I do not know if the Minister of State saw "Prime Time" on Tuesday night-----
Topical Issue Debate
Foster Care Provision
I was in my office on Tuesday night but I am aware of the programme.
I am sure he is aware of the programme. For anyone with any kind of heart or soul, the footage was harrowing to watch. The Taoiseach put it well when he said that there are many levels of crime, but that a crime inflicted on children is possibly the worst form of crime possible.
I want to compliment "RTÉ Investigates" on the work done to highlight this story. The story broke in April 2016 when the perpetrator of the abuse was still saying he was innocent. The women in question decided to come forward and release their names. They have done that in an extremely brave fashion. I have to acknowledge the graphic detail in which they explained exactly what happened to them while in foster care. Keith Burke was sentenced to a seven and a half year prison sentence with a year suspended. However, this story is about Rachel, Amy and Sarah. Rachel is her real name, but Amy and Sarah are pseudonyms. Amy went into foster care when she was a baby. Rachel arrived on the scene when she was approximately seven years of age and made the disclosure aged 11. The two girls developed a friendship. Rachel told the story of how she was repeatedly abused to her mum and once that happened, there was an investigation and a file was sent to the DPP. It is hard to believe that the accused was not prosecuted once that file was sent to the DPP, even though it was found that the assessment of rape was credible. Amy continued to stay in that house. It was also discovered that Sarah had been in the house previously and another boy continued to live there.
We hear stories about the most vulnerable children and those who need assistance or whose families need assistance but we did not provide them with support. We allowed them to continue to live in that house. It was not until 2011 that Amy found the courage to speak out. In the area of mental health, it is said always said that it only takes one person to speak out. Amy found the courage to speak to her teacher. She was 14 years of age and she had been subjected to abuse from 2003. At that stage, she was only three years of age. When she went to her teacher she was 14 years of age.
Where were the checks and balances and the governance? In 2007, when the file went to the DPP, the decision was made to leave those children in that house. Amy did not have the courage to speak up at that stage. She was only a child and did not have the wherewithal to communicate what was happening to her. Her mind could not make sense of it.
As a grown adult myself and having watched that programme, it is really hard to articulate the horrific test of endurance these children were subjected to. Why was an apology only issued by the HSE on Tuesday night? That is the most horrific aspect of all this. Why were those other two children left in that house? What is Tusla now doing about it?
I want to offer the apologies of the Minister for Children and Youth Affairs, Deputy Zappone, who is with President Higgins on official business in the United States this week and could not be in the House. I did not get to see the programme Deputy Rabbitte mentioned in real time, but I watched part of it later and read the horrific story in graphic detail in various newspapers. I share the sentiments of the Taoiseach that crimes against children are particularly heinous, and sexual crimes against vulnerable children deserve a special level of disgust. I believe those sentiments are shared by the House and by everyone who knows the facts of this story. As the Deputy may appreciate, I am not in a position to respond as directly and fully as the Minister to some of her questions, but I will relate the issues raised both to the Minister's officials and to the Minister herself upon her return.
The Government and its agencies are determined that the handling of this case and other serious cases will help inform future policy, safeguards and protections for children. When an allegation of abuse is made, action is taken to protect any child or children who may be at risk. In terms of this particular case, abuse was first revealed in 2007. The HSE found the allegations to be credible and took actions to protect the children at that time. An assessment was carried out and no new placements were made with the family after the disclosure. Following the allegations the son of the foster family left the home and a safety plan was agreed with the family. There were two children in long-term foster placements, one of whom was there from a very early age, as Deputy Rabbitte outlined. They did not disclose any abuse at that time. In 2011, one of the children disclosed abuse that occurred before 2007, and a decision was made to remove the children then. There was no disclosure of abuse happening after 2007, which was after a safety plan was agreed with the parents and the abuser was no longer living with the family. A Garda investigation took place in 2007, but there was no prosecution on the direction of the DPP on that occasion. Later, in 2011, there was an investigation which lead to the prosecution of the abuser. This resulted in a conviction in 2017 and the sentencing of the abuser this month.
