Vol. 656 No. 3
1 Deputy James Reilly asked the Minister for Health and Children the reason dedicated palliative care funding announced by her in 2006 and 2007 was not expended on palliative care services; if she has taken steps to ensure the Health Service Executive will repay funding that was redirected away from palliative care services in order that it will be dedicated to the development of palliative care services; and if she will make a statement on the matter. [22486/08]
In 2007, overall spending by the HSE on palliative care services amounted to €75 million. That includes some, but not all, of the additional €18 million funding that was provided by the Government in budgets 2006 and 2007. The HSE has advised me that some of the remaining funding was used in other parts of its services, particularly in acute hospitals. Clearly, the HSE has to operate within the resources made available to it in any given year. However, that should not mean that new funding provided by the Government for specific service enhancements is redirected to other purposes. Accordingly, we need to focus on improving the management of existing services and associated funding. In particular, making better use of existing capacity within acute hospitals and managing hospital activity on a planned basis would deliver better hospital services and, at the same time, allow primary and community services to be improved in line with the Government's plans.
My primary concern in regard to palliative care services at this stage is to remove existing regional disparities and enhance palliative care services throughout the country. The HSE is currently finalising a plan for the development of palliative care services on a national basis. That is being done in consultation with the Irish Association for Palliative Care, the Irish Hospice Foundation and the Irish Cancer Society. I have asked the HSE to ensure that the implementation of this plan is prioritised within its overall resources and its service planning process.
Is it not the case that it is the Minister's role to advise the HSE on the strategic development of the health service through the identification of areas of need, the setting of targets and the allocation of specific resources to achieve targets? Did the Minister not make specific commitments on palliative care and promise that during 2006 and 2007 some €18 million of Government funding would be dedicated to the purpose? However, when it came to applying the resources the HSE decided to divert the funding away from palliative care to meet core deficits in other areas. When was the Minister made aware that the funding was diverted away from the development of palliative care services? Did she give approval to Professor Drumm to divert resources away from its intended purpose and, if not, what action does she intend to take to ensure that funding allocated to palliative care services will be replaced?
Is it not the case that any budget that is unused is taken back — or as someone put it, robbed back — by the HSE? It appears that the HSE can implement its own policy regardless of the Department of Health and Children or the Government and that by failing to spend money in an allocated area the funding is taken back to be used at its discretion. Does that not undermine democracy and the value of any promise the Minister, the Government or any Government can make if the HSE can undermine policy in such a fashion and through either deliberate obstruction or incompetence not allow people to use up the budgets for recruitment? Is it not the case that HSE south has filled only 17.5 posts out of 33, Dublin north east region has only filled six posts out of 26 whole time equivalents and Dublin mid-Leinster has filled only 15 posts out of 38?
Will the Minister correct the situation that pertains? When was she made aware that the funding was diverted? Did Professor Drumm ask for permission to do that? What is the point of having policy directives and allocations if the HSE can through various mechanisms redirect that money to wherever it deems fit?
Obviously, the HSE like every other organisation has to live within the resources allocated to it. If they do not do that, they cannot have priorities or make plans and it would be highly disruptive. For the past couple of years we are aware that the new development moneys, including in palliative care, have been redirected to deal with day-to-day issues. For example, last year I understand an extra €40 million was spent on drugs for cancer patients that had not been envisaged at the start of the year. Clearly, the executive's priority has to be to live within the resources allocated to it. The Deputy's colleague spoke this morning, as he has done on many occasions, about the fact that we are spending too much. In the past three years we have put in three additional beds in Blackrock, four in Galway, ten in Milford, two in Waterford and six in the Curragh. This year an additional €3 million was allocated to palliative care and I have asked the HSE to ensure that money is spent on service delivery, in particular, in those areas where there are huge regional disparities in the provision of palliative care inpatient beds. One such area is the midlands.
With respect——
We have just 50 seconds.
Will the Minister answer the question? When did she find out and did Professor Brendan Drumm seek permission?
No, he does not require permission.
When did the Minister find out?
Find out what?
That the money had been reallocated.
It has been well known for the past couple of years that new development moneys, including in the mental health and disability sector, were not all used in those sectors. That has been known at the end of each year in 2006 and 2007.
So the Minister has known for a couple of years.
At the end of each year we know whether the new developments took place.
