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Dáil Éireann debate -
Tuesday, 6 Nov 2018

Vol. 974 No. 4

Saincheisteanna Tráthúla - Topical Issue Debate

Illness Benefit Payments

I thank the Minister for taking this issue. I know she has spoken on the matter a number of times already but this Topical Issue was deferred from a number of weeks ago before the Houses went into recess. I appreciate the opportunity to speak to the Minister and I hope some clarification can be offered to those affected by the delays in processing the payment of illness benefit. For over two months now there have been major delays in the processing and payment of illness benefit to people across the country. I have been contacted every day by constituents in Donegal genuinely upset by the disruption to their payment. One can imagine what they were thinking when suddenly no money was coming to their account.

This payment is granted to people unable to work and it is a very important income source for many affected by disabilities of varying degrees. As an income source the money is used to pay typical bills, including rent, mortgages and utilities. One can imagine the chaos that ensued when somebody's main income source suddenly dried up and the person was left to find alternative income. That is exactly what happened. Most people were getting staggered payments of a little here and there but some were not getting any payments whatever with no clarification or warning from the Department. Some constituents who contacted me only found out about this when direct debits and standing orders were not successful and overdraft fees were charged. As a result, people have been forced to take out unnecessary loans or have had their credit rating compromised.

Attempts by people to contact the Department were in vain and many gave up trying, as they preferred to contact my office instead as they panicked about getting their payments restored. Staff in my office were unable to contact the Department and phone calls were continuously left unanswered. For that reason, I asked parliamentary questions of the Minister to see why our calls were not being answered. This is when we discovered the Department was switching to a new system. I have contacted the Department since and the Minister's office has been particularly helpful, allowing us to bypass the lengthy parliamentary questions process for the time being. I thank the Minister and her staff for that. I commend the staff on the support they have offered but we really should not have been in this position to begin with.

I understand the Minister made a commitment that last week would see the end to delays and the resolution of payment issues. However, we are still getting calls from people to say they are still only receiving partial payments. People whose payments were corrected recently have even been delayed again. How can that be possible? The most worrying aspect of this is that the recipients about which we contacted the Department were told they had already been paid when that was not the case. The Department has requested these individuals to provide a copy of their bank statement to prove they have not been paid, which is a completely unfair and unwarranted request. The Department should have to prove it paid the money rather than the other way around, as this is the fault of the Department rather than the recipient.

This matter has not yet been fully resolved and as a result of delays, people are in a compromised financial position. In effect, they are being penalised for something over which they had no control. No initial communication or warning was given to recipients that changes were being made to the system and we still do not understand how it caused such confusion and delays to payments. It is my duty to bring this matter to the Dáil as every week I still get people coming to my constituency offices in Donegal because they are not receiving their entitlement.

I take the opportunity to ask the following crucial questions, which I know are on everybody's minds. What caused this delay? Why was no communication made to recipients prior to changes being made and why was the response to the problems so slow? Why were Department staff not available and phone calls unanswered in the meantime? Most important, will the Department provide a stand-alone compensatory payment to all those affected who have been financially compromised as a direct result of the Department's mistakes?

I particularly thank the Deputy not just for raising this matter but also for his patience and waiting for me to be available to reply to this debate. I know he raised the matter before the Halloween break but I was not available on the day so I am grateful that he is allowing me to put the following on the record of the House and respond to his queries. The matter has affected not just people in Donegal but people nationally so my response applies to all of them.

My Department implemented a new information technology, IT, system on 4 August 2018 as part of a programme of modernising its approach to managing illness payment claims and this was a first step in a programme which planned amongst other things to provide quicker access to payments for customers, move from a paper system for medical certs, greatly reduce the manual processing work involved in administering claims and move illness benefit payments off a legacy payments IT platform that is approaching end of life to a new system that is already managing many of the Department's other payments.

Unfortunately, although the majority of customers continued to receive payments, following implementation a number of difficulties arose. These included some customers missing or not receiving payments or receiving split payments for a week rather than a single weekly payment. In particular, by moving from a week in arrears system to a real-time payment system, difficulties arose with some people receiving split or in many cases lower payments. Additionally, the change from a payment in arrears approach to a current week payment approach coupled with the new system, which has very tightly defined rules and is a very unforgiving system, led to payments being blocked altogether for reasons that might not have been applied under the old human-led manual system. These issues caused difficulties for many customers, leading to a large volume of calls to the Department's helpline and long delays in responding to calls. As the Deputy noted, in some cases the calls were not responded to at all. In order to address this, the Department deployed additional staff to manage customer calls but, regrettably, there were still delays for many customers.

