Adjournment Debate.

Hospital Lands.

Ms B. Moynihan-Cronin

I thank the Ceann Comhairle for giving me the opportunity to raise this important issue in the House. A number of years ago, the then Southern Health Board approved in principle the phased closure of St. Finan's psychiatric hospital, Killarney. The lands at St. Finan's Hospital, which are currently owned by the Health Service Executive are undoubtedly one of Killarney's best public assets. As I stated many times, when the hospital eventually closes it will be essential to retain this public asset for the public good and to keep it in public ownership.

A statement issued by the Taoiseach in December 2003 committed the Government to exploring the potential to use State-owned lands for housing purposes. The 55 acres at St. Finan's Hospital, Killarney, represent a prime opportunity for the Government to deliver on that commitment and it would be an extremely suitable site for local authority and social and affordable housing. As there are up to 500 households on Killarney's housing list at present, there is every need for a substantial housing programme to be put in place and the site at St. Finan's Hospital is a prime location.

Killarney's town clerk has stated that the lands at St. Finan's are ideal for housing. Killarney Town Council seeks 30 acres of the aforementioned lands for housing and facilities for community and voluntary organisations. Recently, a group called the St. Finan's Community Action Group made a number of positive suggestions regarding the use of the lands on the closure of the hospital. In addition to housing, a number of other organisations could benefit from the site. For example, for many years the south Kerry branch of the Multiple Sclerosis Society of Ireland has been seeking a suitable unit from the HSE for those with multiple sclerosis. This group has recently joined the Irish Wheelchair Association, the National Council for the Blind of Ireland and Kerry Care to campaign for a unit that would house their organisations and allow them to carry out their work in suitable premises. The Killarney rugby and judo clubs are also in need of a site and facilities for their members. The local branch of the Order of Malta is applying to the HSE for sufficient lands to allow them to house three ambulances and to provide training facilities for their staff members.

The Minister of State should note that a wide range of community and voluntary groups, in addition to Killarney Town Council, are in need of central sites and it seems logical to utilise fully a prime location like the lands at St. Finan's when they become available.

I have no difficulty with proposals for a health care centre on the site. While the HSE plans for the site will focus primarily on the provision of health services in the area, I firmly believe that consideration must also be given to a number of other possibilities for the site. I fully support the call from the St. Finan's Community Action Group that these lands should be retained for the use of social and affordable housing, as well as for community, voluntary and sporting organisations.

On the wider issue of State lands and health services, Members are aware the Minister for Health and Children, Deputy Harney, and the Progressive Democrats are hell bent on privatising the health services and selling State assets as speedily as possible, without thought on the consequences. I am certain they would not think twice about selling the lands at St. Finan's. This must not be allowed to happen. As previously stated, up to 500 households in Killarney are on the housing list, not to mention a wide range of community and voluntary organisations that are in need of facilities. This prime opportunity must not be allowed to pass. The Labour Party will campaign actively to ensure the site, which has an emotional attachment for many people in Killarney, will be put to the best use when the hospital is closed, to the benefit of all the people in Killarney.

Minister of State at the Department of Health and Children (Mr. T. O’Malley)

I thank Deputy Moynihan-Cronin for raising this matter on this evening's Adjournment.

Operational responsibility for the management and delivery of health and personal social services is assigned to the Health Service Executive, HSE, under the Health Act 2004. The HSE has informed my Department that St. Finan's Hospital campus, to which the Deputy referred, measures approximately 55 acres in total, with approximately 43 acres sited to the south of the ring road in Killarney and the remainder to its north.

At present, mental health services are provided from accommodation within the St. Finan's Hospital building. It is planned to transfer these services to new purpose-built accommodation over the next two years. The HSE's plans for the campus are to develop a range of health care facilities on the campus to provide modern accommodation to meet the present and future health needs of the population of Killarney and its surrounding areas. The plans include the development of a primary care centre and headquarters for HSE services provided to the population of Killarney and east Kerry.

The St. Finan's building itself, and some curtilage, that is, an area of land to make the building saleable, has been identified as surplus to requirements and will be disposed of when the building has been vacated. The HSE has advised that no actual date has been set for the sale of St Finan's building at this time. The HSE is in discussions with the local authority concerning the possibility of disposing of some of the site to facilitate affordable housing.

