Dáil Éireann debate -
Thursday, 3 Jul 2008

Vol. 658 No. 3

Adjournment Debate.

Mental Health Services.

Deputy Dan Neville

I welcome the opportunity to address the report of the independent monitoring group on A Vision for Change. The group is chaired by an eminent person, Dr. Ruth Harrington, and I note that a member of the monitoring group is the former Minister of State in the area, Mr. Tim O'Malley.

The monitoring group, in the conclusions of its first report which was published last year, recognised that 2006 was a year of significant challenge and change for mental health services and expressed the view that it expected to see accelerated action in the second and subsequent years. It is disappointing to report, by and large, that the recommendations of the first report of the independent group have not been addressed in 2007, but they have been prioritised for 2008. However, no resources have been allocated to introduce them because the Minister has suspended giving any further resources to implementing A Vision for Change.

The main concerns of the monitoring group on the implementation by the HSE include the absence of clear, identifiable leadership within the HSE to implement A Vision for Change. The monitoring group considers that the Health Service Executive was mistaken in its decision not to implement the recommendation to establish a national mental health service directorate to drive the changes recommended in the report. The monitoring group does not believe that the administrative arrangements put in place by the HSE are appropriate to the scale of the changes requires. The monitoring group notes that the HSE appointed a director of cancer services in 2007, which was mentioned earlier, to lead implementation of the cancer strategy, and the reform of the mental health services, it states, requires a similar approach. The national steering group appointed to manage the planning and implementation for A Vision for Change is not multidisciplinary and includes no service user or carer representative, as recommended. In addition, the role and relationship of the steering group to the HSE expert advisory group on mental health and the implementation group is unclear. There is a confusion of roles in that regard.

The HSE implementation plan relates to 2008 and 2009 and spans 11 chapters of A Vision for Change, and it identified six key priorities to do so. The plan is selective and vague and is mainly limited to the years 2008 and 2009. Although many of the recommendations require a longer time span for implementation, it does not address the impact of the employment control measures with the HSE on the recruitment of key staff necessary for the implementation of A Vision for Change.

The monitoring group has been informed that a comprehensive plan will be provided by the HSE before the end of 2008. The group regrets that a comprehensive plan has not been published heretofore.

The recommendations of A Vision for Change are not being addressed as a comprehensive package. The monitoring group is concerned that the HSE transformation process is taking precedence over the implementation of the recommendations.

The resourcing of multidisciplinary community health care teams is not being adequately prioritised, an issue which we have raised repeatedly over the past three years in this House. There appears to be a lack of clarity regarding the key central role of multidisciplinary teams, as envisaged in A Vision for Change. Primary care and significant aspects of specialist mental health care, including the multidisciplinary community mental health care group, are concerned about the potential for a blurring of boundaries.

The monitoring group also raises the issue, highlighted on several occasions in the House, of the use of funds. Some €24 million of the €51 million development funding allocated to the HSE for the implementation of A Vision for Change was not used as planned. It was hived off elsewhere and it is not apparent to the monitoring group who in the HSE has budgetary responsibility for mental health services or how budgetary decisions affecting mental health services are made. Will the Minister of State identify who is responsible for making these budgetary decisions? As he has come into the House with a prepared script I am sure the matter will not be addressed.

Minister of State at the Department of Health and Children (Deputy Barry Andrews)

I take this Adjournment debate on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. I thank Deputy Neville for raising this issue. I warmly acknowledge that it has been inspired by a genuine commitment to ensure that persons with mental health difficulties receive the best service possible and, for that reason, I welcome the opportunity to explore this issue in the House this afternoon.

I will discuss the findings of the report, but it is important to acknowledge how far we have come in the area of mental health. I do not wish to dwell on the past, but in 1961 the rate of psychiatric beds per 1,000 of population was 7.3, which was believed to be among the highest in the world. Ireland was described as being "hospital prone". For a considerable time those in need of treatment or care had little choice but to seek it within an institution. Although there was considerable stigma attached to these institutions, they were the only places available.

I am pleased to say that since then, significant developments have taken place——

Deputy Dan Neville

The community based team did not replace——

Deputy Barry Andrews

——with the full implementation of the Mental Health Act 2001 and the launch of two important strategy documents, A Vision for Change, the report of the expert group on mental health, and Reach Out, the national strategy for action on suicide prevention.