My Department has been working hard over the past few weeks to resolve the many issues that arose, including allocating additional staff to illness benefit claim work and developing a number of IT modifications to identify and rectify payment issues. I am pleased to note that payment levels of illness benefit are now at their normal level.

For information, in any one week we pay approximately 50,000 customers who are entitled to an illness benefit payment. Last week approximately 54,000 payments were made, while approximately 4,000 payments in excess of the normal weekly payments were made to customers who were due arrears. The Department would like to assure people that they will receive their back payments that continue to be outstanding as soon as possible, which will be this week and in the coming weeks.

The Department confirms that a normal level of payments will issue to illness benefit customers this week and every week from there on. It is important to note that there will always be some people who will not be paid in a given week for a variety of reasons, due to issues such as delays in receipt of claims and/or certificates, incorrectly completed certificates, human error, inconsistencies between the information submitted and the information already on file or the existence of another welfare payment for the main claimant or his or her dependants on the claim, all of which can lead to payments being suspended or delayed. This is not new and would have occurred under the old system. Therefore, these are routine issues over and above the non-routine issues that have happened in recent weeks.

I acknowledge that the majority of the delays in the past few weeks were due to system and processing issues rather than the normal levels of exceptions. I genuinely and sincerely apologise, not only to the Deputies who have been representing their constituents but to all persons who were not in receipt of proper payments of illness benefit in recent weeks.

I call Deputy Pringle.

I would like to finish by saying-----

The Minister will have a further two minutes.

I thank the Minister for her response so far. It is true that this is exceptional and not the norm, as the Minister acknowledged in what she said. That is vitally important because it would not be a Topical Issue if it was normal. What really sticks with people is the fact that it happened out of the blue and the first they knew about it was when the money did not appear in their accounts. They had received no correspondence from the Department about what was happening or indicating that there was a change taking place. Something could have been communicated to them to tell them to expect delays because of the change. These are the customers of the Department if we look at it in an economic sense and it has let them down badly. If it was Dunnes Stores or Bank of Ireland, we would be jumping up and down and saying it is not acceptable that they should treat people like this. I get on very well with officials in the Department which is generally very good in dealing with clients and customers and gives them a good response, but in this instance it has failed. That has to be acknowledged and recognised by it. People are suffering as a result and that also has to be recognised by the Department. That is why I have asked the Minister if she will apply the stand-alone compensatory payment for people who have incurred genuine extra costs through no fault of their own. They depend on this system which has failed them and let them down. The Minister should issue an exceptional needs payment to them.

I do not dispute anything the Deputy has said. I am grateful to him for acknowledging the good service given by the Department. It is apt for me to state the Department of Employment Affairs and Social Protection makes 1.2 million payments every week and has a really good record, which is why it is so difficult to understand how this issue was as badly managed and communicated as it was.

One of the questions the Deputy asked me earlier was why there had been no communications prior to the change. I do not yet have an answer for him, other than to say it was supposed to be seamless and people were not supposed to see any change, except that the system would be more efficient. That was a mistake.

The other question the Deputy has asked me is what caused the issue to arise. There is not just one issue, there were a number of issues that conspired together to cause a problem to arise in one week that was solved the following week and which then gave rise to another issue. That tells me that we should have tested the system for far longer in the virtual world as opposed to going live in the real world and affecting customers as badly as we have.

The Deputy has said we failed people. I only accept failure when something is over and cannot be fixed. We have fixed it this week, but I acknowledge how badly we have let people down.

On direct communications with customers in the past couple of weeks, we wrote 55,000 letters, albeit they were late, but I hope that explains to our clients, customers and the people in receipt of illness benefit what happened. More importantly, lessons need to be learned. We have arranged for an independent review to be carried out of how the changes in illness benefit payments were planned, how they were implemented and, most importantly, how they were or not communicated to clients. The report is being conducted by an independent person outside the Department and I expect to have it by Christmas.

What is most important to me is that I can say everybody who is entitled to receive an illness benefit payment, outside of routine issues that can happen to anybody at any time and human errors, is receiving the payment to which he or she is entitled. Because of the lessons we have learned, we will go back to a payment in arrears system for all new payments from this week onwards.