In April 2016 the case was referred to the expert national review panel, NRP, and that review is nearing completion. The review is expected to look at the professional decision-making in 2007. The NRP is appointed independently. It reviews deaths and serious incidents affecting children in care or who are known to child protection services. The NRP was set up in response to the recommendations of the Ryan commission. Tusla plays no role in carrying out the NRP reviews. We await the outcome of the review and the opportunity to consider all of the findings and recommendations.
It is important to acknowledge that foster carers undergo a rigorous assessment process. Approval takes several months of intense work. All general foster carers are fully vetted, assessed and approved before a child is placed with them. Most foster care placements will have a link social worker and the child will have his or her own social worker in whom he or she can confide. Across Ireland thousands of people open their homes and lives to children in need and provide love and care. We must not lose sight of that in the midst of this terrible case. HIQA inspections have shown that there are areas of foster care services that must be improved. Tusla has responded positively with actions and ongoing national reforms addressing the key issues.
The Minister, Deputy Zappone, received correspondence yesterday from the solicitor of one of the women who as a child was sexually abused in that foster home. The correspondence related to an inquiry, and will be actively considered by the Minister, Deputy Zappone, when she returns from the United States as a way to get to the facts of this case and to learn lessons to ensure that it will not happen again, and also to discover whether there was any negligence involved.
It is right to say we have some very good foster care families in this country. We need every one of them and we need more because they do Trojan work. It is unfortunate we are bringing a spotlight onto a particular case but it is incumbent on us to highlight it so we can do the right thing for children.
The Minister of State acknowledged that foster carers undergo a rigorous assessment process. That is absolutely the case but where it falls down is in regard to the follow-up, the governance and the procedures covering checks and balances. I am reading HIQA reports monthly, and I have read reports from areas such as Cavan, Monaghan, Cork and Dublin, where I can see major non-compliance. Some of the instances of non-compliance are very simple, for example, Garda vetting, which is a simple requirement that we need in order to protect children.
I and my colleagues in Fianna Fáil believe that the possibility of an independent commission of investigation should be examined. There have been far too many cases where poor and tragic decisions have been taken with regard to children in the care of the State, such as the Grace case last year and the Mary case. I do not want a litany of such cases. I want us to find how best to protect our most vulnerable.
We know from the testimonies of foster parents, as well as from Tusla figures, that even where protocols are in place, they are simply not being enforced or implemented by Tusla. At the end of 2017 over 10% of children were awaiting an allocation of a link worker - a social worker intended to support foster carers - and some 5% of children in care did not have an allocated social care worker. In January 2018 there were 4,256 child protection cases awaiting the allocation of a social worker, and 1,787 of these cases were high or medium priority.
I have laid out the position. What I and my party want is an independent commission so we can learn from all of these cases.
As I said, the correspondence was dated 24 April and the Minister is actively considering it. We are awaiting the national review panel report, which should be completed very soon, according to the information presented to me by the officials before I came in. The Deputy asked a direct question earlier about why the apology was only made on Tuesday and I am not in a position to answer that.
We have had too many of these cases. I deal with foster families, as do all Members of the House in their constituencies, and I know the care they offer is invaluable and much-needed, and more is needed, as the Deputy pointed out. However, those families are done a huge disservice when the system does not work, in particular when governance do not work. The time, love, attention and care they give to children is not matched by some parts of the system when we see examples such as this case.
When the Minister, Deputy Zappone, returns, I will speak to her directly on the issues the Deputy has raised and, in particular, on the correspondence she has received in regard to an inquiry.
Rail Network
Over two months ago I asked the Minister in a parliamentary question for his views on the reliability of the route profitability figures published in the 2016 rail review carried out by Roland Berger from the National Transport Authority, NTA, and whether his attention had been drawn to anomalies in the figures in the report. His response was that his Department had consulted the NTA and the NTA was not aware of any anomalies. I had a fair idea of what the NTA would say and I was probably more interested in the Minister's thoughts.
On 3 January 2017 the Minister was sent a letter from a statistician raising serious concerns about the reliability of route profitability figures in the 2016 rail review. I have a copy of the letter and the generic response from the Minister's private secretary. In the letter the statistician provides clear evidence of cost misallocation across various routes, including four earmarked for closure. Across ten routes he examined he noted that the cost figures were either impossible or improbable.