Basically, the Minister knew it in 2006——
The HSE produces——
——and she allowed it to happen again in 2007, and we can expect more of the same in 2008.
No. The organisation has to live within the resources allocated to it.
Why does the HSE——
The Minister should be allowed to conclude.
——not reallocate funding from administration or the burgeoning bureaucracy? It does not do that, it takes it off front line services.
Will the Deputy allow the Minister to conclude?
No, it does not take it off front line services. We had no palliative care specialty or facilities a couple of years ago. Ireland was the second worst country in Europe. In addition to the inpatient services we are developing, we also have huge investment in home care services in palliative care.
Can I come back on that point?
Clearly——
It is interesting that in the midlands and the north east where the HSE is responsible, as opposed to the voluntary sector, only 20% of posts have been put in place. In the other areas where voluntary organisations are in charge, who are interested in patient care, the uptake is much higher. That speaks volumes.
The voluntary organisations are supported by the State.
I remind colleagues of Standing Orders. They require that I now proceed to Ceist Uimhir a dó. I apologise.
Much of the support for the voluntary organisations comes from the HSE. For example, the Blackrock Hospice is a voluntary organisation but the activity is funded by the HSE. Equally, while the HSE is not directly providing the beds itself, it is funding various hospices around the country to provide the service. In Milford, for example, which I visited on a number of occasions——
That is the point. Where there is a strong voluntary voice to demand the service——
My time is being eaten into. I asked the second question and I want the time for it to start when the reply to this question finishes.
The Deputy should trust the Chair. I will do my job in so far as I am able. The full time allocation will be given to Ceist Uimhir a dó.
The Chair called the Minister on Question No. 2.
Yes, I did. I lost a little bit of control through no fault of my own.
I do not blame the Chair.
That is okay. The Deputy can trust me.
2 Deputy Jan O’Sullivan asked the Minister for Health and Children if her Department has planned for the effect of the transfer of private patients from public hospitals where co-location is to proceed; the cost implications for the running of those hospitals; the staffing implications particularly where specialist clinical staff will be required in both hospitals; the way it is proposed that public patients will have access to the private facility; and if she will make a statement on the matter. [22312/08]
The aim of the co-location initiative is to make available approximately 1,000 additional public acute hospital beds for public patients by transferring private activity, with some limited exceptions, from public acute hospitals to co-located private hospitals.
The process for the development of the co-located private hospitals is governed in each case by a detailed project agreement between the public hospital and the developers of the private hospital. The HSE has retained external professional advisers in regard to the procurement, financing and legal aspects of the process in order to ensure that the public interest is protected at all times. Detailed provisions in regard to all aspects of the relationship between public hospitals and co-located private hospitals will be the subject of a service level agreement between the parties in each case.
The revenue cost to the public hospitals will be minimal. That is because the beds in public hospitals which will be freed up for public patients are already staffed and the back-up services and facilities required to support them are in place. The only staffing cost envisaged is the appointment of additional consultants, something that the Government is now doing in the light of the agreement. The loss of private health insurance income to the hospitals from private health insurers is estimated at €80 million in respect of the six sites where the co-location initiative is most advanced. That loss of income will be mitigated, in part, through income from the lease of the land and a potential share of profits from the co-located facility. It is recognised that provision will need to be made to allow the budgets of participating public hospitals to be adjusted appropriately to reflect the net private patient income forgone.
Public patients will have access to the private facilities under the service level agreements between the public and private partners. Under the terms of the Finance Act 2001, the co-located hospital must ensure that at least 20% of its bed capacity is made available to the HSE for the treatment of individuals awaiting inpatient or outpatient hospital services as public patients. The fees charged must be not be more than 90% of the fees that would be charged for equivalent treatment provided to a patient with medical insurance.
The staffing and operating costs of the co-located hospital will be a matter for the private partner. In accordance with the recommendation of the independent chairman of the consultant contract talks, discussions will take place between health service employers and the consultants' representative organisations on the practical issues arising from co-location, where appropriate.
I am confused. Is the Minister suggesting there will be two identical hospitals with, for example, two clinical teams from cardiology to orthopaedics on both sides? For example, in order to cover for someone needing appendectomy in the middle of the night, will two full teams be needed, one in each of the two hospitals? If someone breaks a hip, will full teams be needed in both hospitals to deal with all the different specialties? People who work in the hospitals are puzzled about that.