School Accommodation Provision

The Minister and I have been on the opposite side of debates in the past, but this is important. The amalgamation of the schools in Kanturk, County Cork is a long running issue. There have been many promises, commitments and press releases and when the people of the community hear of another statement on the school development, they throw their eyes up to Heaven and say they have heard it all before. We raised this issue back in March to establish what the process was. It started with the enabling works which are ongoing on the site in Kanturk.

Where is the amalgamated school? I understand there was a commitment and that funding has been locked down for the last eight or nine years for the project. There have been many false dawns and many people involved in the project are frustrated, but much work has been done on the ground to try to bring it together in relation to access and planning permission, in the seeking of which the Department had to take the project back to An Bord Pleanála. We now have planning permission and access has been achieved through the work done locally. What we need is a definite timeframe for the school. We want to know where the tender process is at. When is it envisaged that construction will start? One of the most fundamental questions I want to have answered is what is the completion date for the project and when is the school likely to open for students and teachers alike? We need a clear timeframe and to be able to say the project is going ahead and that there is a commitment to it. I have put more questions about this issue which I have raised in Topical Issues debates than on any other in the number of years I have been lucky enough to be in this House. As I said, we need a clear timeframe for the tender process. Where is it at and when will it be completed? When will construction commence and what is the timeframe for it?

I ask the Minister to ensure the Department and the officials involved in it will adhere to whatever timeframe is set or commitments are given because we do not want to go back to the school community or the community of Kanturk and Duhallow only for them to say they have heard it all before because questions keep coming up about what progress has been made and when the school will open because flowery commitments have been made to generations of people during the years since the project started and they have all come to nought. Will the Minister outline what he and his Department are doing?

I ask the Leas-Cheann Comhairle to let me use the remaining time later.

The Deputy will have a further two minutes.

Gabhaim buíochas leis an Teachta as ucht an cheist fadúda an scoil i gCeann Toirc i gContae Chorcaí.

I thank Deputy Moynihan for raising this issue. The Deputy will recall the update provided by the former Minister for Education and Skills, Deputy Bruton, in March. He will also be aware that this project has had a difficult history, both on the site acquisition front and during the statutory planning processes which started back in 2012. These matters have been complex to resolve and my Department fully understands the frustration of the schools and the local community.

As the Deputy knows, the project in question is to provide a new primary school building to accommodate the amalgamation of St. Colman's boys national school and the Convent of Mercy girls national school in Kanturk. A 16 classroom school with a three classroom autism spectrum disorder, ASD, unit is planned for delivery. The site for the project was purchased by Cork Education and Training Board, ETB and the project is being delivered by the Office of Public Works, OPW. The project has been delayed primarily due to planning permission issues but also as a result of complications with site ownership and in respect of the provision of services to the site. The resolution of these issues involved a large number of complex and interrelated matters, including appeals to An Bord Pleanála and the acquisition of licences to allow works to take place, all of which took time to resolve. However, I am glad to be able to report that the vast majority of these issues are now resolved and we hope that the path is now clear to progress the project as quickly as possible.

I welcome the opportunity to outline to the House the up-to-date position. I am delighted to be able to provide assurances to Deputy Moynihan that the project is now progressing well and the funding to progress it is in place to the end of this year and into next year. As the former Minister previously outlined, the resolution of the issues around land ownership has permitted necessary enabling works to begin. After successfully concluding the tender process for this element of the project, a contractor was appointed and these works commenced on site on 24 September last. The expected timeframe for completion of the works is five weeks, meaning that they are expected to conclude shortly. The ESB will then go on site to check the works, following which it will programme the associated cable installation works. We do not, as yet, have a date for the completion of this element of the programme. Meanwhile, the OPW is proceeding with the pre-qualification of contractors for the main works and published a notice on the e-tenders website on 4 October last in that respect. The pre-qualification process should take between six and eight weeks. Once it is completed, we will approve the project to proceed to tender and construction.

Deputy Moynihan asked when the school will be finished. It is too early at this stage to give a definite timeline for project completion. All going well, however, the tendering for construction will take place in the first quarter of 2019.

I thank the Minister for his reply and wish him the very best of luck in his new portfolio.