A Vision for Change, launched in January 2006, represents an action plan for the development of a quality mental health service which places the patient at the centre. It recognises both the strengths and inadequacies of existing services and a strategy for building on the innovations outlined in previous strategy documents. The Government has accepted the report as the basis for the future development of our mental health services and is firmly committed to its full implementation.

Although there have been great strides taken in the development of mental health services in Ireland, I accept that we are not where we want to be, but we are getting there. A Vision for Change is an ambitious and aspiring publication, containing 200 recommendations to be implemented over a seven to ten year timeframe. The challenge is to maximise the benefits of having such a progressive strategy to ensure that real benefits for the patient and indeed for society as a whole are realised.

The second annual report of the independent monitoring group was published on 27 June 2008. I welcome the findings and recommendations in the report. The group expressed its disappointment at the slow rate of progress in implementing A Vision for Change. We must accept that much work needs to be done and I look forward to seeing increased progress this year and in subsequent years.

The HSE recently approved its implementation plan which sets out six key priorities for 2008 and 2009. These include the provision of eight additional consultant child psychiatry teams. The HSE recently advertised an additional 12 consultant child and adolescent psychiatrists and is examining new ways of working to address waiting lists. Another priority is the provision of 18 additional beds for children and adolescents at St. Anne's Hospital in Galway, St. Vincent's Hospital in Fairview and St. Stephen's Hospital in Cork. This will increase the bed complement from the current provision of 12 to 30 during 2008, which represents a 150% increase in child and adolescent inpatient bed capacity. A third priority is the construction of two 20 bed units for children and adolescents in Cork and Galway. Construction of these units is expected to be completed in 2009.

The HSE will also expand multidisciplinary community based mental health teams and complete existing teams. It is intended to support new and existing teams to develop the multidisciplinary nature of their services and provide a more comprehensive range of medical, psychological and social therapies to service users and families. Adopting a holistic approach to developing services lies at the core of A Vision for Change.

Work is also advanced nationally on the process of replacing the remaining psychiatric hospitals with a range of modern mental health services. Closure plans for existing psychiatric hospitals will be put in place by the end of 2008 and the revenue raised from these sales will be directed towards improving mental health services.

Mental health has been in receipt of unprecedented investment in recent years which has allowed us to make real improvements to mental health services. However, it is not just funding that has made a difference. It is a completely different approach that has and will enable new mental health services to develop. We now have a much greater focus on community services, the provision of multidisciplinary teams, early intervention services and many others. The modernisation and reform of services is in line with what patients want and what they need.

I assure Deputy Neville that the Government is firmly committed to the implementation of A Vision for Change. The Government's decision to establish an office for disability and mental health reflects its ongoing commitment to developing a more coherent and integrated response to the needs of people with disabilities and mental health problems. The overall vision is to establish structures which provide greater cohesion in supporting disability and mental health across the public service. The office brings a new impetus to the implementation of A Vision for Change, working in partnership with the HSE and other stakeholders to achieve implementation of agreed targets. The HSE has undertaken to prepare a more comprehensive implementation plan for beyond 2009 by the end of this year and I reiterate the Government's commitment to the full implementation of A Vision for Change.

Drug Dealing.

Deputy Joe Costello

I am delighted to have the opportunity to speak about this pilot programme in the House. Much drug dealing takes place in public houses. Moreover, there is a great propensity for multi-drug use with alcohol consumption. Publicans have a legal responsibility to ensure that drugs are neither traded nor consumed on their premises.

Last Christmas the supply control committee of the Dublin north inner city drug task force, of which I am chairman, linked up with Store Street Garda station through the good offices of Inspector Gus Keane, a very active member of the supply control committee. Inspector Keane organised several meetings with the proprietors of public houses in the north inner city. We explained the need for publicans to ensure their premises were drug free. Large posters were produced, advertising the publicans' responsibilities and displaying dedicated telephone numbers with "dial to stop a drug dealer" emblazoned, for display in each public house. The Garda funded the cost of these posters. Large quantities of beer mats were made available for distribution on bars and tables in public houses.