The report of the expert group on mental health policy, A Vision for Change, which was launched in January this year, outlines an exciting vision of the future for mental health services in Ireland and sets out a framework for action to achieve it in the next seven to ten years. The expert group found:

Mental hospitals have been the mainstay of mental health services in Ireland for many years. However, the type of person-centred, recovery-oriented care recommended ... cannot be provided in institutions of this size or environment.

On that basis, the group recommended that steps should be taken to bring about the closure of all the remaining psychiatric hospitals which are a legacy of a bygone age and to reinvest the resources released by these closures in the mental health services.

As the Deputy may be aware, the closure of the large mental hospitals and the move to modern units attached to general hospitals, together with the expansion of community services, has been Government policy since the publication in 1984 of the policy document, Planning for the Future. A number of the large psychiatric hospitals around the country have already been closed, including Our Lady's, Cork, St. Patrick's, Castlerea, St. Columba's, Sligo, St. Mary's, Castlebar, and Our Lady's, Ennis. The reorganisation of services which these closures entailed has resulted in the expansion of community facilities, new acute psychiatric units in some cases and, most importantly, an overall improvement in the delivery of services for the service users, their families and carers.

Most of the remaining stand-alone psychiatric hospitals in the country cater in the main for long-stay patients, many of whom are over 65 years of age. I understand this is also the case at St. Finan's, Killarney, in which the majority of patients are cared for in elderly care wards.

The HSE has indicated that it anticipates the closure of psychiatric hospitals and the reinvestment of the proceeds in modern, replacement facilities to take place on a phased basis. It has also emphasised that hospitals can only close when the clinical needs of the remaining patients have been addressed in more appropriate settings, such as additional community residences, day hospitals and day centres, together with a substantial increase in the number of well trained, fully staffed, community-based multidisciplinary community mental health teams.

The implementation of the recommendations will be a matter primarily for the HSE, which has established an implementation group to ensure the recommendations are realised in a timely and co-ordinated manner. I have established an independent monitoring group to monitor progress on the implementation of the mental health strategy, A Vision for Change. The Government has commenced implementation of this strategy and provided €26.2 million in funding in 2006 for this purpose. A further €25 million has been made available in 2007.

I am sure the Deputy will agree the Government is fully committed to the implementation of the national mental health strategy, A Vision for Change, as the basis for the future development of our mental health services.

Mental Health Services.

Mr. Deenihan

Last week's "Prime Time Investigates" television programme starkly revealed the human suffering of those children and parents who have been abandoned by Ireland's under-resourced psychiatric services. Child and adolescent psychiatric services account for only 5% to 10% of spending on mental health services, while serving 22.68% of the population. This underinvestment has resulted, as Members saw last week, in child and adolescent services which are sporadic or non-existent.

The Kerry Child and Adolescent Mental Health Service is based in Greenview Clinic and is run by the Brothers of Charity. The clinic deals with children who experience severe and complex behavioural difficulties such as ADHD. At present, the waiting period for assessment at Greenview Clinic depends on the category in which one is considered to be — general, priority 2, which is semi-urgent, or urgent. There are 11 children currently in the general category, with a waiting period of 56 months — four years and eight months. There are 109 individuals on the priority 2 list, with a waiting period of 22 months, and there are 83 individuals on the urgent list, with a 16-month waiting time.

Figures obtained from the Health Service Executive under the Freedom of Information Act reveal that, nationally, over 3,000 children under the age of 16 are on waiting lists to get an assessment. The length of the waiting time depends on where one lives. In Dublin, the waiting time is two years, while it is three years in Mayo and, in many cases, over four years in Kerry.

According to an unpublished Health Service Executive report on child mental health teams, in September of this year there were only nine psychiatric nurses in the HSE, south, area, when really there should be 24. In a survey of teachers from over 200 schools, many of which were in Kerry, conducted by "Prime Time" and the Irish National Teachers' Association, over three quarters stated that their teaching had been compromised by a pupil with a mental health problem.