The most glaring anomaly in the figures appears to be on the Gorey to Rosslare segment of rail track, a route that could be earmarked for closure. Here I will give just three examples but there are many more. Perhaps someone can explain how the five stations on the Limerick to Ballybrophy line - three staffed and two not staffed - can cost €31,000 per annum to maintain while the four stations on the Gorey to Rosslare line - two staffed and two not staffed - can cost €1.17 million per annum to maintain? How can CCTV on just one crossing on the Limerick Junction to Waterford line cost €252,000 per annum to maintain while on the Ennis to Athenry route, CCTV costs on seven crossings work out at €71,000, or just over €10,000 each? Why does the report state that €194,000 could be saved in wages for centralised signalling by closing the Gorey to Rosslare segment, when the centralised signalling base is in Greystones and the controllers will still be employed?
There is no doubt the figures Irish Rail, the NTA and the Department are working off which will determine whether rail lines are kept in service or closed, are flawed. I am aware the NTA states it is confident the route profitability methodology used by the experienced consultants is robust and suitable for the comparative analysis that was carried out, but why have these experienced consultants only been awarded one contract across all Government Departments since 2011? I ask the Minister to direct that an independent audit be carried out on the figures arrived at in the 2016 rail review.
Closing rail lines is probably one of the most regressive decisions any Government could take. Threatening to close rail lines using incorrect costing figures in conjunction with a flawed business model is doubling down on this stupidity. The Rosslare to Dublin rail line is one of the most spectacular routes, not just in Ireland, but in Europe. However, not enough people avail of it, the route is slow and the service is not regular enough. The trains do not match up with the ferries that arrive in Rosslare and, in another moment of madness, the station at Rosslare Harbour was relocated a good distance away from the terminal - close to 600 m away. It is almost like someone set out to sabotage this line to make it unusable and then adjusted the figures to make it seem even more unprofitable and unviable.
There is no doubt there has been no political pressure for many years about this line. However, while it does not require political will to continue to have it operating, closing it would essentially amount to branding Wexford as a backwater of lesser socioeconomic relevance than towns like Sligo, Killarney, Westport and Dundalk. It would be a poor decision if it was ever closed.
I am glad we have the opportunity to debate this in the House so I can expand on the reply which I gave in written form to Deputy Wallace. It is a bit of a straw man that he is putting up. He is saying that another consultant produced figures which would indicate there was a good case for closing this line. Let me say one thing. While we can argue this until the cows come home, including the merits of the various consultants, I and the Taoiseach have said there is no intention whatsoever to close rail lines. That is Government policy. To say the idea of closing a rail line is abominable is something the Government and the Deputy share. However, we are the ones who make that decision, as Government policy, and it is not Government policy to close any rail lines, which includes the Rosslare to Dublin rail line.
I note that Deputy Wallace is concerned about this and he has every right to be because it is his constituency and he is doing the right thing. However, whereas, as he suggests, the Dublin-Rosslare, Limerick-Galway, Limerick Junction-Waterford and Limerick-Ballybrophy lines were the ones which came out worst in the review, there is no intention to close any of those rail lines, despite the findings. We recognise the need of people for railways and we recognise the need to run what are, in certain cases, very uneconomic rail lines.
That may not be a good commercial decision, but it is a good social decision, and it is Government policy that these rail lines, despite the findings of the rail review, will not be closed.
This review was undertaken jointly by the National Transport Authority, NTA, and Iarnród Éireann and was published in 2016. The purpose of the review was to look at the existing rail network, identify the funding required both to maintain the network and to provide the necessary capital works and to consider the gap in funding. The review also examined the potential of the rail network to meet the economic, environmental and social needs of the State in the future and discussed the importance of maintaining a rail network to support sustainable strategic growth in travel demand. The review highlighted the considerable amount of taxpayer support currently provided to the rail network. It also provided an overview of the estimated amount of additional funding needed to support the network over the period from 2016 to 2021. My Department has consulted the NTA on the matter raised by the Deputy and the authority has advised that it is not aware of any anomalies in the figures published in the 2016 rail review, despite what the Deputy says. The NTA has stated that it is confident that the route profitability methodology used by experienced consultants on behalf of the authority and Iarnród Éireann is robust and suitable for the comparative analysis that was carried out. The review identified a funding gap for Irish rail of the order of €100 million per annum at that time.