This initiative was announced three years ago. Its purpose was to bring extra beds into the system. Three years later no sod is turned on any of those hospitals. We are now told the banks may be holding up their development because, in spite of them being PPPs, they want a guarantee that the State will ensure there is no loss of money.
The public does not understand what will happen here. Will we have two completely separate hospitals? The Minister has often said that in the area of cancer a minimum throughput of patients is needed and that we should have eight centres of excellence. However, in all the other specialties we will separate the private and public patients and have separate groups of doctors delivering the service. I do not understand that and it does not seem to fit in with what she says about cancer and the need for specialists to deal with a large number of patients in any one specialty.
I am surprised at the Deputy's question. St. Vincent's and the Mater in Dublin are two cancer centres with co-located facilities. There will be a single clinical governance on the site. Clearly, the whole purpose of the initiative is to free up approximately 1,000 beds. In the case of these six hospitals, we are talking about 600 beds. Those 600 beds will be provided for €80 million in addition to 300 day beds that are used for private patients, so we will get 600 inpatient beds and 300 day beds for €80 million. At the moment for €80 million we would get approximately 230 inpatient beds so it is terrific value for money.
In the main, the same consultants will work in both. Under the new contract of employment the private activity of consultants is greatly restricted. The idea is that the private work on fee-paying patients, who are paying themselves or through their medical insurance, would be done in the co-located facility. The idea is that the two hospitals would complement each other. When we announced this initiative, hospitals were free to apply to participate. The hospital boards, and in particular the medical boards, of the hospitals chose to apply for sanction under the initiative.
The idea for the initiative came from a group of consultants in a regional hospital, who suggested to me that if they could free up the 70 beds used by private patients they would cover those beds for public patients if a private facility could be built adjoining their hospital. When the idea was researched and analysed under the public sector benchmark, it proved it would deliver terrific value for money for the taxpayers. In terms of the capital cost, it delivers the beds for less than 50% of the cost of doing it the traditional way. In terms of the running costs, instead of getting 230 beds, we are getting 600 inpatient beds and approximately 300 beds in the rest of the hospital that are used for fee-paying patients but are not ring-fenced for private patients.
Consultants will now be able to sign up to three different kinds of contracts. In addition, some consultants can opt to work entirely for private hospitals. How will it work? For example, how will it work in practice if a cardiologist signs up for one particular contract without the proper mix of public and private? Will we need another cardiologist in the private or the public hospital?
As the Deputy knows, we have approximately 50% of the consultants we need and we will double that. We have advertised for 128 new consultants so that we will have consultant-delivered services. The arrangements will not be made centrally, but will be made on the ground at each hospital. The private provider will be responsible for the employment of all the staff to run the private facility. There will be no liability whatever on the taxpayers in that regard. There may well be people who will only work in the private facility. However, many of the doctors in hospitals such as St. James's and Beaumont will be people employed to work in the public hospital and will do their private work, which they are entitled to do if they opt for two of the contracts, in the private facility on site or in some cases under the existing category 2 contracts they can do that work off-site. We have three different contracts of employment for consultants. The ones who do full-time public work will only work in the public hospital. They clearly will not get any fees in addition to their full-time salaries. Therefore, the issue of working in the private facility does not arise in their case.
There is grave concern among clinicians as to how this will work.
There is grave concern among a tiny few clinicians. It is not the case with most clinicians that contact me, including clinicians that have contacted me over former Deputy Joe Higgins's objection regarding Beaumont. They are very upset about it.
I hear a very different story.
I think I might know to whom the Deputy is talking.
3 Deputy James Reilly asked the Minister for Health and Children the reason the primary care strategy has not been rolled out in line with the commitments given in the social partnership agreement, Towards 2016, which promised the delivery of 300 teams by 2008; and if she will make a statement on the matter. [22487/08]
The key objective of the primary care strategy is to give people direct access to integrated multi-disciplinary teams of general practitioners, nurses, physiotherapists, occupational therapists, home helps and others. It is clear that the membership of primary care teams and networks are drawn from existing professional and other staff working in primary, continuing and community care services, and that there would also be a major enhancement of the level and nature of services available in those settings.