Mental health services for children in Kerry are under-resourced, understaffed, fragmented and inaccessible in many cases. Planning nationally has been haphazard and there are only two public units for adolescents in Ireland. Two, three or four year waiting times are devastating for children, who deteriorate enormously in that period without diagnosis or treatment.

Spending on mental health has halved in the 18 years from 1988 to 2006 and Ireland now has the fifth highest youth suicide rate in Europe. Many of these illnesses, including ADHD, are eminently treatable but for this to happen, early diagnosis is crucial and must be followed up with the administration of the relevant medication and training strategies and facility provision for the child and the parents involved.

The lack of psychotherapists, family therapists, clinical psychologists, occupational therapists and other key staff seriously inhibits the internationally acknowledged best practice for the provision of child and adolescent psychiatric services through multidisciplinary teams.

Mental illness can affect any one of us at any time. It is estimated that one in four of us suffers with a mental illness, but the Government does not seem to recognise this area. Since 1997, the proportion of the total health budget spent in this area has dropped from 11% to under 7%. Mental health has been neglected for too long.

This neglect is manifesting itself now in County Kerry. People were amazed by the "Prime Time" report on the services for young people in County Kerry. I appeal to the Minister of State, Deputy Tim O'Malley, as a Deputy from a neighbouring county, to take on board the challenge faced at this time by the people who are involved in the services in County Kerry. There is a major difficulty in Kerry. I do not want to exaggerate for the sake of effect, but I appeal to the Minister of State to look to the HSE to draw up a special report based on what an independent "Prime Time" reporter discovered in County Kerry. I trust that he will take on board the points I have made. The issue is too important to ignore and to fail to follow it up with positive initiatives.

Mr. T. O’Malley

I thank Deputy Deenihan for raising this matter. I assure the House that work is continuing towards ensuring that appropriate psychological assessment of children with mental health problems takes place without delay.

Operational responsibility for the management and delivery of health and personal social services is assigned to the Health Service Executive, HSE, under the Health Act 2004. I am of the view that waiting lists must be constantly kept under review to ensure that children and adolescents are referred to and seen by an appropriate professional as soon as possible and that urgent cases are prioritised for immediate assessment.

An exercise is under way in the HSE to assess what needs to change in particular areas, including Kerry, to reduce waiting times. Dramatic improvements in waiting times can be, and have been, achieved. For example, the child mental health services in Kildare succeeded in greatly reducing their waiting times following the appointment of an advanced nurse practitioner who worked in close collaboration with the local multidisciplinary team to improve service access.

This is the type of service improvement I want to see achieved elsewhere in the country. It has been done practically, effectively and cost effectively. I have asked the HSE today to learn from this experience and apply it to reduce waiting times and improve access to child and adolescent services nationally, starting with those areas where access problems and delays are occurring.

My Department has been informed by HSE, south, that the Greenview Clinic, Kerry Child and Adolescent Mental Health Services run by the Brothers of Charity, provides a community outpatient multidisciplinary mental health service to children and adolescents in County Kerry on behalf of the HSE. All clinical cases referred to the service are prioritised based on clinical severity and complexity. Emergency cases, such as children who have self-harmed or are at risk of doing so, are seen immediately and are not placed on a waiting list.

Improving awareness and detection rates of mental health problems in young people is an important Government priority. The HSE has developed an on-line training programme for GPs with a comprehensive module on child and adolescent mental health needs. This is an important development and builds on expertise and knowledge within our services.

The HSE child and adolescent mental health services work closely with colleagues in the education sector and accept referrals from schools and the National Educational Psychological Service, NEPS. The HSE is also actively working with a number of voluntary and community agencies to provide added protection for children with mental health difficulties. Examples include Dublin East Treatment and Early Care Team, DETECT, in south Dublin, Ireland’s first pilot project for early intervention in psychosis assessment, as well as the national roll-out of applied suicide intervention skills training, ASSIST, with a particular emphasis on personnel who work with young people.

The national mental health policy, A Vision for Change, sets out the model of child and adolescent mental health service that needs to be provided and resourced into the future. A Vision for Change acknowledges gaps in the current provision of child and adolescent services and makes several recommendations for the further improvement of these services. Recommendations include early intervention and health promotion programmes, primary and community care services, specialist mental health services for the treatment of complex disorders and the provision of additional child community mental health teams. The Government has already commenced implementation of this strategy and provided €26.2 million in funding in 2006 for this purpose. A further €25 million has been made available in 2007.