I am glad to point out that since the report was published in 2016, the Government has announced significant additional funding for rail infrastructure and services, which is addressing the funding requirement. Public service obligation, PSO, subvention increased in 2016 and 2017 and is increasing further this year. Over those three years, PSO subvention will be increased by some 35%. In budget 2017 alone, we allocated over €50 million in additional funding to Irish Rail, bringing the total amount for the year to over €300 million. This significant increase in funding allows for increasing investment in maintenance and renewal of the network and the rolling stock, and also provides more funding for safety projects. On the capital side, in budget 2018 we announced €2.7 billion of Exchequer investment in public transport infrastructure and facilities over the next four years. The recently published ten year national development plan will prioritise key investment actions that protect the quality and value of the existing extensive transport networks and progress new key capital public transport programmes over the years leading up to 2027.
The public consultation process held by the NTA following the publication of the review helped to begin an informed discussion about the current and future role of rail transport in Ireland. More than 300 submissions were received in response to that consultation process.
I am glad to hear the Minister confirm again that he does not have any intention of closing the line. However, I could be forgiven for suspecting that Irish Rail does not have much of an appetite to keep it open. I still insist that this particular report, which would have been driven and very much determined by Irish Rail, is a flawed one. The Minister and the Taoiseach may not be captive to it, which is good news. I am sure the experienced external consultants referred to are very experienced, but they would have been totally captive to the way Irish Rail presented the information to them. What input did the Commission for Railway Regulation, CRR, have into the review, particularly in respect of attaching infrastructure costs to specific routes in the network? CRR is mandated to independently monitor the infrastructure costs of the network. That is distinct from the role of the NTA in awarding PSO services contracts, which is purely related to the operation of the services. The NTA is, therefore, not expert on infrastructure costs of maintenance and renewal.
The Minister must agree with me that assumptions on data on those infrastructure costs are critical to any analysis of route profitability. Although he says that neither he nor the Taoiseach have any intention of closing it, God knows that there may be a change of Government one of these days, and maybe Irish Rail will get its evil way and force the closure.
The Minister said that more money is being invested in this area. Is any money specifically targeted at the Rosslare-Dublin line? At the moment an express train runs from Gorey to Dublin, which is good. What about a train from Rosslare to Wexford and Enniscorthy, and which then goes on an express run to Dublin? The line needs help. I know it is not used by an awful lot of people, but we can change that. It would be a good thing to do all-round.
I think the Deputy has raised this question about the south-eastern line before, and I think he got a response. It is significantly constrained south of Bray as it is a single-track line with limited passing capacity. This reduces the competitiveness of rail against travel by road. In addition, Wexford is currently well served by commercial bus services provided by Wexford Bus and Bus Éireann and as a result, there are no plans to provide an express rail service from Wexford. In other words, the roads have had a large amount of money spent on them already and there are no plans to do what the Deputy has suggested.
The merits of various consultants and their reports can certainly be argued by Deputy Wallace or myself. My guess is that the consultants to whom Deputy Wallace referred, who were asked to produce the rail review, had a mandate which was very much weighted towards the commercial side. What they came up with in the rail review were the figures for losses on the Dublin-Rosslare line, which I have read out. The cost per passenger journey to break even was €30.80 in 2014 while in 2015, it was €29.10. However, we cannot measure its value by this alone. That is what Governments and Government policy are for. We cannot measure every rail line in terms of commerce. These are commercially unviable rail lines which we are running for social reasons.
What about the environment? Is that an issue?
This is the whole point. We are not closing them, even if consultants say that they are not commercially viable. They are run for the benefit of the people who live in the areas, to which the Deputy referred.
Services for People with Disabilities
I thank the Minister of State for coming to the House to discuss this Topical Issue matter in the absence of the Minister of State with special responsibility for disability issues, Deputy Finian McGrath. Hopefully, she will be able to take some of the concerns I will raise back to the Minister of State. I raise these concerns pertaining to the progress of disability services and the lack of those services on the ground on behalf of my constituents in Kildare North who are parents of children with disabilities.
As I raise this Topical Issue matter, I am conscious that the Minister of State, Deputy Finian McGrath, met these parents on a number of occasions at my request. I want to put that on the record and thank him for doing that and for his co-operation. Before Christmas, I think, in November, he also secured extra funding in this area. Unfortunately, however, as in so many other areas, we are not seeing the dividend of that investment on the ground and services are not being delivered.