There have been substantial enhancements in the services provided in primary and community care settings with corresponding increases in the numbers of staff concerned. At this stage, the main focus needs to be on the reorganisation of existing services and staff into primary care teams and networks. This requires changes in work practices and reporting relationships, with an emphasis on joint working by various health professionals. It also requires significant work in mapping and profiling of areas. Work under many of these headings is well advanced and I am pleased with the level of interest in, and engagement with, primary care teams among general practitioners. I understand that 500 general practitioners are involved in the development of teams, with a further 700 projected to become involved.
Specific additional funding was provided the years from 2006 to 2008 to facilitate the roll-out of extra primary care teams. Some of this funding was used to appoint extra front line professional staff. I emphasised to the HSE the importance I attach to the continued development and roll-out of primary care teams.
The Government announced the primary health care strategy way back in 2001. Now seven years later all we have are virtual teams. I believe that there might be ten or 11 projects that have seen the light of day. When the Minister talks about the funding, is it not the case that in many of the areas where 13 were supposed to be put in place, three ended up being appointed. While it is clear to me and others involved in primary care, the question must be asked as to whether the primary care strategy is dead. The original funding will not happen as the Minister said in 2005. Is it not the case that the HSE is now rapidly creating phantom primary care teams? Where GPs expressed an interest in primary care teams, this is now construed as being active participation and is meaningless.
Not alone has the failure of the Government to keep its promise to fund primary care to the tune of €1.1 billion as promised by the Minister's predecessor, Deputy Martin, been extremely damaging, but because it was in the pipeline it stymied many developments that might otherwise have taken place in general practice, some of which are now starting to come on stream as people realise that the funding will not be provided and these developments will not take place so people need to look to themselves to try to make things better. The situation has got so bad that this morning Senator Liam Twomey issued a statement pointing out that a GP cannot even get a blood test carried out for an elderly lady. If he is to repeat that, the laboratory still cannot guarantee it will be able to do the test because it has not got the resources. How is that for resourcing of primary health care?
As the Minister pointed out, the funding as originally envisaged will not happen and there is no identifiable strategy to allow any of these developments to take place. This is key. Does the Minister agree that it is the HSE's view, through Professor Drumm, that primary care should take a much more active role? How is that to happen in the absence of funding? It is all the more laughable to talk of reducing bed numbers and not delivering the 3,000 promised. The Minister mentioned co-location, which clearly will not work. I understand why the banks are nervous. The future of the NTPF under a change of Government will have to be reviewed. That should be borne in mind. Is the primary health care strategy dead? What specific funding has the Minister made available? She mentioned the past two years; the funding has been abysmal.
Deputy Reilly should leave a little time for the reply.
I shall. Would the Minister like to hazard a guess at how long it will take to roll out the primary health care strategy if she continues with the level of funding she gave last year and the year before?
If Deputy Reilly was in my job, the economy would have gone under a long time ago because he thinks we should treble and multiply funding, representing, as he does, every vested interest that arises in health care.
The Minister without interruption.
If the Minister made any sense I would not interrupt, but that outlandish statement was laughable.
There is huge investment in public health services, as Deputy Reilly well knows. It is not all a question of additionality, but of switching activity from the acute to the primary care setting.
The Minister will not even fund the training places for GPs.
Some GPs cannot get a GMS practice.
That is a separate issue.
I hope Deputy Reilly does not stand over that. It would not make sense training more GPs if they cannot get access to the GMS.
Absolutely. It should be opened up.
I am delighted to hear that and Deputy Reilly might use his influence on others.
It should be opened up to well-trained GPs.
Deputy Reilly negotiated a restriction on that on behalf of his profession.
I did not. I fought to retain it.
I am very surprised to hear Fine Gael would close down the National Treatment Purchase Fund that has very successfully treated more than 100,000 patients. A Fine Gael Deputy here for the vote, Deputy Sheehan, asked me about somebody needing a hip replacement in west Cork and when I told him about the treatment purchase fund, he said he would be very delighted to get some information to tell his constituent.
How many did the NTPF treat in November and December? The money ran out.
The treatment purchase fund has been highly successful and I am amazed Fine Gael plans to close it down. Many people would be surprised at that.