The HSE currently has 45 child and adolescent mental health teams. Eight additional consultant-led child and adolescent psychiatric teams per year will be established nationally for the next four years to enhance community and inpatient services. This year, an additional €3.25 million was allocated for the enhancement of child and adolescent services, including the development of eight new teams. A further €7.95 million is being provided for 2007 to significantly improve both community and hospital based services and facilitate the provision of early intervention services. The additional funding will enhance the multidisciplinary composition of existing child and adolescent mental health teams and provide for the development of a further eight new teams in 2007. Additional beds for the treatment of children and adolescents are to be made available shortly pending the construction of four new dedicated 20-bed child and adolescent units in Dublin, Cork, Limerick and Galway.

It is important to note that HSE mental health services are now funded on a population based model which takes account of population size and profile, including factors such as social deprivation. Services are being planned and resourced from a national perspective. From March 2007, the HSE will have more detailed information on the age profile of our population with the further analysis of the 2006 census data. This will allow the executive to target resources to areas of greatest need and to ensure the most appropriate services are available to young people throughout the country. In addition, recognising the link between social deprivation and mental illness, the HSE this year used a deprivation index to direct additional resources to areas of greatest need.

I assure the Deputy that the Government is fully committed to decreasing the waiting times for psychological assessment for children with mental health problems in Kerry and across the country.

Health Services.

Dr. Upton

I thank the Ceann Comhairle for the opportunity to raise this matter. A number of constituents have contacted me about the unacceptable waiting times to get an appointment for assessment at St. James's Hospital following diagnosis of arthritis by their GPs. In one case, my constituent was given an appointment for 12 months later following referral by her GP. This lady waited for a few months in some considerable pain and then decided, at significant personal financial hardship, to get a private assessment in a different hospital.

Arising from the information provided by this lady and a number of others, I made inquiries with St. James's Hospital to establish the average waiting times and the number of patients awaiting assessment and treatment. There are approximately 500 patients on the waiting list. I understand the average waiting time for assessment is 15 to 18 months following referral by a GP. If the case is defined as urgent, it can take as long as four months to be seen by a consultant, unless the patient is admitted as an emergency case.

From my constituent's perspective, living in pain for 12 to 18 months was the immediate concern. However, what might not be obvious to her or other people suffering from arthritis is that many long-term effects are associated with delayed treatment. These include irreversible joint damage and internal organ damage. It is estimated that a delay in providing treatment for inflammatory arthritis can reduce life expectancy by ten years. Many related medical problems, including heart disease, osteoporosis and increased susceptibility to infections and cancer may also develop as a consequence of delayed treatment. Early diagnosis, assessment and treatment indicate a more positive outcome for patients.

What plans are in place to reduce waiting times for these patients? What resources will be provided to St. James's to allow waiting lists to be addressed and patients to be seen within a reasonable timeframe?

Preventative medicine is the Cinderella of the health service. Early intervention would make a huge difference to the quality of life of my constituent. In the case of the other 500 patients on the waiting list, it would also result in long-term savings to the State if the consequential illnesses were prevented. This debate is about quality of life, the avoidance of unnecessary pain and the right to access medical treatment when recommended by a GP. It is about life expectancy and the avoidance of other complications setting in later in life. It is also about wise investment and management of resources so that prevention becomes the priority.

We all know people suffering from arthritis. While it may not have a high profile medically because it is not seen as life threatening, the hidden consequences should give food for thought. I ask the Minister to put in place the personnel, services and facilities to reduce the suffering of the patients I have mentioned.

I visited St. James's Hospital because of the concerns raised by my constituent. I found the staff with responsibility for the care and management of patients with arthritis are doing their best to accommodate as many patients as possible in conditions that leave much to be desired. I urge the Minister to undertake to review the provision of facilities and staff resources for the delivery of arthritis related services. It is not good enough that up to 500 patients are left waiting and in pain for a service that could easily be enhanced and upgraded for a relatively modest investment.