The community in Kanturk is exasperated. The Minister has just said that a contractor started work on 24 September and the work involved was expected to take five weeks. Completion of that work is a week or ten days overdue now. There must be real time limits in place because people are totally frustrated by what has happened with this project over the years. When will the ESB go on site to check the enabling works? Is it possible for the Minister to get a definite timeframe on that issue so that we can say that the enabling works are completed to the required specification and to the satisfaction of the OPW, the Department and the ESB?

On the pre-tendering process, a notice was published on 4 October and the process itself takes between six and eight weeks. Can the Minister say with certainty that this process will be completed by the first week in December? We must stick to the timeframes outlined because people will get very exasperated if there is any further slippage. If the pre-qualification process is complete by the first week of December, will the tendering process take place in the first quarter of 2019? How many weeks after completion of the pre-qualification process before the project goes to tender? How long will the tendering process take? When will the contractors be appointed to construct the school? It is vitally important that no more time is lost. An enormous amount of work has been done by many people to get the project this far and we must make sure that the OPW, the Department and all those involved stick to the timeframe laid down. There can be no slippage.

I ask the Minister to clarify whether the enabling works have been completed and to give me an assurance that the pre-qualification process will be completed by the first week of December. How long will it take after the pre-qualification process for the project to go to tender?

I understand that the Deputy is trying to keep the momentum going on this project. He can see the starting line and wants to get the diggers on site. The initial works began on 24 September and were scheduled to take five weeks. We are in that space now and once that work is complete the ESB will go on site. I have no doubt that the Deputy will use his influence at a local level to try to ensure that happens as quickly as possible and raising the matter in the House tonight will do the project no harm. The OPW is proceeding with the pre-qualification process for contractors for the main works and published a notice on the e-tenders website on 4 October. According to the information I have been given, the pre-qualification process takes between six and eight weeks. While I cannot guarantee that the process will be finished this side of Christmas, I can say that the Department understands the importance of this project to the local community in Kanturk. This project has been in the pipeline since 2012. The journey has been a long one and the community wants to get it over the line. We are in a space now where everything is coming together. Funding for the project is committed for this year and next so there should be no delay. I will speak to my officials directly to make sure it is moved along as quickly as possible.

Hospital Facilities

I am grateful for the opportunity to raise the important issue of the development programme for Naas General Hospital in County Kildare and the urgent need to approve the remaining stages of same. The hospital is located in the greater Dublin area, GDA, on the edge of our capital city and meets an enormous level of demand for high quality services but pressure is growing for more services to be provided at the hospital. The need for a new endoscopy unit has been well publicised and it is time to move ahead with that development. A great deal of work can be done now before tendering begins so that the process is not delayed any further.

The quality of life for both staff and patients is a function of the services available throughout the hospital and the standard of the accommodation. In terms of the proposals to which I and Deputy Heydon refer, it is time to push ahead. The necessary measures must be put in place to ensure that the hospital recognises where it is going in good time. If approval is given soon it will be to the benefit of the hospital and the quality of services provided therein.

I thank the Minister of State for being here to discuss this important issue today. Kildare and west Wicklow have a combined population of approximately 241,000. Times have changed significantly since the Lakeview mental health unit and Naas General Hospital were designed and built. Lakeview, for example, was designed and built in the 1980s when the combined population of Kildare and west Wicklow was only 135,000. The 30 bed mental health unit is no longer fit for purpose because demand is far outstripping supply, unfortunately, due to demographic pressures and the size of the youth population in particular. Regularly, people in Kildare who need acute mental health services must avail of acute beds in overflow in Portlaoise and Tallaght. That is not good enough. People in Kildare who need acute mental health services deserve to be treated and cared for in their own county, close to their family and friends who will help them through their darkest days.

It is crucial that we push on with a redevelopment of a new stand-alone unit for Lakeview.

The long-planned endoscopic unit for Naas General Hospital, which would include a physical therapy and medicine unit, oncology unit and a day ward, is critical for the greater development of Naas General Hospital, not just for Kildare people on waiting lists or who have to travel for such services, but also to strengthen the links between Naas, Tallaght and St. James's hospitals as part of a strategic development for the Dublin and Midlands hospital grouping.

