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Dáil Éireann debate -
Thursday, 8 Jul 2010

Vol. 715 No. 2

Adjournment Debate

Mental Health Services

This is my first opportunity to raise these issues as regards the development of the mental health services. Some people will say this will not be noticed but at least I take every opportunity I can to raise the matter.

The independent monitoring group report on the blueprint for improving the psychiatric service is a severe indictment of the Minister for Health and Children and the Government. It is not acceptable that little substantial progress was made in 2009 in the implementation of A Vision for Change. The lack of clarity around the new assistant director for mental health, the lack of authority around this post and the emerging clinical management and administrative structures within the health services is totally unacceptable. The monitoring group expressed frustration and confusion about constantly changing management structures. The assistant director for mental health that has been appointed, incidentally, is an excellent first-class public servant and this has nothing to do with either his ability or potential.

It is difficult for the newly appointed executive clinical directors to carry out their task when there is an absence of detail in their precise roles, the relationship with clinical directors and the management structure of the HSE. It is another damning indictment that the monitoring group found an absence of mental health leadership.

The revenue allocation envisaged in A Vision for Change was not delivered in 2009 as promised. In the absence of new capital and revenue resources, it is difficult to see how the HSE and the Government can achieve their objective to implement A Vision for Change.

There is a continuing drop in the expenditure on mental health. In 2009, expenditure was at 5.3% of total health care which reflects a continual decrease in the last number of years. The Government must immediately introduce an overall national strategy to ensure the service user and family involvement is an integral part in the mental health care service development.

The independent monitoring group report on the blueprint for improving the psychiatric service is a severe indictment of the Minister for Health and Children and the Government. I call on the Minister to account for this neglect and to honour the Government commitment to develop the mental health services.

There is a continuing drop in the expenditure on mental health. In 2009, expenditure was at 5.3% of total health care. It is extremely disappointing and unacceptable that little progress has been made in establishing fully developed and staffed community mental teams, both in adult and specialist mental health services. In the absence of developed resources and staff, it is difficult to see how a vision of a community based mental service can be implemented.

The Minister and the Government must immediately explain why there was a lack of significant progress during 2009 in the development of appropriate specialist mental health services such as rehabilitation, in recovery for older people, people with intellectual disability, forensic psychiatry, the homeless, co-morbid severe mental health, substance abuse problems and eating disorders. I met Ms Jacinta Hayes from Bodywise today to discuss the problems to do with eating disorders. There is also liaison, neuropsychiatry and borderline development disorder to be addressed. No progress has been made on those issues.

There was some progress as regards child and adolescent mental health services, but nonetheless these services have not received the priority and urgent attention they require. In the absence of any child and adolescent psychiatry anything would be seen as progress, but nonetheless I welcome whatever tentative steps have been made in this regard.

Ireland deserves a 21st century community-based person-centred mental health service grounded on the principles of recovery. People recover from mental illness. One in four will suffer a mental health problem at some stage of his or her life. Early intervention means complete cure while delayed intervention presents difficulties. Finally, the Government and the HSE must immediately renew their commitment to the full implementation of A Vision for Change.

At the outset, I would like to thank Deputy Neville for raising this report on today's Adjournment. It is an issue close to my heart. I have been chairman of the Roscommon Mental Health Association for many years and hold that position at the moment.

When A Vision for Change was published in 2006, it was universally welcomed as a progressive, evidence based and realistic document which proposed a new model of service delivery that would be patient-centred, flexible and community based. The Government accepted A Vision for Change as the basis for the development of our mental health services over a seven to ten- year period. Much has happened and much has changed economically in the four years since the report was launched, but it remains a progressive document and our roadmap, charting the way forward for our mental health services.

Deputy John Moloney, Minister of State with special responsibility for mental health, published the 2009 annual report of the independent monitoring group for A Vision for Change on 1 July last. The report acknowledges progress in relation to the development of child and adolescent services, the appointment of an assistant national director for mental health, executive clinical directors, and the gradual movement towards the creation of catchment areas as outlined in A Vision for Change.

However, overall the monitoring group was disappointed with the progress achieved since the launch of A Vision for Change over four years ago. I know that the Minister of State, Deputy Moloney, shares that disappointment and accepts progress on implementation in some areas is too slow. It is important to recognise and acknowledge, however, that in many parts of the country, services are pressing ahead with the implementation of A Vision for Change. Some significant steps have been taken over the past several years, including an increase in the number of inpatient beds for children under 18 and the doubling of bed numbers since 2007. In addition we now have 55 child and adolescent mental health teams in place. Additional beds have been provided in the Central Mental Hospital and a six-bed, high support step-down facility was opened in west Dublin to cater for patients on temporary release from the hospital.