Mr. T. O’Malley

I thank Deputy Upton for raising this matter. I am responding to this on behalf of my colleague, the Minister for Health and Children, Deputy Harney.

Operational responsibility for the management and delivery of health and personal social services is assigned to the Health Service Executive under the Health Act 2004, and funding for all health services has been provided as part of its overall Vote. The former Comhairle na nOspidéal undertook a review of rheumatology services and published its report in 2005. The report recommends the creation of additional consultant posts in rheumatology and recognises the need for the appropriate allied health professional staff, including physiotherapists, to work alongside consultants in a multidisciplinary team approach. Responsibility for the implementation of the report rests with the Health Service Executive.

The executive has advised that it established a working group on arthritis and related conditions earlier this year. The group reflects the range of stakeholder interests in this area including consultant medical, specialist nursing, GP and patient input. The group will undertake a comprehensive needs assessment, propose a model of care and make recommendations for the development and reconfiguration of services across the full spectrum of care. The HSE has also identified chronic disease management as a priority and arthritis is included within this category. To address chronic diseases, the HSE has this year established an innovative self-care management programme and hopes to develop this further in future years.

As the Deputy will be aware, the National Treatment Purchase Fund was established in 2002 to deal with those public patients who are longest on public hospital waiting lists. To date, more than 50,000 inpatients have been treated under this initiative. Happily, we are now at a stage where most public patients who have been waiting more than three months on a public hospital waiting list for a surgical procedure can access the NTPF.

The main referral pathway for arthritis sufferers is via a general practitioner to either an orthopaedic or a rheumatology outpatient clinic for assessment. At the Minister's request, the NTPF expanded its activity in 2006 to include working with public hospitals on outpatient waiting lists. The fund also undertook an outpatient initiative on a pilot basis on the rheumatology outpatient waiting lists in Galway and a further pilot is being undertaken in Dublin with St. James's Hospital.

Flood Relief.

Mr. Finneran

I have raised this matter so the Minister for the Environment, Heritage and Local Government might provide emergency funds to Roscommon County Council so that it might raise a number of roads in the county, particularly in the south Roscommon villages of Clonown, Cloncoran, Moore and Derrycahill-Ballyforan, where the roads servicing a large number of families are flooded to a depth that leaves them impassable.

It is a sad state of affairs that in the mouth of Christmas 2006 up to 50 families are marooned in south Roscommon. A large number of roads into the villages I mentioned are not sufficiently raised above flood level. I brought this issue to the Government in 2001. Some €500,000 was allocated and the raising of roads took place. Due to the passage of time and a more severe flood, that raising of road levels is not sufficient today.

I know the Minister of State may say Roscommon County Council has been given an allocation in recent days to deal with this. That is not adequate nor appropriate funding for raising of roads. In many cases these roads need to be raised by up to three feet. This would allow those villagers to go to Mass, visit the doctor, go to school or go shopping in times of flood. It is a sad state of affairs that people in south Roscommon must use tractors and lorries to traverse the roads and go about their day-to-day business.

I have been in touch with the HSE and understand that a four wheel drive ambulance has been made available in case of emergencies. I have asked for the Army to be put on alert in case people, stock or fodder have to be moved. There is great hardship in the farming community, with 50,000 acres under flood. I will urge tonight that Roscommon County Council be given the moneys to raise the roads to the village of Clonown in south Roscommon and to smaller villages off the Carricknaughton Road, as well as the Carricknaughton Road itself, by a minimum of two feet. Cloncoran is cut off, with water to a depth of 1.5 feet on the road. In certain areas of the parish of Moore people cannot get to fodder their stock. Derrycahill, on the banks of the River Suck, is cut off by two feet of water and only one person on a tractor has been able to get out of the village for almost a week. The Ballyforan-Feevagh Road is cut off to children attending Feevagh national school, who must undertake a five-mile round trip.

This is totally unacceptable in the Ireland of today, with the coffers overflowing with money. These people are in a desperate situation and the hardship inflicted on them by this flood is unacceptable. I call on the Minister to immediately enter negotiations with the manager of Roscommon County Council, Mr. John Tiernan, and his staff, to make available adequate funds. I am not talking about large funds or spending millions of euro to build highways, I am talking about raising stretches of road that will allow people to gain access to their farms and, in particular, to their houses, places of worship, shops, doctors and other services they may need. It is not asking too much to provide people with a basic entitlement such as a road to their house that is not under two feet of water.