The new 50-bed unit for Lakeview, as listed in the capital development plan, Project Ireland 2040, would include a high observation unit which would provide an improved safety and working environment for the staff, better facilities for the elderly and single rooms to ensure patient privacy. The proposed new stand-alone mental health facility would also be on the site of Naas General Hospital. This would be a win-win because a development of a new standalone mental health facility on the grounds of Naas General Hospital would free up the existing Lakeview mental health unit, which is adjoining Naas General Hospital in close proximity to the emergency department, and would provide the opportunity to deliver quickly increased capacity for Naas General Hospital, which is needed with the growing population in Kildare.

I thank Deputies Bernard Durkan and Martin Heydon for raising this important issue because I know the two Deputies are committed to the development of the health service in Kildare and in particular Naas General Hospital. They have been supportive of me as Minister of State with special responsibility for disability issues.

I welcome the opportunity to update the House on the capital development projects at Naas General Hospital. As you will be aware, my colleague the Minister for Health has previously met with management of the hospital to discuss the plans for increased endoscopy and other healthcare services. There are two distinct development proposals for Naas General Hospital currently. The first development consists of accommodation and ancillary services to support the new endoscopy unit, physical medicine unit, physical therapy unit, oncology unit and day procedure department. It will also include a duplex, rather than simplex, reverse osmosis filtration system and two lifts.

This new development is a key strategic priority for the Dublin Midlands Hospital Group, DMHG, and would help to clear the significant urgent scopes waiting list. Naas General Hospital would become a major ambulatory centre within the hospital group and this development would also enable significant strategic links to be developed between Naas, Tallaght and St James’s hospitals.

As the Deputies are aware, planning permission has been received and the project is at tender stage. Funding for this development is included in the HSE’s capital programme 2018-22. It is anticipated that the tender for construction of this project will commence in 2019. All stages of capital projects, including the design and tendering processes, are subject to review to ensure the projects deliver value for money. This includes, where possible, future proofing to ensure that capital developments meet not just current standards, but that provision is made for additional capacity and/or improved equipping and that these are addressed appropriately. This has resulted in a significant increase in the scope of both of these projects at Naas General Hospital and as a consequence impacted the estimated timescale and costs.

Increasing capacity is a priority of this Government. Over the past 12 months an additional 240 beds have been opened including 11 beds in Naas General Hospital which came on stream in the last quarter of 2017.

With regard to mental health services, the original development proposal comprised the provision of an eight-bed intensive care unit at the existing 30-bed mental health unit called Lakeview on the grounds of Naas General Hospital. A design team had been appointed for the mental health project. Following a review of the proposal, a significant expansion of the project scope is now proposed, with an associated increased in project value. This has meant the design team’s engagement has recently been terminated and HSE estates is now preparing to procure a new design team for this much expanded project.

The timeframe for the completion of the new acute mental health unit project will be informed by the work of the project team and this work will be undertaken in conjunction with Naas General Hospital and the HSE. I am happy to confirm that both of these developments at Naas General Hospital have been included in the national development plan, NDP, announced earlier this year as part of the Project Ireland 2040 policy initiative. The NDP provides €10.9 billion for health capital developments across the country, including both national programmes and individual projects, across acute, primary and social care. Health capital projects and programmes currently underway will continue. As is to be expected with a ten-year plan, many proposals are at an early stage and will require to progress through appraisal, planning, design and tender before a firm timeline or funding required can be established.

The delivery of NDP projects and programmes, including these projects in Naas, will result in healthcare facilities that allow for implementation of new models of care and for delivery of services in high quality modern facilities.

Investment in healthcare infrastructure, including these projects, must be considered within the overall capital envelope available to the health service. The HSE will continue to apply the available funding for infrastructure development in the most effective way possible to meet current and future needs, having regard to the level of commitments and the costs to completion already in place.

At the outset, I thank the Minister of State for coming into the House and for the positive tone of his reply. I acknowledge the quality and standards of the services provided by the management and staff at Naas General Hospital. They have done exceptionally well over a long number of years. In order to give a realistic imprimatur to their work, now is a good time to bring forward the date for the finishing of the tendering process and approval of contract. Quite an amount of time can elapse between the two so it would be no harm at all, by way of acknowledgement of their work so far, if that could be done.

The quality of the services demanded in a very competitive area, with an increasing population, is something that we must keep in mind and recognise that pressure increases with every day that passes. The request and demand for a high quality standard of services does not go away.

I thank the Minister of State for his positive response. The provision of acute beds for mental health support in Kildare-west Wicklow currently is one of the lowest levels per head of population in the country. We are starting from behind and playing catch-up. Procuring a new design team and getting on the 2019 corporate plan is crucial for a new and much needed expanded Lakeview.