Some 630 staff have been assigned to primary care teams and I had the opportunity to visit one of them in Castleisland last Friday. It is not just about additionality but about how people work together and how the existing resource of public health nurses, physiotherapists, occupational therapists and GPs work in a community. In the first instance, we want to get them to work as a team because they deal with the same patients. We need better facilities. The HSE recently sought expressions of interest on more than 100 sites around the country and there were 400 expressions of interest. The first 18 contracts will be entered into very quickly and I welcome that level of interest from GPs and others around the country to provide the physical infrastructure so teams can operate effectively in a single centre.
That is hardly an accolade. May I ask a supplementary question?
No.
Some 4,136 children are waiting on average 18 months for speech and language services, 4,062 children in the HSE for Dublin north east await orthodontic treatment and 3,596 children await psychological assessment countrywide, a third of whom have waited longer than 12 months. There are enormously long waiting lists for occupational and physical therapy and home help. There is the primary care strategy. That is the reality for people. It is another myth.
Deputy Reilly has made his point and I must stick to the Standing Orders so I apologise.
4 Deputy James Reilly asked the Minister for Health and Children the steps she has taken to ensure administrative staffing levels within the Health Service Executive will be reduced so that resources will be devoted to front line services; and if she will make a statement on the matter. [22488/08]
I have previously made it clear that I want to see appropriate staffing structures in place throughout our public health service. This includes management structures and front line service delivery. My main aim in management structures is to ensure clarity of roles, responsibilities and reporting relationships to improve the overall governance and management of our health services. The board and management of the HSE have been considering possible improvements in their existing management structures which would optimise their operational or service delivery capacity. These proposals are still being finalised and will be considered by me in the near future.
Separately, the HSE has commissioned a review of its administrative staffing. I understand this review indicates that the HSE is not over-resourced in clerical, administrative and managerial staff compared to Scotland, England, Wales and Northern Ireland. Between December 2004 and March 2008, direct front line service staff in both the HSE national hospitals area and primary and community care have increased by approximately 10% while HSE corporate staff levels have reduced by a similar proportion. A properly planned and managed voluntary redundancy scheme could have an important role in helping to streamline management within the HSE and, as a result, in improving the delivery of health services to patients. Such a scheme would need to be built upon a clearly delineated organisational structure and the associated human resource requirements. It would also need to demonstrate that it will deliver value for money, having regard to other options such as natural wastage and the scope for re-deployment.
Discussions about a possible redundancy scheme are still at an exploratory stage. In accordance with established practice in the public service, any such scheme would operate on a voluntary basis and would require the approval of the Minister for Finance. There would also need to be discussions with the relevant staff associations. This option requires further work but could help deliver significant benefits in terms of a much more streamlined and integrated management structure.
I ask Deputy Reilly to try to stay within his time.
I will do my best. I remind the Minister that she did not read out the full paragraph of the report, as follows: "The external report found that while the number of clerical, administrative and managerial staff compared favourably with those in similarly public owned health services in Northern Ireland, Scotland and Wales, there were too many staff at senior level." These are our famous grade eights of which there were six in 2000 and the last time I asked the Minister there were 714; perhaps it is gone up since then. When the Minister has the information she might tell us the current figure.
The report also said the proportionate number of managers within the overall clerical, administrative and managerial ranks was slightly higher than the UK National Health Service. Would the Minister not agree that at the formation of the HSE she and her Government failed to bite the bullet? They merged 11 companies and promised everybody they would not have to move job and that nobody would lose their job. This was an impossible starting place. As her Government failed to bite the bullet, patients are choking and dying on that bullet.
In the past the Minister has said it would be premature to speculate about the appropriate staffing levels, yet we have report after report after report. How many reports does the Minister need before she takes action? Will she indicate when this much-needed re-balancing in the HSE away from administration and to the front line will take place? Will it be done as a matter of urgency? Has she any time lines by which she can measure it or will it be more fudge and fuddle?
Since I became Minister, 423 fewer people are working in the corporate headquarters of the HSE, 6,000 more people are working in hospitals and 5,600 more in primary care. I could give Deputy Reilly all the percentages across all the professions. One cannot decide in advance of establishing an organisation who should be made redundant. Deputy Reilly knows that.
It can be negotiated beforehand.
The appropriate action is to establish an organisation on a statutory basis, which happened in January 2005, and charge the management and board of that organisation with making decisions on appropriate staffing levels. I repeat that nothing on this scale has ever been embarked on in the public or private sector in Ireland by way of reorganisation and transformation. We are in active discussion. I have had no report on appropriate staffing levels.