One area I want to focus on is the assessment of need. At the moment, an assessment of need is carried out on a child with a disability, but despite what is being said, a period of between 18 and 24 months elapses from then until the actual care plan is implemented. A child with a disability, or some degree of special need, needs to get the appropriate supports as early as possible, as any of us would in order to reach our maximum potential, but that is not happening. When the actual care plan begins to be implemented after 18 to 24 months, that child's disability has developed and progressed further. The care plan that is being implemented therefore does not accurately reflect the child's needs at that time. That is a massive problem.
Occupational therapy, speech and language therapy and physiotherapy, which are critically important in these cases, are not there. They are not being delivered. The reason the resources are not forthcoming and the care plan is not being implemented is not that they are not being provided and the staff do not want to implement the care plan but rather the staff are not there and the services for these children and their parents are not there. We all acknowledge that these parents work tremendously hard. They do an excellent job at caring for these children and helping them to develop to their maximum potential. They do wonderful work. However, it should not be part of their job to fight the system every single day to get services that are needed for their child's development to progress. That is what is happening at the moment, and that is what needs to change.
Another concern is that reviews are suffering because care plans are not being implemented. Once an assessment of need has been carried out, a care plan should be implemented quickly in the areas identified. Thereafter, a review of the case and the child's needs should be carried out within 18 months or two years and the plan progressed accordingly. None of this is happening, however, despite what the Minister of State may have been told and what she may tell me. I speak and engage with the parents in question, who also met the Minister of State, Deputy Finian McGrath, and that is the message they have given.
Certain equipment is critical in helping children with disabilities to make progress. In one case before Christmas, a child needed insoles to assist with walking. In a letter to the child's parents, the Health Service Executive, HSE, stated the insoles could not be provided because it did not have the funds to do so. I provided the Minister of State, Deputy Finian McGrath, with a copy of the letter in question, which flatly contradicts the statement made by the Minister of State six weeks ago that there was plenty of money available for services. While I do not doubt the Government's commitment to provide funding for services for disabled children and young adults, this funding is not getting through and the services are not being delivered.
Area respite is vital for carers, parents and guardians of children with disabilities as it allow them to recharge. However, it is not available to some carers. Providing care is a big job and parents need to be at the top of the game at all times to give their child the full care required. If respite and other appropriate and necessary supports are not available, it will have a negative impact on parents.
The Government must deliver in the areas I have highlighted. I will raise a number of other issues when the Minister of State has responded.
On behalf of the Minister of State, Deputy Finian McGrath, I thank the Deputy for raising this important issue. I apologise that the Minister of State cannot be present for this discussion. I will make a statement and refer to some of the issues the Deputy raised. I hope I will also be able to fill in some of the gaps for the Deputy.
I am pleased to confirm that the national programme, Progressing Disability Services for Children and Young People, is changing the way services are provided across the country to make access to services equitable and consistent for all. The programme is based on family-centred practice based around a child's natural environments and the everyday routines, activities and places of daily life of the child and his or her family. This model is recognised as an effective model of support for children with complex needs and lifelong disabilities to support the development of skills to maximise active participation within their communities and daily life. It also recognises that children with complex needs may present with requirements across a number of areas and that services provided in isolation within one environment of a child's life are not appropriate. For these reasons, support and intervention are provided in a variety of environments such as home, school, clinic and community settings.
Under the national programme, all children disability services in Kildare west Wicklow were reconfigured in May 2014 and three network disability teams were established in south Kildare west Wicklow, mid-Kildare west Wicklow and north Kildare, respectively. Significant investment has been made in the children disability network teams in Kildare west Wicklow. In addition to the staff that reconfigured in May 2014, an additional 22 permanent posts have been allocated to the Kildare west Wicklow network disability teams. Another nine temporary posts have also been provided as part of a waiting list initiative.
The Kildare west Wicklow teams have developed strong working relationships with many of the schools in the area. Supporting children to actively participate within the school environment forms a significant part of the daily work of the network disability teams' therapists. The referral rate to the service continues to grow across all three teams. The average referral rate to the Kildare west Wicklow network disabilities team is 35 children per month, while the current average wait time for services is between six and 13 months.