The endoscopic unit, as the Minister of State has outlined, is at a different stage. It is much more advanced. It has its detailed design and its planning permission is secured. We need to progress to tender for construction as soon as possible. That is both for Kildare patients who are currently on waiting lists for scopes, or who are currently travelling outside of the county to have those scopes done, but also for the wonderful staff in Naas General Hospital whose morale would be greatly boosted and who deserve to work in improved, state-of-the-art facilities. It is crucial. Kildare's population has grown exponentially and it must be recognised by Government. Project Ireland sets that out and it is up to myself and Deputy Durkan, working with the Minister of State, Deputy McGrath, and his colleagues in the Department of Health, to deliver for Kildare as soon as possible.

I thank the Deputies for their responses and, in particular, Deputy Bernard Durkan for his comments about pushing for a realistic date. That is something to which I will give my support and I will bring that message to the Minister for Health, Deputy Simon Harris.

Deputy Martin Heydon made the point about the increasing population up to 241,000 people. I take his points on board. I also take on board the Deputy's points about mental health and the staff morale in Naas General Hospital.

Naas General Hospital serves the catchment area of Kildare-west Wicklow which is an area with a rapidly growing population. The hospital provides quality patient care, delivered safely by skilled and valued staff through the best of available resources. As I said earlier, there are two distinct development proposals for Naas General Hospital currently: the mental health one and the new accommodation and services. There has been significant increase in the scope of both projects and, in these circumstances, the current position is the Health Service Executive expects to commence construction on the endoscopy project in 2019 and is preparing to procure a design team for the expanded mental health unit. The Deputies can take it that I will take their strong messages back to the Minister for Health, Deputy Simon Harris, and they will have my full support on these projects.

Mental Health Services Staff

I welcome the opportunity to speak on this important issue. We have been informed today by groups working on the front line that the specialist ACCES team for homeless people with severe mental health difficulties, located on Conyngham Road in Dublin, is now closed to new referrals due to staff shortages. This special community mental health team for homeless people is a vital service that liaises with homeless agencies to ensure that at least some people within homeless services who are very unwell can access appropriate mental healthcare. The absence of this service is likely to lead to people with acute psychosis not getting appropriate treatment. We know that homelessness is at an unprecedented level with over 10,000 people, many of them parents of young children, suffering because of the housing crisis. They are forced to couch surf, to sleep in hostels, on cots or in hotel rooms totally inadequate for anything other than the shortest of emergencies. Some feel they have no choice but to sleep on the streets. These people are under huge strain and the damage that this experience is doing to their mental health should be clear to anyone who cares enough to consider it.

We know that those who suffer homelessness are seriously vulnerable to mental health problems not just because that is common sense but because the statistics show it. Some 47% of people in homelessness last summer were found by Simon and Mental Health Reform to have at least one diagnosed mental health condition. Those are just the ones who can be diagnosed. We know that these strains lead to worsening or development of substance abuse problems which make recovery and rehousing even more difficult for individuals and services. A survey found that 17% of those surveyed had attempted suicide in the previous six months and 19% had engaged in self-harm. Some 21% said they had experienced barriers to accessing mental healthcare.

It is difficult enough to access services. These are front-line people who provide a vital service and yet we are heading into the winter, with people who are in dire circumstances, homeless and have mental health difficulties which are often severe, and no more referrals will be taken in this centre. I cannot understand why this issue keeps coming up about staff shortages. Can we find out when this will be resolved? Was this flagged up beforehand? There are recurring staff shortages with no forward planning. I am very conscious that the Minister of State mentioned staff morale in an earlier Topical Issue debate. It is important to acknowledge that staff are doing their very best in extremely difficult circumstances. We as legislators, the Minister of State and the Government are letting these people down terribly. We are aware that things will worsen. Can anything be done to resolve this issue as soon as possible? Otherwise we will unfortunately face more deaths on the streets.

I thank Deputy Buckley for raising this important issue. I take this opportunity to emphasise that mental health remains a priority in the programme for Government. Since 2012, approximately €200 million, or 28%, has been added to the HSE mental health budget which is now €910 million. We have secured an additional €55 million for new developments in the recent budget. Despite serious financial pressures overall, 2019 will see a total HSE mental health budget of almost €1 billion, an increase of 40% on 2012. Dual diagnosis in particular has been given specific attention.