Deputy Reilly asked me how many reports I need. The HSE commissioned two reports, one by McKinsey examining the management structure and one examining the clerical and administrative areas. The first report is to hand. The second is being completed with the board of the HSE. I am in discussions with the chairman of the HSE, whom I will meet later with Professor Drumm, around some of these issues to ensure we have the appropriate management structure down the line. At that point we will be able to decide where we need to redeploy people. There are major disparities. That is a hangover from the former health boards.
Many of these famous grade eights were in acting positions under the former health boards. Many are nurses and other professionals who became managers through industrial relations agreements, for example. It is not correct of Deputy Reilly to suggest that a plethora of new people have come in as managers. That is not correct. Many of them have resulted from industrial relations agreements.
The Deputy asked recently at the Committee on Health and Children how many additional ones we had approved in the past year. I understand the answer is one and that the remainder were replacements for those who were moving on, retiring or otherwise. We have approved one additional post in the area of child care. There has been full scrutiny of all these positions in the Department of Health and Children for the past 12 months.
How many have we got? It is playing semantics to say they are not new posts. They are new posts. That has been the whole problem. People are being progressed up through the system into these senior management positions and they have not got——
Some of them are working on the primary care teams——
Where is the——
——or as physio managers, for example.
The Minister's own report referred to an ethos of administration and no ethos of management. She is perpetuating this and refusing to address the issue. Will she tell us how many grade eights there are now?
I will allow the Minister to reply if she can be brief.
I understand there are 700 grade eights
There were 714 the last time we asked the Minister.
That is the same. There has not been any increase. There are actually 710.
5 Deputy Dan Neville asked the Minister for Health and Children her view on the findings of the Inspector of Mental Health Services who stated in her 2007 annual report that she has serious concerns regarding the conditions of long-stay wards in psychiatric hospitals, that the recruitment embargo has greatly impeded the development of mental health services and that there has been little progress in implementing A Vision for Change; if, in view of the development of a quality national mental health service, she will reconsider the decision to relocate the Central Mental Hospital to Thornton Hall in view of expert opinion and have it reconstructed on the current grounds of the Central Mental Hospital, Dundrum, County Dublin; and if she will make a statement on the matter. [22489/08]
I share the concerns of the Inspector of Mental Health Services regarding conditions in the long-stay wards of some psychiatric hospitals. I point out in this regard that capital funding of €145 million was provided and expended on the upgrading of mental health facilities under the National Development Plan 2000 to 2007 and additional funding of €20 million per annum will be provided from the new plan in the period 2008 to 2011.
A Vision for Change, the report of the expert group on mental health policy, recommends that a plan to bring about the closure of all psychiatric hospitals be drawn up and implemented and that the resources released by these closures be protected for reinvestment in the mental health service. Work is advancing nationally on the process of replacing the remaining psychiatric hospitals with a range of modern health services. I expect that closure plans for existing psychiatric hospitals will be put in place by the end of 2008. These plans will have due regard to the preferences and the assessed needs of each patient. I also understand that a comprehensive programme for the valuation and sale of mental health facilities is currently in progress. Revenue raised from these sales will be directed towards improving mental health services.
The recruitment pause put in place in September 2007 was initiated as part of the HSE financial break-even plan to facilitate the delivery of services on budget in accordance with the provisions of the 2007 national service plan. This temporary pause in recruitment ended just three months later on 31 December 2007 and any posts falling vacant from 1 January 2008 can be filled, subject to the provisions of the HSE employment control framework for 2008.
With regard to the implementation of A Vision for Change, the position is that the HSE recently approved an implementation plan which sets out six key priorities for 2008 and 2009. Following concerns raised by the Office for Disability and Mental Health regarding the need for a longer-term focus, the HSE has indicated that it will prepare a more comprehensive plan before the end of this year.
A Government decision in May 2006 approved the development of a new national forensic mental health facility at Thornton Hall, north County Dublin. The new hospital will provide a therapeutic, forensic psychiatric service to the highest international standards. The decision to relocate the Central Mental Hospital is consistent with A Vision for Change. In the circumstances, there are no proposals to revisit the Government decision of May 2006.
I congratulate the Minister of State on his appointment as this is his first time to answer questions in the House. I wish him well.
I thank the Deputy for his good wishes.