We are now providing in-reach services to prisons in Dublin and the midlands. A court liaison service has been introduced to try, where appropriate, to divert persons from the criminal justice system to local psychiatric services. We now have fewer involuntary admissions and shorter episodes of inpatient care have been achieved. Up to 50% of discharges occur within two weeks of admission. We have established a national service users executive which works on a partnership basis with the HSE and the Mental Health Commission on the planning, delivering, evaluating and monitoring of mental health services.

The results of a recent survey of service users were very encouraging with satisfaction levels very high for some local services. Within the HSE, a national lead on mental health has been appointed to ensure the delivery of mental health services in line with legislation and the Government's policy. Executive clinical directors in psychiatry have also been appointed to lead reform in catchment areas serving populations of 350,000 to 400,000.

A significant amount of work on the ground and preparatory planning has taken place within the HSE which will, I am confident, show tangible progress in 2010 and 2011. This coupled with the provision in budget 2010 for a multi-annual programme of capital investment in high priority mental health projects, which will be funded from the proceeds of the disposal of psychiatric assets, will allow further progress to be made in the implementation of A Vision for Change. In 2010 the HSE will proceed to dispose of surplus assets and reinvest an initial sum of €50 million in the mental health capital programme. Provision for continued funding of the programme will be made in the 2011 Estimates and subsequent years, in the light of the previous year's programme of asset sales.

Major initiatives for 2010 include the completion of two 20-bed child and adolescent inpatient units in Cork and Galway. Construction has commenced for a new acute psychiatric unit in Donegal, a new child and adolescent mental health facility in Cherry Orchard, Dublin, a new community nursing unit in Mullingar and Clonmel and a new acute unit at Beaumont Hospital to replace the acute unit in St. Ita's Hospital, Portrane. Acute admissions to St. Brendan's Hospital, Grangegorman, will transfer to Connolly Memorial Hospital, Blanchardstown. Investment of over €18 million will be made in County Wexford for the development of a modern mental health infrastructure to replace St. Senan's.

A Vision for Change is a work in progress. I accept progress has been somewhat slower than anticipated. I am confident, however, the pace of implementation will improve now that the funding for the modernisation of our infrastructure has been secured and a care lead for mental health has been appointed in the HSE to drive the reform programme.

I want on behalf of the Minister of State, Deputy John Moloney, to assure the House of the Government's unwavering commitment to the implementation of A Vision for Change.

Voluntary Housing Associations

I thank the Ceann Comhairle for allowing me to raise this issue.

It is an issue concerning a voluntary housing association in Kildare that could have wider implications for others across the country. While I have no evidence to suggest anything untoward has happened, I am a little uneasy with a recent discussion with the local authority in respect of this association and similar housing associations.

Voluntary housing associations are financially supported by the State under the capital allowance programme with free sites made available to them. After completion of the estate, the association is required to establish a company to run the association, have an AGM, publish an annual report and liaise with its tenants regularly. Up to 10,000 houses are held under such schemes.

In the scheme in question, several tenants have become uneasy. In the beginning everything went to plan with all instructions carried out in accordance with the rules and articles of association. In the meantime a reluctance seems to have emerged on the part of the company to meet with the tenants and the local authority. I have insisted on such a meeting and called for an audit to be carried out on the association's activities to protect the Department, the local authority, the company and the tenants.

Will the Minister of State arrange for the association in question to meet with the relevant officials in the local authority and the tenants to address various questions that have emerged? These include the possibility of an audit of the association's activities in the past seven years, when it last held an AGM, whether it has responded to tenants properly, whether it has reviewed rents annually and maintained the properties to the required level. While I accept all of these may have been already addressed, it must be remembered that as associations receive funding from the Exchequer, it is incumbent on them to be transparent in answering such questions.

There are arrears in the case of some tenants which one would expect if there were no rent reviews in the good times and then unanticipated rent increases in the downturn. I hope the Minister of State will be able to get the association to address the tenants' concerns and ensure the sector does not fall into disrepute when there is a reluctance to give information when requested.

I thank Deputy Durkan for raising this item as it allows me the opportunity to acknowledge the very good work done by the voluntary and co-operative housing sector.

The sector has a proud record of achievement in the provision of rental accommodation to substantial numbers of vulnerable households over the past 20 years or so. Since the 1980s, more than 23,000 homes have been delivered through the capital assistance scheme and the capital loan and subsidy scheme. These capital funding schemes provide 100% funding for the provision of accommodation for people with special housing needs and low-income families respectively. Both schemes are administered by housing authorities and it is a matter for each authority to ensure compliance with the terms and conditions of the schemes.