The HSE mental health division has recognised the need for a clinical programme for dual diagnosis to respond to people with substance misuse, both alcohol and-or drugs, together with mental illness. The aims of this programme are to develop a standardised evidence-based approach to the identification, assessment and treatment of comorbid mental illness and substance misuse. This includes increasing awareness of the frequent co-existence of mental illness and substance misuse; ensuring there is a clear pathway for management of people with such a dual diagnosis including when they present to emergency departments; ensuring a standardised service is provided throughout the country; and ensuring adolescents are also included within the scope of the clinical programme. An additional €2 million in funding was made available from the €35 million of new development funding for mental health in 2016 to address the specific needs of homeless persons in the Dublin region, with a particular focus on mental health needs.

A key requirement was that any mental health supports provided would be provided as part of an overall cohesive response to homelessness. This €2 million has helped to fund the expansion of in-reach services and supports for temporary accommodation for charities such as the Peter McVerry Trust, Crosscare, Sophia Housing Association and Dublin Simon Community. The additional funding has continued to be provided to fund these additional services for homeless people with mental health and addiction needs. As part of these services, the Assertive Community Care Evaluation Services, ACCES, team is based in Parkgate House, Conyngham Road, Dublin. This specialist community mental health team for homeless people is a service that liaises with homeless agencies to ensure that people within homeless services who are very unwell can access appropriate mental healthcare. I understand that ACCES is currently unable to take on new referrals. I take Deputy Buckley's earlier point. The HSE has informed me that there are vacancies at psychologist, social worker and occupational therapist levels. While the psychologist is on maternity leave and is due back in March 2019, the HSE is attempting to recruit the new social worker through the national recruitment service and the occupational therapist has been recently appointed and is awaiting a start date.

I thank the Minister of State for his answer. I will revert to what I mentioned earlier about the problems with staff shortages and forward planning. It is not a personal attack on anybody but if somebody is going out on maternity leave, surely there is forward notice or somebody will cop on that if somebody is expecting to go on leave, which they are totally entitled to, something should be put in place where the HSE can plan ahead, so it can know that someone is due to go on maternity leave on a certain date and should be able to recruit and fill that gap temporarily.

March is five months away. October, November, December, January, February and March are very bad months here so I am not optimistic about the forward planning, as we call it. Vacancies for a psychologist, social worker and occupational therapy is a huge gap in services. How have people been coping with this? It goes back to the morale of the people on the front line. I am black and blue from coming in here and to committees and asking Ministers why the powers that be and the HSE cannot plan ahead. We have said it repeatedly. We will be facing a major issue in the next couple of years. We will possibly have 500 people in mental health services retiring and nobody is planning for it because the system works on a basis of having to wait first for the individual to retire, then it goes into a 12 month cycle and the crisis gets larger. I want to highlight it. It is not a personal attack on the Minister of State and I appreciate the answers he gave me. I am disappointed that we do not have forward planning. We have another emergency in Dublin with people who will be severely affected, not just with mental health difficulties and weather, but we are being told the best the Department can do is say that it will see them again in March.

I thank Deputy Buckley for highlighting the issue. It is very important. I take his point about forward planning. It is a strong message which we will have to bring back to the HSE. I will bring it back to the Minister, Deputy Harris.

The Government is committed to ensuring all those in need of mental health services and supports will have access to them, in particular vulnerable groups such as the homeless and those to which the Deputy referred. It is not acceptable that somebody who is homeless, poor and marginalised cannot receive a service. A broad range of support initiatives are under way or planned across mental health services to cater for that group and I believe the initiatives will help us to achieve equity of access and support for those individuals in order that they can access care at the earliest possible stage.

I accept the Deputy's point about the ACCES team receiving ten to 15 calls per week inquiring about referrals. It amounts to approximately 150 to 200 calls per year. I agree with the Deputy that such persons could be facilitated with some forward planning. Money is not the issue; rather it is a case of planning to implement services and find people to fill the posts. There is a difficulty in filling posts, including in my area of responsibility, namely, the disability sector. In recent months we have had a steady stream of occupational therapists and speech and language therapists returning from England, in particular. That will help to address the issue. I agree with the Deputy that there is a need for more forward planning in order to resolve the issues. I will bring the message back to the Minister and the HSE.