The programme has been in operation for 12 months. There was originally a slow take-up, but it was very important that all publicans bought into the programme. They turned up in large numbers at the meetings. Anecdotal evidence suggests the initiative is providing encouragement to people to reject drug dealing and refrain from drug consumption in public houses in the area. Publicans have signs prominently displayed. They are happy with the initiative, happy to participate, and they feel reassured by their ability to demonstrate they are actively implementing the law by preventing drug dealing and drug consumption on their premises. It is reassuring for them to have these signs prominently on display and to have corresponding beer mats on the tables.

This is a practical initiative that adds to the curtailment of the activities of drug pushers. If it was rolled out nationwide, it would make a valuable contribution to the fight against drug abuse. I call on the Minister for Justice, Equality and Law Reform to take steps to mainstream the "dial to stop a drug dealer" programme as quickly as possible. If the programme were successfully established on a wide basis, it could be extended to other retail outlets in community areas such as off-licences and shops. There could be bus stop advertising too and we could begin the process of creating drug free zones where a premises would have on display material stating it is drug free — steps to ensure this have been taken.

This is a practical initiative which, in so far as it has been operational, demonstrates that it has good effect. It is not a very expensive programme and requires no extra personnel or staffing. Costs would be limited to the necessary materials. The steps involved are to organise several meetings, explain what is intended, explain the law and get the programme operational.

Deputy Barry Andrews

I reply on behalf of my colleague, the Minister for Justice, Equality and Law Reform, Deputy Dermot Ahern. I thank Deputy Costello for raising this matter. The Government very much welcomes and wholeheartedly supports this initiative taken by the Garda Síochána in its introduction of the "dial to stop drug dealing" project in the Garda Dublin north central division and the similar initiative on which it was based, which was led by the Blanchardstown local drug task force in its area during 2006.

Before getting into the detail of the Government's specific proposals, which will now further assist the development of such initiatives, I would like, on behalf of the Minister, to first set out the context in which this work needs to take place. First, all of us in this House are well aware that the issue of drug misuse remains one of the most pressing social problems facing us. It is, sadly, a problem experienced globally for which there is no quick and easy solution.

Given the severe harmful and destructive consequences brought about by drug abuse at individual, family and community levels, it is undoubtedly an issue on which we as a society must continue to collectively maintain a keen focus and urgency in addressing. As the Minister and many of my other Government colleagues have stated previously, the focus in our jurisdiction must be to strive constantly to ensure that the measures and policies we have in place to address the problem are appropriate and flexible enough to be able to respond to what is a global and dynamic issue.

As the House will, I am sure, appreciate, the remit of the Department of Justice, Equality and Law Reform under the national drugs strategy is primarily, although not exclusively, in the area of drug supply reduction and drug law enforcement remains a key feature of the Government's drug policy framework. It follows that the "dial to stop drug dealing" initiatives which have emerged recently are of such particular interest to my colleague the Minister, Deputy Dermot Ahern.

An Garda Síochána retains primary responsibility in this regard and it will continue with the Government's full support to invoke vigorously the range of broad strategic responses it has in place to address the issue. However, any assistance which can be provided to the Garda by the public in tackling the crime of drug dealing is to be welcomed and fully encouraged.

"Dial to stop drug dealing" campaigns offer a real opportunity to deliver the integrated action to which I referred to earlier in a very pragmatic way. The Minister understands that the campaigns in Blanchardstown and Dublin's north inner city are deemed to have been successful local initiatives with feedback on their operation from the local drug task forces there, An Garda Síochána and the local community all of a supportive nature. An Garda Síochána has reported that the information generated in some of the reports made to the confidential numbers has been particularly helpful in terms of identifying new dealers, confirming existing suspicions and generally assisting police intelligence on local drug dealing activity. The campaigns have directly led to a number of arrests for drug dealing in the local areas.

The Minister also understands that during the formal evaluation of the Blanchardstown model, the gardaí in the local area particularly welcomed the sense of an increased co-operative approach between An Garda Síochána and the local community to tackling drug dealing in the area, which the campaign there appears to have generated. All of this is very positive and I am pleased to advise the House that following the success of these initiatives, the national drugs strategy team in conjunction with An Garda Síochána is currently finalising proposals to begin a national roll-out of this programme this year in conjunction with the 14 local and ten regional drug task forces.

