis with construction planned for commencement in late 2004 and completion in 2007. When complete, the development will provide an additional 31 beds at the hospital, bringing the total complement up to 230 beds.

James Connolly Memorial Hospital provides acute medical and surgical services to the catchment areas of north-west Dublin, north Kildare and south Meath, which have a combined population of 256,000. There are currently 348 beds at the hospital, 110 of which are extended care beds, and some 1,000 staff.

Accident and emergency services are provided in the James Connolly Memorial Hospital on a 365-day, 24-hour basis, as part of the eastern regional network. The major development at the James Connolly Memorial Hospital is being funded jointly by the Northern Area Health Board, through the sale of surplus lands, and the Department. The projected full cost of the project is over €100 million. The construction of the new hospital was completed on target and within budget. Equipping and commissioning of the new hospital is ongoing.

The first phase of the transition to the new development at James Connolly Memorial Hospital, Blanchardstown, was completed in 2003, with the transfer to the new building of the coronary care and cardiac unit, the therapeutic psychiatry of old age unit, the day hospital and the rheumatology service.

Earlier this month, the Department of Health and Children approved funding of €10 million necessary to commission the acute psychiatric unit, the new surgical block, the emergency department, the critical care unit and the operating theatres. This has enabled the hospital to proceed to full commissioning. When fully commissioned the capacity of the hospital will be significantly increased with the provision, for example, of two additional theatres, ten new day beds, eight critical care beds and three preoperative assessment beds. The necessary funds and sanction for additional posts have been put in place. The only practical obstacle to the full commissioning of the hospital concerns the practicalities associated with recruitment. The accident and emergency unit, to which the Deputy referred, is scheduled to open this month.

The new psychiatric unit is a 56-bed unit comprising 44 acute psychiatric beds, six high observation beds and six psychiatry of old age beds. Patients from the existing acute admission unit at the hospital will be relocated to the new unit. Patients in the acute unit at St. Brendan's Hospital will also be moving to this new unit.

The authority provided funding to Peamount Hospital in 2004 at a level consistent with the level of services commissioned across all the care areas that they provide: older people, neurological disability, intellectual disability, TB and non-TB services. There was no reduction of funding from 2003 and additional funding was provided for intellectual and physical disability services.

Peamount will also benefit this year from sessions from two new consultants in rehabilitation and old age medicine. The authority has recently agreed to the appointment of a new respiratory physician for the south-west area who will also provide some sessions to Peamount.

The Eastern Regional Health Authority has established a working group on tuberculosis services in the eastern region and respiratory services in the South Western Area Health Board to examine the options for the future management of TB, both acute and non-acute, in the eastern region. This group will also address and identify other respiratory services that might be appropriately delivered in Peamount Hospital, taking into account best practice.

The group consists of a respiratory physician, a specialist nurse and director of nursing from Peamount, a management representative from Peamount, two local general practitioner representatives, a public health specialist and an acute hospital accident and emergency representative. The group has clear terms of reference which will address the key issues regarding future service delivery. It is envisaged that the group will report by the end of the year. Existing day and residential services for older people, people with intellectual and physical disabilities continue to be provided.

I assure the Deputy that the Government will continue to invest in the development of high quality, equitable and accessible hospital services so that those availing of the services continue to receive timely and appropriate care.

Prisoner Releases.

Mr. Gregory

I thank the Ceann Comhairle for allowing me to raise this matter on the Adjournment. Two weeks ago I tabled parliamentary questions to the Minister for Justice, Equality and Law Reform on the need for action by the Garda Síochána following a series of house break-ins in the Clonliffe-Ballybough area of Dublin 3. I was assured in the replies that the Garda Síochána was giving the matter serious attention. Subsequently, I was told that gardaí had arrested the person they believed to be implicated and had charged him, that he was in Mountjoy Prison and that all was well.

During that time I had attended a meeting of 200 or more residents, many of them elderly, who were very concerned by the break-ins. Senior gardaí were present at these meetings and were fully aware of the serious public concern which was widespread in the area.

I now understand that when the person was arrested he was unlawfully at large; that is, he had been in Mountjoy Prison, had been granted temporary release, but had not returned from temporary release. During that time he committed the alleged break-ins. He was then arrested, charged with the break-ins — or, so I am told — and returned to Mountjoy Prison. I was astounded to hear that within days of being put back in Mountjoy Prison he was again granted temporary release. I was even more astounded because I heard this not from the gardaí but from people in the presence of the gardaí. The gardaí denied it or knew nothing about it, and said they would check it out. When they checked it they found that the people were correct.

I may be mistaken in fact, but on the very day the Minister of State, Deputy Brian Lenihan, was replying to an Adjournment debate on this issue, the individual was being released from Mountjoy Prison for a second time. I heard the Minister, Deputy McDowell, say that he had got rid of the revolving door system. I felt it necessary, therefore — not just for that reason, but including it — to bring this matter to the Minister's attention. It seems the door is revolving faster than ever.