While I appreciate the Minister of State's comment, if they were true, I would not need to raise this issue. The reason I am raising the issue is that the parents of children with disabilities are tired and worn out. They are at their wits' end as they seek to access the necessary and appropriate supports and services identified for their children. They are no longer able to fight. We have all heard about various cases. The Acting Chairman, Deputy Durkan, and I share the same constituency and both of us have heard these problems being outlined at many meetings. Given that the problem has been ongoing for many years, I am not making a party political point.
Services are not available and parents are no longer able to fight. They want the services identified as necessary for their children to be provided. As I outlined, once an assessment of need has been carried out, a care plan should quickly follow. A review should then be carried out after a certain period and the care plan should be changed and modified according to the child's needs as he or she develops. The equipment identified as necessary for a child should also be provided and families should not be told such equipment is not available because of a lack of money. Respite is not available at the moment and must be provided.
Behavioural therapists and psychiatrists must also be involved in the assessment and review teams, which is currently not the case. In addition, the July provision should be made available to all children with mild and profound disabilities. This has not been the case for some time. There is also a lack of communication between the Department, the HSE and parents. This is a critical area and the parents of children with disabilities do wonderful work. If they are to sustain this work, they need access to the supports and services identified as necessary for their children and which they deserve.
I thank the Minister of State for taking this matter. I hope she will take my message back to the Minister of State, Deputy Finian McGrath, who kindly met me a couple of times to discuss this issue. I ask that the Minister of State meet me again in the next few weeks to discuss the points I have raised, with a view to providing a timeline for the delivery of these issues, which are important for children who require services and their parents.
As I indicated, the rate of referral to the services in Kildare west Wicklow continues to grow. As a public representative, I understand that parents need to have their children assessed within a specified timeframe. If a timely assessment is not carried out, a child will, unfortunately, regress to a certain extent. While there is no issue with funding for services, sometimes staff are not available.
Having spoken to the Minister of State with responsibility for disability, Deputy Finian McGrath, I know everything is being done to deliver services to facilitate respite, especially for children. We all understand that in families with a child with special needs, there can be turmoil in the home and parents need a break to be able to take time for themselves. I concur with many of the points made by Deputy O'Rourke and I will convey them to the Minister of State, Deputy McGrath. I will also ask the Minister of State to meet Deputy O'Rourke.
The Kildare west Wicklow network disabilities teams currently support 367 children in services. There are 21 children on the waiting list and the average waiting time is between seven and 13 months. The area has 19.7 speech and language therapist posts and there is one vacancy in this area arising from long-term sick leave. The service also has 11.8 psychotherapist posts and there are five vacancies for psychotherapists, which is a significant vacancy rate. The Deputy is correct that services are not available in certain areas. Recruitment is a problem in all parts of the health service.
Mental Health Services
I thank the Leas-Cheann Comhairle for giving me the opportunity to raise this very important issue. I have just attended a mental health launch by the Joint Committee on the Future of Mental Health. It was shocking to read the committee's report. According to the HSE's health capacity review, Ireland's hospitals need at least 2,600 new beds in the next 15 years. The review goes on to say the number could jump to 7,000 if HSE reform is not prioritised. There is no reform. It was also reported last year that more than 2,400 children were availing of child and adolescent mental health services, CAMHS. At the same time, Ms Anne O'Connor, national director of mental health with the HSE, made the astonishing claim that the problem is that CAMHS takes everyone because there is nothing else. Imagine, the director of mental health in the HSE said that. We should let it sink in. There is nothing else there. Ms O’Connor went on to say that in an ideal world the first step for a young person presenting with a mental health problem would be to get help in school and go to his or her GP to get access to primary care-based psychology or family counselling services. She said the HSE’s mission was in fact to keep people out of CAMHS. At every point of intervention described by Ms O’Connor, there are profound and systemic failures. Primary care, GP services, school-based solutions and family counselling services are all in near total disarray despite the heroic work of the front-line staff involved. The most recent report I have indicates that almost 220 children have been waiting for more than one year for access to CAMHS while at least 70 posts across CAMHS teams nationally remain unfilled. Meanwhile, the HSE continued to recruit all through the recession with three out of every four recruits being managers and pen-pushers. There is something rotten in the HSE when 70 posts in CAMHS are left unfilled nationally. According to the College of Psychiatrists of Ireland, at 6%, spending on the delivery of mental health supports in the context of national concerns on this issue remains scandalously low, particularly when compared with the UK at 12% and Canada and New Zealand at 11.5%.