I appreciate the extra funding given by the Minister to all county councils but an enormous expenditure will have to be undertaken by Roscommon County Council to repair the roads damaged by the flood. I ask that emergency funds be provided for Roscommon County Council for the repair of roads to houses and villages and that negotiations start immediately with the county manager and his staff so that we can tell the people of south Roscommon they are not abandoned.

Mr. T. O’Malley

I reply on behalf of the Minister for the Environment, Heritage and Local Government, Deputy Roche.

County councils and other major local authorities are responsible for managing and maintaining all non-national roads in their area. They have to commit an appropriate share of their own resources for this purpose. In addition, the Department of the Environment, Heritage and Local Government assesses the non-national roads programmes of local authorities each year and makes substantial grant allocations to local authorities which supplement their own resources.

In 2006, the total of these grant allocations from the Department of the Environment, Heritage and Local Government to Roscommon County Council for non-national roads was €15.254 million. This represents increases of 216%, 124% and over 20% respectively on the corresponding 1994, 1997 and 2005 payments to the council.

The question of special funding to take account of severe impact of weather conditions on roads is regularly raised. The approach taken by the Department of the Environment, Heritage and Local Government under successive Ministers, and agreed with local authorities is that we do not hold back a reserve allocation at central level to deal with weather contingencies. Such an arrangement would mean a reduction across all local authorities in the road grant allocations to them at the beginning of each year. Instead, the allocation made by the Department of the Environment, Heritage and Local Government to local authorities is inclusive of the weather risk factor. Local authorities are expressly advised that they should set aside contingency sums from their overall non-national roads resources to finance necessary weather-related works.

In 2006, the discretionary improvement grant allocation to Roscommon County Council is €1,014,000, an increase of 7% on the initial 2005 allocation. The selection of works to be funded from this allocation is, in line with what I have said, a matter for the council. On 25 January 2006, after the 2006 non-national road grant allocations had been announced, Roscommon County Council wrote to the Department of the Environment, Heritage and Local Government seeking a special allocation of €100,000 for a study on the ground conditions, methods of construction and cost of carrying out improvement works on the Athlone to Clonown Road. The council was informed that the 2006 grants were fully allocated but that it was open to the council to use a combination of its own resources and discretionary improvement grant allocation for this purpose.

The council was also informed that, as an alternative, if a suitable formal application were submitted, the Department of the Environment, Heritage and Local Government would be prepared to consider giving approval to the council to proceed with the study on the condition that the scheme would be submitted as a priority on the council's 2007 EU co-financed specific improvement grant list of applications.

In July this year, the Department of the Environment, Heritage and Local Government sought applications for consideration for funding in 2007 under that scheme. Last month, Roscommon County Council submitted, inter alia, an application for €50,000, for consideration for funding in 2007, for the appointment of consultants to enable a detailed study of the Clonown Road to be carried out. This application will be considered in the context of the 2007 non-national road grant allocations. The Minister for the Environment, Heritage and Local Government, Deputy Roche, will announce these allocations early in the new year.

General purpose grants from the local government fund may also be used by local authorities to meet their ongoing and special expenditure requirements, including flood relief. In this regard, I have announced increased local government fund allocations of almost €948 million in general purpose grants to all local authorities in 2007. Roscommon County Council will receive an allocation of €22,198,317 in 2007, which represents an increase of over 7% on its 2006 allocation.

The weather conditions of recent times undoubtedly create difficulties for the road infrastructure and for road users in parts of Roscommon. Problems of this kind call for adaptation and prioritisation on the part of the local authority concerned, with the assistance of the considerably increased funds being made available by the Department of the Environment, Heritage and Local Government. I encourage Roscommon County Council and all local authorities facing similar challenges to find solutions within this framework.

The Dáil adjourned at 11 p.m. until 10.30 a.m. on Thursday, 14 December 2006.

Dáil Éireann debate - Wednesday, 13 Dec 2006