People in the Clonliffe area have reacted with disbelief to these farcical but very serious events. There appears to be no communication whatever between the Garda Síochána and the authorities in Mountjoy. Despite the background to the re-arrest of this individual, no effort was made by the Garda Síochána to inform the authorities in Mountjoy that the individual should not be given further temporary release. Perhaps they felt in the circumstances that this was self evident.

At the same time, as far as I can establish, no effort was made by the prison authorities to consult local gardaí on the wisdom or otherwise of a further granting of temporary release to the individual concerned. The affair seems almost laughable but for its seriousness. The Garda attitude now is that this individual is out and nothing can be done about it until he comes to trial whenever that might be. It certainly will not be this year.

How can the Minister stand over this farcical state of affairs? Surely there were conditions to the man's temporary release. I would like to hear a full explanation and be told what, if anything, the Minister can do about it. Residents have asked me if, at the very least, an exclusion order can be served on this individual barring him from the area at risk. Meanwhile, people there are living in fear of break-ins or perhaps even worse. I am simply quoting the fears I have heard from people at public meetings. What can the Minister do or say to alleviate the fears and concerns of local people, not to mention the breakdown in trust and confidence in the gardaí, the prison authorities and, indeed, in the Office of the Minister for Justice, Equality and Law Reform? What can be done to prevent this sort of thing from recurring? Can the Minister of State give an assurance that the area at risk will be properly and effectively policed?

Minister of State at the Department of Justice, Equality and Law Reform (Mr. B. Lenihan)

I thank Deputy Gregory for raising this matter on the Adjournment. He also raised it with me earlier this week in the course of a parliamentary debate.

In relation to the issue of temporary release in general, early release on a case by case basis is a feature of prison systems worldwide. It is accepted as an important feature for reintegrating an offender into the community in a planned way. In every case, due regard is had to the risk which a particular release might pose.

Temporary release may be granted for various reasons to prisoners serving sentences of imprisonment. Short-term releases may be granted for different periods of time ranging from a few hours to one or two days and for a variety of reasons. Prisoners may also be released towards the end of their sentence as an aid to their rehabilitation.

In the past, a persistent, high level of overcrowding in the committal institutions in the Dublin area resulted in the granting of early release to some offenders who would not normally be considered suitable for such release. There has, however, been a significant reduction in the proportion of prisoners on temporary release from a peak of 550 during the height of the revolving door crisis in the 1990s to a figure of 253 today. This represents 7% of the total prison population.

The person referred to by the Deputy was serving a six-month sentence in Mountjoy Prison for the unauthorised taking of a mechanically propelled vehicle. Allowing for the normal remission of one quarter of sentence, he was due for release on 25 September 2004. In light of his impending release date, the length of sentence served, the fact that he was serving a sentence for a non-violent offence and had not been in prison custody for a number of years, this individual was granted temporary release from 1 September 2004. The views of the Garda were sought on this case prior to this release.

However, the person concerned subsequently failed to sign on at Mountjoy Prison the next week and was declared unlawfully at large. The Garda returned him to custody on 2 October 2004 and his release date was recalculated as 20 October 2004, to reflect the time he was at large. No additional committal warrant was served on the prison authorities in respect of this offender. The individual's case was resubmitted by the local prison authorities again for consideration for temporary release on 6 October 2004, at which stage he had two weeks left to serve, and he was granted full temporary release.

The Minister for Justice, Equality and Law Reform has sought urgent reports from the Garda Commissioner and the prison authorities in the matter. It must, however, be pointed out that the individual concerned has not yet been convicted of any new charges and, as such, it is not appropriate for me or the Minister for Justice, Equality and Law Reform to comment in any further detail on the case. It must be borne in mind that the courts did not remand the individual in custody when he appeared in court on new charges in early October 2004.

The Minister for Justice, Equality and Law Reform intends to commence the Criminal Justice (Temporary Release of Prisoners) Act 2003 within the next week.

Waste Disposal.

Dr. Upton

I thank the Leas-Cheann Comhairle for allowing me to raise on the Adjournment the serious matter of a large illegal landfill at Grand Canal Harbour, Dublin 8. I am disappointed that the Minister is not here to respond to the motion. The site in question is adjacent to James's Street CBS and close to Dublin's busiest tourist attraction, the Guinness Storehouse. I want to address two issues this evening. One is the answerability of Ministers to the Dáil and the other is the urgent need for all agencies to find a resolution to this illegal dump.

The site in question on Grand Canal Harbour has been in use as an illegal dump for scrap metal, household white goods and rubbish for two years. The site is mainly in the ownership of Dublin City Council but it has reneged on its responsibilities in this regard. I tabled a parliamentary question to the Minister, Deputy Roche, on this issue last week. This followed his reputation for highlighting similar problems in County Wicklow. I had hoped he would take the same "zero tolerance" approach to illegal dumps everywhere. On Thursday, 7 October, my question was disallowed on the grounds that the Minister did not have responsibility for this matter. I was disappointed to receive this response and I had intended to follow this up with a letter to the Minister.