To facilitate this, an allocation of €300,000 has been secured from dormant assets funds to proceed with this programme. On behalf of the Minister, I am pleased also to advise the House that the Department of Justice, Equality and Law Reform is also providing additional funding of €50,000 to support this initiative. The Minister understands that the national drugs strategy team anticipates that the roll-out of this programme nationally will begin this autumn. The Minister looks forward to the implementation of this programme and he will continue to support it in every way he can.

Water and Sewerage Schemes.

Deputy Joe Carey

I thank the Ceann Comhairle for allowing me to raise this most important issue. We have no records that Coleridge's ancient mariner ever made it as far as Ennis, but the refrain, "Water, water, everywhere, nor any drop to drink", certainly gets one thinking.

Some 30,000 people are dependent on the Ennis water supply, which services Ennis, Clarecastle, Barefield, Crusheen, Doora, Drumcliff and Spancilhill. Since July 2005, these 30,000 people have had to deal with boil notice after boil notice on their water supply due to the presence of cryptosporidium. The spring at Drumcliff from which the Ennis water supply is drawn remains volatile, due to its limestone karstic base, and is considered highly susceptible to cryptosporidium.

Almost three years ago, in July 2005, the first reported outbreak of cryptosporidium in the Ennis water supply came about, yet it took a full 13 months before an interim treatment plant was commissioned to filter the water. Ennis has also fared quiet poorly in comparison to Galway.

In Galway, a water voucher scheme was established within weeks of the first outbreak of cryptosporidium and rate payers also received a rate rebate. None of these measures was introduced in Ennis and residents and business people alike are very angry as a result.

Since the provision of the temporary water filtration plant, five or six full boil notices have been placed on the Ennis water supply. Since July 2005, the HSE, together with the local authority, has placed a partial boil notice on the water, which advises water be boiled before consumption by the immuno-compromised, infants and pre-school children.

Given these circumstances, confidence in the Ennis water supply is at a very low level. Last Sunday, that confidence was almost sunk when residents were informed that they should conserve water, as the quantity of treated water passing through the interim treatment plant was not sufficient to meet demands because of heavy rainfall. I understand that following consultation with the Environmental Protection Agency and the HSE, Clare County Council later decided to partially bypass the filtration system with a view to increasing the quantity of water that could be dispatched to consumers.

This move was designed to replenish the storage levels in reservoirs, restore supply to all consumers and ensure that critical areas such as the fire service and hospitals such as Ennis General and St. Joseph's hospital had an adequate volume of water. To think that a town's water supply was put out of action because of heavy rainfall is both ironic and tragic.

This latest problem with the Ennis water supply highlights the fact that we now urgently need an alternative water supply not just to address the water quality issue, but also the water quantity issue. This evening, I propose a solution to the daily problems which residents encounter, such as having to boil or buy water to brush teeth, wash vegetables or simply drink a clean fresh glass of water. Significant water pressure problems also exist throughout parts of Ennis, Clarecastle and Doora, which prevent people from washing and taking showers when they want.

I ask the Minister of State to fast-track the delivery of the Ennis water augmentation scheme. This scheme will provide Ennis with a new water supply which will be a plan B. It will be a source of water free of cryptosporidium and which will address our water quantity issues.

The scheme up to now has been looked upon as a long-term project. It is clear Ennis needs access to an alternative water supply as soon as possible. I ask the Minister and Department to engage directly with the local authorities in Ennis to drive the speedy delivery of this vital scheme.

The outstanding elements of the Ennis water augmentation scheme consist of the following elements. A new pumping station a Clareabbey must be built, a new reservoir at Edenvale must be constructed and extraction capacity at Castle Lake must be increased. The remaining piping work, which has been laid along the Newmarket-on-Fergus bypass and new Ennis bypass, must be completed.

As an immediate action, I am asking that a simple pump and less than a kilometre of piping be provided from Carnelly to Kerins Cross in Clarecastle, as this work would access the Castle Lake water supply and provide a solution to the water shortages in Clarecastle and Doora, taking pressure off the Ennis town supply. I have proposed this measure several times in the past in the chamber of Clare County Council; it makes common sense and must happen as soon as possible.

I am appealing to the Minister on behalf of the 30,000 people who are dependent on the Ennis water supply. I am looking for a commitment that the Minister will ensure that the Ennis water augmentation scheme is prioritised. This scheme will solve the daily intolerable problems relating to our water.