The Minister of State must be extremely concerned and appalled at the recently published report of the Inspector of Mental Health Services showing the unacceptable squalor that many psychiatric patients live in while the mental health services and the HSE are sitting on billions of euro worth of property, which the Minister of State has again committed to sell on behalf of the health services. In 2006, over €1.3 million worth of health service property was sold and €776,000 worth was sold the following year, but all of the proceeds of the sales were surrendered to the Exchequer and nothing was reclaimed to fund developments in the psychiatric service.
The inspector stated that the condition of our psychiatric services was poor, to put it mildly, as was the structural fabric of the hospitals. She stated it was a running battle to keep ahead of damp, mould, falling plaster and peeling paint and that the funding needed to maintain these hospitals is considerable. Does the Minister of State accept it is not acceptable that the most vulnerable people are forced to live in these conditions? The commitments made since 1984 by various Ministers have not been implemented. Given that there are no further funds for the introduction of A Vision for Change this year, how can we have confidence that something will be done?
The problems filling the multidisciplinary teams and the vacancies that occurred had an enormous effect on the delivery of services in 2007, according to the inspector. The problem is that the vacancies that occurred between September and October are not being filled.
I have also read the report of the Inspector of Mental Health Services, which was published on 29 May. I am in this job three weeks and I give a full commitment that, whatever has happened before, I intend pushing forward immediately with the sale of lands and properties owned by the HSE. I do not intend to travel just for the sake of travelling. The hospitals outlined specifically in the report need to be sold off. I have asked the officials of the Department to draw up a current list of valuations.
I intend to invite the Oireachtas Members who represent the specific areas to a meeting in Leinster House this month to get their public support for selling those properties. I accept the views expressed in the report with regard to the need to move from the old days — some of these institutions have been there for 150 years — and to build proper modern facilities. I intend to progress this and I will not make a report on progress next year or the year after, but on a six-monthly basis.
Not all of the expressions in the commission's report are bad news and it is important to note the report is broadly positive. I recognise not just the fact that facilities are poor, but also the positive structures which are moving us to a situation where we are doing what is right for people who suffer mental health difficulties. The report highlights the significant changes that have occurred following the full implementation of the Mental Health Act 2001 and it makes the point that this includes the independent review system for those admitted involuntarily, which is important. We had looked for this process for years but the tribunals are now in place. All of these matters are positive.
I ask that rather than being critical of what has happened, let us move forward on a positive note. Following the meeting with Oireachtas Members, I intend to invite in all of the stakeholders, as the Minister, Deputy Harney, did in the area of cancer. We can progress, evaluate and realise the valuable assets we have. I give the following specific commitment. What is raised in this area will go specifically and only into mental health.
In view of the concern and the round rejection by all concerned with forensic medicine of the move of the Central Mental Hospital to Thornton Hall, will the Minister of State revisit this matter? There is overwhelming expert opinion with regard to locating a therapeutic centre beside a custodial prison.
I want to be direct in all my answers. I have no intention whatsoever of reviewing that. The Deputy asked me some minutes ago how we were to implement A Vision for Change and what we were going to do for the psychiatric services. The nonsense that we are talking about a prison and a hospital in the very same setting could not be further from the truth. It is two separate approaches and two separate roads. More importantly, if we are talking about scarce resources, the sale of Dundrum would realise €350 million and the building of a hospital would cost €150 million. The balance of €200 million will be invested in exactly what the Deputy is seeking. I am as concerned about the patient as anybody else. If the Deputy is blaming——
Everybody, including international opinion, says it is wrong.
I am trying to answer the question. On the one hand, the Deputy is blaming Government for not initiating change.
On the other hand, I am criticised when I try to do that.
I am consistent in discussing the position of patients.
I am also being consistent.
They do not agree.
I have every confidence in the ability and expertise of the medical staff in Dundrum——
Then listen to them.
——and I am certain they will put the patient at the centre——
They already have.
——just as I do. In regard to wasting time on revisiting Government decisions, I fully intend to implement this policy and I am putting the funding we can secure from the sale of the Dundrum lands into the same basket as other properties we will sell throughout the country. I hope we receive the support of the public in ensuring patients come first.
That is what we want.
I wish to be associated with the congratulations to the Minister of State on his recent appointment on which I wish him well.
I do likewise.
I thank the Acting Chairman and Deputy Reilly. Long may it last.