An article by Lara Bradley in the Sunday Independent of 10 October highlighted the magnitude of this illegal dump and the failure of Dublin City Council to act. Following this article, the Minister appeared on “Today with Pat Kenny” on Monday, 11 October to comment on this issue. The interview in question discussed the Grand Canal Harbour issue and the Minister voluntarily went on RTE. We now have a situation where Ministers are more answerable to the media than to Dáil Éireann. The Minister, Deputy Roche, aired his views on RTE, yet he was not able to air the same views in the Dáil. The Minister could have declined to go on RTE, referring the matter directly to Dublin City Council or the Environmental Protection Agency.

I appreciate the media have an important role to play in the affairs of the country. However, this role should not take supremacy over the role of the national parliament. The media themselves are not accountable and they also have the luxury of picking and choosing the issues they like. Ministers should be more accountable to the Dáil and so should all State agencies. This includes the local authorities. As I said earlier, this illegal dump has operated unchecked for two years. The matter has been raised by my colleagues on Dublin City Council, the local school and me on a number of occasions. I took the trouble to e-mail senior council officials photographs of the problem to bring to their attention its serious nature. I suggest that colleagues look at last weekend's Sunday Independent for a good aerial photograph of the landfill.

It is not acceptable that students, staff of the school and residents in the area must put up with this revolting sight, with the associated health risks. The school principal, Willie O'Brien, said:

We have to call the fire-brigade on a regular basis because the black smoke blows in through the windows. The smoke is dense and has a rubbery, plastic smell. It is full of poisonous gases. There is an area between the school and the halting site which becomes flooded and is infested with rats. We can see the rats from the school. Rats are always dangerous, but it is also very bad for the morale of the staff, and for parents and pupils."

I would be grateful for every assistance from the Minister in resolving this matter. The staff of CBS James's Street are frustrated that their efforts have failed to get a satisfactory response from Dublin City Council.

Mr. B. Lenihan

I thank Deputy Upton for raising this matter on the Adjournment. I am making this reply on behalf of the Minister for the Environment, Heritage and Local Government, Deputy Roche. The Minister is on business abroad today and is unable to deal with this matter. In the course of the broadcast concerned, he was asked to comment on instances of illegal waste activity, including some examples in County Wicklow and an allegation of such activity at a location in Dublin 8, which I take it is the location to which the Deputy refers. As pointed out by the Minister, these are enforcement matters which are the responsibility of the relevant local authorities and the Office of Environmental Enforcement.

Substantial powers were provided to local authorities under the Waste Management Act 1996 to enable them to tackle illegal waste activity. These were further strengthened by the Protection of the Environment Act 2003. Local authorities are empowered to order measures to be taken in regard to the disposal of waste, including the remediation of any adverse environmental impacts. They may also directly take appropriate actions to remedy or counteract such activities and to recover their costs through the courts. Local authorities also enjoy substantial powers to halt vehicles, inspect premises and examine records found.

The courts can now assume, in certain cases, that a landowner consented to the illegal activity unless the contrary can be shown. It should also be noted that the maximum penalties attaching to illegal waste activities are substantial, up to €15 million or a ten-year sentence. To assist local authorities in acting on these powers, €7 million has been allocated from the environment fund to support directly the ramping up of the overall environmental enforcement effort, with a particular emphasis on combating dumping and other unauthorised waste activities.

Of equal importance is the recent establishment of the Office of Environmental Enforcement whose primary initial focus is to improve implementation and enforcement of waste management legislation. The office has established an unauthorised waste working group, including representatives of the local authorities and my Department, whose functions include co-ordination of enforcement actions against companies and individuals involved in the illegal movement and disposal of waste in Ireland. The office has also established an enforcement network consisting of the various stakeholders concerned and they will be holding a two-day conference in November dealing exclusively with waste enforcement matters. This will serve to energise and focus further the more aggressive approach now being taken by the relevant authorities to this type of environmental crime.

The Government has already demonstrated the seriousness with which it views incidences of illegal dumping. The Garda Síochána was requested to assist in the investigation of such activities in Wicklow. An investigative team from the national bureau of criminal investigation is involved in ongoing inquiries into these matters. Individuals are before the courts and further prosecutions are in prospect.

In a further measure, the Minister is giving consideration to issuing statutory guidance to the local authorities on the question of remediation of such sites. He will meet the director general of the Environmental Protection Agency to explore further the actions that can be taken to enhance the capacity of the authorities to deal with these illegal activities.

I am sure the House will acknowledge that, taken together, these measures will greatly assist local authorities in tackling the problem of illegal waste activities and send out a clear message to those involved that such activities will no longer be tolerated. Substantial powers and funding have been put in place for local authorities to deal with these matters. In the first instance, addressing the issue raised by the Deputy is a matter for which Dublin City Council has responsibility.

The Dáil adjourned at 5.20 p.m. until 2.30 p.m. on Tuesday, 19 October 2004.

Dáil Éireann debate - Thursday, 14 Oct 2004