I ask the Minister to take a hands-on approach to this issue because if he does not, our problems will only worsen. Water is a basic right and we live in a First World economy. The people of Ennis, Clarecastle, Barefield, Doora and Crusheen are depending on the Minister to provide that basic right of clean fresh drinking water with proper pressure and service.

Deputy Barry Andrews

I am taking this matter on behalf of the Minister for the Environment, Heritage and Local Government.

Since its adoption in 2002, the objectives of the national spatial strategy have been among the key criteria local authorities have taken into consideration in their needs assessments for new water services infrastructure. It will be no surprise, therefore, that the current water services investment programme, announced by the Minister last September, allows for investment of some €2.6 billion in the hubs and gateways over the next few years. The programme is available in the Oireachtas Library.

The range of new water and sewerage schemes planned and in progress in the hubs and gateways provides strong evidence of the Government's determination to safeguard the environment in these areas while making provision for new housing, new jobs and all the other requirements of a successful hub or gateway location.

In the period since 2000, over 400 water services infrastructure schemes have been completed by the Department, many in hubs and gateways. The completion of major wastewater infrastructure projects in Dublin, Cork, Limerick and Galway are cases in point. In the hub town of Ennis, the Department is providing substantial funding towards new long-term water services infrastructure which will serve the objectives of the national spatial strategy and benefit the residential and business communities in the town.

Three major water supply scheme projects are included in the Department's Water Services Investment Programme 2007 to 2009. A new water treatment plant is being constructed as part of the Ennis town water supply treatment scheme. I understand the council signed the €8.3 million contract in July 2007 and work will be finished in February 2009. The Ennis town water supply augmentation scheme, which will supplement the Ennis supply with water from Castlelake, is in the programme at an estimated cost of €6.3 million. The Department of the Environment, Heritage and Local Government approved Clare County Council's proposals to lay the pipework for the scheme in conjunction with the Ennis Road bypass and completion of these works is a matter for the council.

The water services investment programme also contains the €21 million Castlelake water supply scheme, which will improve the Castlelake source to cater for future needs. I understand the Department is awaiting a brief from Clare County Council for the appointment of consultants to draw up the preliminary report for the scheme. Also included in the programme is the Ennis-Clarecastle sewerage scheme which will cost in the region of €58 million.

The Minister is aware that there have been problems with the town's present water supply for some time and there is a continuing precautionary boil water regime in place for certain groups, such as the elderly, the very young and people who are immuno-compromised. This is not what should be expected in this day and age. However, I understand the council has tried to minimise the problems by installing a temporary water treatment plant while the new permanent €8.3 million treatment works is constructed. The Minister provided special local government fund assistance towards the running costs of this temporary plant in 2006 and 2007 and will soon announce the 2008 round of allocations.

I understand the temporary plant has been unable to meet demand in recent days. Clearly, it would be much better if this situation had not come about. However, a temporary plant is just that and cannot be expected to perform as well as the new permanent treatment facility which will come on stream next year. The Minister shares what must be the view of everyone in the town that progress with the new plant must be kept on track in terms of time and I understand Clare County Council is doing everything possible to ensure it is completed on time. In the meantime, it is a matter for the council, as the statutory water services authority, to take whatever steps are needed to ensure the requirements of all consumers in the town are accommodated to the greatest extent possible.

Water Quality.

Deputy Lucinda Creighton

I thank the Ceann Comhairle for the opportunity to raise this issue. It was interesting to listen to the Minister of State's response to the issue raised by Deputy Joe Carey regarding the Ennis water supply. I hope the state-of-the-art sewerage plant scheduled to come on stream next year will be much more successful than the Ringsend plant in my constituency of Dublin South-East where the entire process has been farcical, to say the least.

I will raise two connected and significant issues. First, as reported in the media in the past week, the Ringsend sewage treatment plant is operating at between 20% and 30% above its capacity. I have found it difficult to obtain concrete information, other than a submission to An Bord Pleanála, from Dublin City Council on this matter. It is astonishing that the Minister has claimed population growth in Dublin city could not be predicted. The CSO's prediction of even greater population growth than we have experienced contradicts the Minister's bizarre and ridiculous claim, made on the national broadcaster, that he did not know what population growth was expected in the capital city.