The detailed requirements and relevant guidance are set out in the Department's memorandum, capital funding schemes for the provision of rental accommodation by approved housing bodies. As outlined in the memorandum, housing bodies seeking funding under the schemes must have approved status under section 6 of the Housing Act 1992. Such a body must have as its primary objectives the provision of accommodation for low-income families or persons with special needs and must have in its memorandum of association or registered rules, as the case may be, provisions prohibiting the distribution of any surplus, profit, bonus or dividend to members and requiring that the assets of the body be applied solely towards its objectives.

In order to ensure that the voluntary and co-operative housing programme is best positioned to deliver on housing need, my Department commissioned an independent report by outside consultants on the future policy and direction of the programme. The report, which I launched late last year, contains recommendations to identify strengths and weaknesses in corporate governance practices, including the examination of current practice with regard to monitoring and regulation of the voluntary and co-operative housing sector.

Stakeholder consultation on the implementation of the principal recommendations of the Grant Thornton report is now well under way and is being done through the working group on voluntary and co-operative housing, which is representative of the Irish Council for Social Housing, the National Association of Building Co-operatives, the County and City Managers' Association and my Department.

This brings me to the housing association specifically raised by Deputy Durkan. Léim an Bhradáin Housing Association was granted approved status by my Department in 1997. This housing body was properly established, is still effective and has submitted up-to-date returns to the Companies Registration Office. In 2000, my Department approved funding of over €3 million under the capital loan and subsidy scheme for the provision of 32 houses by this approved housing body.

I am sure Deputy Durkan will appreciate that my Department's primary role in voluntary and co-operative housing is to ensure sufficient funding is provided to meet ongoing demand for new projects. Approved housing bodies are the owners of the accommodation financed under my Department's capital funding schemes and are responsible for the proper management and maintenance of dwellings, the fixing of rent and compliance with all relevant statutory requirements. It is the responsibility of the body to ensure that proper procedures and governance arrangements are in place to achieve compliance with the terms of the capital funding schemes.

I understand officials from Kildare County Council have been engaging closely with this approved body. I draw the Deputy's attention to my earlier comment that it is a matter for the housing authority to confirm compliance with the terms and conditions of the scheme and to have suitable liaison arrangements in place to oversee the administration of the schemes.

I understand an AGM was held recently. Kildare County Council is in discussions with the body and is seeking the information to which it is entitled. I hope there will always be a co-operative approach among tenants, bodies and local authorities in such situations. I am supportive of this type of scheme and I would not like to see anything untoward happening in any area, although I am not saying that is the case here. I have confirmation from Kildare County Council that it is in discussions with the association. If anything further comes to the attention of my Department, I will be only too willing to pass it on to the Deputy.

I thank the Minister of State for his comprehensive reply.

I thank the Deputy and wish him a pleasant summer.

I extend the same good wishes to the Acting Chairman and the people he represents in Tallaght, although I will not mention the various areas.

European Economic and Social Committee

I wish to share time with my colleague Deputy Hoctor. We are playing for the Tipperary team tonight. I apologise for not being here earlier as I was not expecting to be called so soon.

Since we joined the EEC in 1973, the farming pillar has had two seats at the European Economic and Social Committee, one held by the IFA and one by the Irish Creamery Milk Suppliers' Association. I was only a schoolboy in Cahir at that time. The ICMSA is an 18,000-strong farm organisation that particularly represents dairy farmers, while the IFA concentrates more on sheep, beef, tillage and mixed farming.

As the name implies, the EESC is a forum for representatives of the economic and social sectors in the member states to discuss common problems and submit recommendations to the European Commission. Last week, it was announced that there will no longer be two seats at the EESC for the farming pillar. One seat will be kept for the IFA, but the other seat — strangely enough, the dairy farmers' seat — is to be reallocated to BirdWatch Ireland.

I emphasise that I have no problem with BirdWatch Ireland; its members in my own constituency do much good work with regard to nature reserves and so on. However, this decision is totally cuckoo. We had the cuckoo in my area in April, and he is still giving the odd chirp, but what is happening here is bordering on lunacy. The only sector in Ireland that has the potential to build the export business that every economist agrees is the sole hope for rebuilding our economy has been unceremoniously dumped off a vital EU economic forum and replaced with an organisation that represents bird watchers. Goodness gracious.

Is it really wise to remove an expert dairy representative from the EESC and replace that voice with one from BirdWatch Ireland? Is it in the national interest? I say "No". Will economic recovery be helped more by the presence of a representative of the Irish dairy sector — the biggest indigenous exporter we have — or a representative of Ireland's bird-watching community? I do not think many people would have a problem giving the answer to that.