There are a number of young children in my constituency who are incarcerated – I have to use that word – in South Tipperary General Hospital. I could name them - a Boyle girl and an O’Brien girl from Carrick-on-Suir. The parents have contacted me, particularly those of the Boyle girl. I apologise, she is a Kennedy and a 14 year old. This is her tenth week in a children’s ward in a general hospital where she is getting no treatment. It will be her 11th week on Monday. That is frightening, shocking and appalling. If it was a war situation, the Government would be hauled in for war crimes. It is a totally unsuitable setting. The nurses and other staff are doing their best but her mother or someone else has to sit with her all night and on a 24-7 watch. She is waiting for a bed in Cork University Hospital, CUH, or somewhere else. It is appalling. I have raised this with the Taoiseach over the past two weeks. It is the same with the O’Brien girl. She is 13 and has also been waiting several weeks. There have been four or five others over the past six to eight weeks in the same situation. These are adolescent girls. They are nearly adults but they are in a paediatric ward which is totally unfit and they are getting a small level of treatment each day from CAMHS. It is pathetic and disgraceful.
I attended the report launch today and heard consultants talking about the matter. I saw the sheer frustration felt by everyone present because of the inertia and lethargy of an inept and uncaring HSE. It must be disbanded in order to allow people access the services to which they are entitled. It is despicable to have these children in a ward that is so overcrowded. Those beds are needed for sick children. These young adults must not be left to languish in these conditions in a hospital which is unfit to deal with them. They need specialist treatment and they must get beds somewhere else. Something has to be done about the HSE in order that sense will prevail.
I apologise to Deputy Mattie McGrath on behalf of the Minister of State, Deputy Jim Daly, who cannot be here. I have been asked to take this matter on his behalf. I have taken notes because the initial issue submitted was so broad and the reply may not cover all of the matters to which the Deputy referred.
Mental health remains a priority care programme for Government. Since 2012, approximately €200 million, or 28%, has been added to the HSE mental health budget, which now totals over €910 million. This is a significant investment by any standard and the programme for partnership Government gives a clear commitment to increase our mental health budget annually as resources allow to expand and modernise all aspects of our services, including those in Tipperary. HSE mental health funding for Tipperary this year is in the region of €24 million. One of the strategic priorities for mental health in the HSE national service plan 2018 is to deliver timely, clinically effective and standardised safe mental health services in adherence to statutory requirements.
The provision of acute inpatient care to the adult population of north Tipperary, which is in community health organisation, CHO, 3, is provided between the acute unit in University Hospital Limerick, which has 50 beds, and the acute psychiatric unit in Ennis, which has 39 beds. The 44-bed department of psychiatry based in St Luke's General Hospital in Kilkenny is the designated approved centre for acute inpatient services for south Tipperary, which is in CHO 5. This enables all acute inpatient admissions for the CHO area to be managed at a single site. Referrals to the department of psychiatry are through a consultant psychiatrist who makes the clinical decision to admit on the basis of the level of acute presentation or need. In addition to the department of psychiatry, there is a dedicated psychiatric liaison team operating from the emergency department at St. Luke's. All service users presenting to the emergency department who require psychiatric assessment will receive that assessment within agreed timeframes in line with the relevant department of psychiatry and emergency department guidelines. Onward referral pathways are agreed with all service users upon completion of psychiatric assessment in the emergency department. Pathways can include admission to an acute unit, referral to a relevant community mental health service team or referral back to a GP.
There is a range of other mental health services for adults in Tipperary. These include, for example, psychiatry of old age teams, non-acute beds, day hospitals and day centres, community mental health teams and high, medium or low support community residences. There are three CAMHS teams operating in Tipperary; one in north Tipperary and two in south Tipperary. The CAMHS acute units at Eist Linn in Cork, and Merlin Park in Galway, which has a total of 42 beds, serve the Tipperary catchment area.