Second, Dublin City Council paid a startling sum of money to the ABA consortium which has operated the Ringsend sewage treatment plant in a shameful fashion. Not only was the sum of €38 million paid out, but it was sanctioned by the Minister who represents the constituency in which the plant is located. It is extraordinary that the Minister who sanctioned this payment has, in press statements and media interviews, called for an investigation into how the payment was made and went wrong. This would be laughable if it were not so serious.

The reason I object to the payment of a substantial sum to the ABA consortium is that it did not honour the contract it signed up to in terms of operating the sewage treatment plant in Ringsend. In response to a recent question I submitted to Dublin City Council, I received an extraordinary update in which the council detailed the short-term remedial works which have been done at the plant since 2006. The company covered channels, installed additional odour control units and improved sludge handling and drying. These steps should have been taken from day one. The plant was sold to the people of Dublin as a state-of-the-art facility in 2003.

The long-term works referred to in the council's reply included the covering of the primary treatment tanks. A sewage treatment plant was built in the centre of a large urban population without the tanks being covered up and Dublin City Council is surprised to learn that an odour was emanating from the facility. The company which constructed the plant clearly did not do what it should have done to ensure it was of an adequate standard to serve the population of Dublin. Having failed to do this work, Dublin City Council did not have the capacity to demand from the company any form of accountability. The ABA consortium should have paid for the remedial works but was instead paid by Dublin City Council to do works it should have done in the first instance. It is a fundamental flaw of the public-private partnership process that the contracts signed do not include penalty clauses. This is a major problem across the board.

I wish Deputy Joe Carey luck regarding the sewage treatment plant in County Clare. I hope it is not the disaster we, in Dublin South-East, have had to endure for the past five years.

Deputy Barry Andrews

I am pleased to reassure the House, on behalf of the Minister for the Environment, Heritage and Local Government, Deputy Gormley, that there is no imminent threat to water quality in Dublin Bay. This is clearly demonstrated by the Environmental Protection Agency's bathing water quality report for 2007, which shows all bathing areas from Skerries to Killiney comply with EU standards. Indeed, Dollymount Strand has also gained a blue flag in recognition of premium water quality.

I am also pleased to confirm that Dublin City Council reports that the Ringsend plant consistently meets the required effluent standards for treated waste water. The Minister is aware of suggestions in recent days that the plant is operating beyond capacity but this needs to be qualified in order for the full picture to be seen. Capacity can be calculated in a number of ways, namely, from influent flow, biochemical oxygen demand, BOD, suspended solids, chemical oxygen demand and nutrients, each of which would give a different capacity figure. When a plant is being designed, it must have sufficient capability to deal with load fluctuations higher than the design average on all these parameters.

The design capacity of the Ringsend plant is a nominal 1.64 million population equivalent, average load, based on BOD. The plant provides secondary treatment to approximately 99% of waste water arising in the Dublin region. It deals with the waste water treatment needs of approximately 1.1 million people, with the non-domestic load associated with areas as far apart as Dún Laoghaire, Ratoath, Ashbourne and Portmarnock. The critical fact is that the required effluent standards are being met. This has transformed water quality in Dublin Bay and that improvement is being maintained.

While water quality in Dublin Bay has greatly improved, the Minister is aware that there were protracted delays during the commissioning and testing of the new plant in 2002, when difficulties were experienced in achieving the required performance standards. In particular, he is conscious of the odour problems that were experienced by residents in his and Deputy Creighton's constituency within a short time of the plant coming into operation and that have occurred intermittently since. Works under way to resolve this issue are due for completion later this year.

To resolve as many as possible of the questions surrounding the design and capacity of the plant and past efforts to deal with the odour issue, the Minister is arranging for an independent examination of the design parameters of the works to determine whether they adequately addressed existing and projected loads at the time they were approved. A broad range of issues will be considered during this examination. These include the appropriateness of the design capacity of the plant, having regard to the information available at that time; the volume and timing of actual waste water loads going to the plant by comparison to the load projections when the design capacity was determined; and the factors that contributed to the odour problems and the effectiveness of the actions taken to deal with such odours. The Minister expects to be in a position very shortly to appoint a suitably qualified person to carry out the examination and report back to him before the end of the summer.

The Dáil adjourned at 5.20 p.m. until 2.30 p.m. on Tuesday, 8 July 2008.