Who exactly does BirdWatch Ireland represent and what is its capacity for economic and social research and analysis? Is this move politically motivated? I believe it is. Is the Green Party putting in place sleepers to maintain their influence in key positions? I believe it is. I am glad the Minister of State at the Department of the Environment, Heritage and Local Government is here. Where was BirdWatch Ireland, and other people, when we were trying to get the Lisbon treaty passed in two referendums? The ICMSA stood steadfast with us. It should be obvious to any reasonable person that this is a ludicrous decision. It must be reversed, or, at least, another seat must be provided to allow for the very important work of the ICMSA to be represented at the committee.

I add my strong voice in support of my colleague, Deputy Mattie McGrath, on this difficult issue for the farming sector and particularly the dairy sector. Like my colleague, I emphasise that I have absolutely no difficulty with BirdWatch Ireland; I acknowledge the good work of this organisation not only in Tipperary but across the country. However, I wish to resolve this issue if at all possible.

According to the EESC:

The EESC has currently 344 Members who are appointed for a term of four years. The current mandate (2006-2010) ends in October 2010. Following the new Lisbon Treaty, from October 2010 onwards, the mandate will be five years. The number of EESC members will remain 344, but the Lisbon Treaty permits the number to grow up to 350 Members with the next EU enlargements.

This area needs to be examined. An extra seat could be provided to meet the needs of the extra environment pillar which has been created in the social partnership structure, to be allocated as appropriate to the sector. I believe the Government should enter into negotiations with EU to secure this extra environmental pillar seat.

In the meantime, I propose that traditional allocation of two seats for the farming sector — that is, the IFA and the ICMSA — be restored. It is important that the ICMSA as well as the IFA be represented on the committee in view of the upcoming reform of CAP, which is crucial for our dairy sector. I acknowledge the work of all the groups that have been mentioned in our speeches tonight.

I thank Deputies McGrath and Hoctor for their contributions. The European Economic and Social Committee, EESC, plays an important role in the European policy making process and I am delighted with the opportunity to speak on the matter this evening.

The EESC is a consultative body of the European Union and is the prime forum for the representation of organised civil society within the European decision making process. The committee has 344 members, broken down into three groups — employers; employees; and various interests. The various interests group represents a wide variety of organisations, including non-governmental organisations, farmers' organisations, co-operatives, non-profit associations and environmental organisations. Ireland has nine places on the committee and membership is divided equally between the three constituent groups of the committee, with three places for employers, three places for employees and three places for various interests. The Government sought nominations from the social partners in line with long established practice and these were then conveyed by the Government to the Secretariat of the European Council. The business and employers' pillar and trade union pillar both provide three nominees, including one trade union representative from Northern Ireland. For the first time, the various interests group of the committee now includes a representative from the environmental pillar. This change reflects the decision which was taken by Government last year to create a fifth pillar of social partnership to represent environmental concerns. The community and voluntary pillar and the farming pillar each provide one nominee.

The environmental pillar consists of 27 organisations with a diverse range of interests. The Irish Environmental Network provides a secretariat for the pillar. This is the first time that environmental interests have been represented in Ireland's nominations. The EESC is mandated to consider environmental issues. Other countries have long had environmental organisation representatives among their nominees and environmental sustainability is a key focus of European policy. The environmental pillar selected an employee of BirdWatch Ireland as its nominee on the committee. She was selected to represent the pillar as a whole and represents the interests of the 27 organisations in the environmental pillar and environmental interests more generally. It is therefore not accurate to characterise her appointment as a BirdWatch Ireland appointment.

This change to the composition of the Irish representation on the committee does not reflect any diminution of the Government's commitment to the agricultural industry. The farming sector is an extremely important part of the Irish economy and the Government continues to strongly support its development at national and EU level. The prosperity of many rural areas is heavily dependent on the performance of the agri-food sector and we all, Government, farming organisations and the wider agri-business community, need to continue to work together to meet the continued and ongoing challenges ahead. It is also important to note that the farming pillar of social partnership and farming interests continue to be represented on the committee through a representative of the Irish Farmers' Association. I would, however, like to take this opportunity to acknowledge the work of representatives of the Irish Creamery and Milk Suppliers Association, ICMSA, on the EESC, including the most recent ICMSA representative, Mr. Frank Allen who has been an active member since his appointment.

The EESC plays an important role in formulating policy at European level and I would like to wish all of Ireland's nominees the very best for the forthcoming term of the EESC.

I wish the Minister of State, colleagues and staff a pleasant and happy summer.

The Dáil adjourned at 10.55 p.m. until 2.30 p.m. on Wednesday, 29 September 2010.
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