The Minister of State, Deputy Jim Daly, recently met with Oireachtas Members, and various local representatives, to discuss current and future provision of mental health services in Tipperary, including reviewing bed capacity. He also visited mental health facilities in south Tipperary in February last. Deputy Mattie McGrath can rest assured that the Minister of State will continue to closely monitor the development of all mental health services in Tipperary, particularly in the context of progressing new service developments agreed under the HSE service plan and through additional investment for mental health provided by Government. I will come back on other issues raised by Deputy Mattie McGrath.
I thank the Minister of State, Deputy Jim Daly, for coming to Clonmel to meet us. He seemed to make an effort. However, if the Minister of State, Deputy Catherine Byrne, continues to read out stuff officials write for her, we will change nothing. It is pure and utter balderdash. We do not have a single bed in Tipperary for mental health services. The Minister of State may talk about Ennis and Kilkenny but units there are overcrowded. The HSE is spending €400 million of the mental health budget every year on medical treatments for illnesses but just €10 million on psychological and counselling services while the Ministers of State in the Department and the Minister, Deputy Harris, read reports and listen to balderdash and baloney from the HSE. These are mandarins who are not accountable. CHO managers and others move on in a chain. Mr. O'Brien is going off into the sunset and leaving also. Meanwhile, unfortunate children and others with mental health issues would be in a wasteland but for volunteers, the suicide watch people in Clonmel and all of the other organisations doing such great work in this area. It is unbelievable that the Minister of State should come to the House and read out such rubbish replies and that she or another Minister of State will do so again next week. I do not mean any disrespect to the Minister of State personally but ministerial officeholders must take charge of the HSE and its budgets and demand accountability. They must listen to front-line workers and stop hiring more mandarins and pen-pushers.
Three out of every four new recruits to the HSE is a manager. It is despicable, out of control and morally, and in every other way, wrong. To deny these young adolescent girls and boys these services and have them languishing in hospitals is wrong. It is wrong that their parents and their families at home are traumatised because of this upset too. However, all we get are toilet paper replies like this. It is disgusting.
At the report launch today, the entire health committee attended. Several clinicians told us the system is so broken and rotten they cannot change it. They said there is no accountability. What are the jobs criteria for these HSE managers? They have not a clue what they are trying to manage. Above all, they have no empathy. It is devastating that we are going to put up with this and continue listening to it from the HSE. It does not care about the people. All it wants are offices. We have a hospital in Tipperary which is closed up and is a bed-free zone. That is how the HSE operates. Its managers are all about furthering their careers and to hell with the people and the services.
I assure Deputy Mattie McGrath that I do not take it lightly when I am asked to read from a prepared statement in the Chamber. I am sure the Minister of State, Deputy Jim Daly, can reply to the Deputy personally. I will ask him to do so. To claim money is not being poured into the mental health services is wrong. This year the budget allocation is €910 million.
It is being misused.
The Minister of State to reply without any interruption.
Up to €24 million will be put into funding mental health services in Tipperary this year.
I understand the concerns the Deputy has raised and his frustrations. I can hear them. I am not deaf.
What about the parents?
The Minister of State to reply.
It is not nice to come down here to be ridiculed.
I have read a statement-----
The Minister of State should not encourage the Deputy.
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When Ministers keep giving these replies, we will respond like this.
The Deputy has had his say.
I have read a statement from the Department. Whether the Deputy agrees with the statement is a different case.
I do not agree with it.
To accuse me of not being able to reply back is not fair, however.
Not the Minister of State personally.
I understand the Deputy's frustrations and concerns. I will take them personally to the Minister of State, Deputy Jim Daly. To claim the Government does not take mental health services seriously is wrong.
It is a fact.
I totally disagree with the Deputy, as somebody who has personally been affected by a family member who has had to use mental health services in the past two years. I can stand over the care provided by my local mental health service to my daughter, who was struck with bad post-natal depression. The service was provided in our community. That is what I was trying to relate back to the Deputy in the Minister of State's reply.
The Deputy's issue was very broad and I may not have been able to cover some of the questions he raised. I will bring his concerns back to the Minister of State.
As a parent whose daughter suffered from post-natal depression over the past two years, I have to put my hand on my heart and say I am proud of the public health service in my own community.
Thanks be to God.
The people in it are working hard and are extremely professional. I doubt anybody who works in mental health services goes into it for any wrong reason. They do it to help people with mental health issues.