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Dáil Éireann debate -
Tuesday, 27 Feb 2024

Vol. 1050 No. 3

Ceisteanna ó Cheannairí - Leaders' Questions

The crisis in child and adolescent mental health services, CAMHS, has escalated to a full-blown emergency. On the watch of this Government, waiting lists for first-time appointments have increased dramatically, while the number of young people waiting more than one year has nearly trebled. It is virtually impossible to access services. The reviews into CAMHS by the Mental Health Commission and the Maskey report were damning. The system is plagued not only by dangerous waiting times but also by alarming issues with clinical governance, high staff turnover and recruitment problems, and the absence of an out-of-hours emergency service. Vulnerable, at-risk children and young people are locked out of the urgent mental health care they so desperately need. They spend years crying out for help and knocking on the door of a system that is broken. It is a wilderness for children and young people suffering with severe depression, anxiety and suicide ideation. Even when young people get inside the system they face alarming levels of dysfunction. Children are prescribed powerful antipsychotic medications with very little intervention. Often, vital follow-up care disappears and children get lost in the system. Children with disabilities in need of a dual diagnosis and mental health care are sent from pillar to post and they fall through the cracks. Those who turn 18 years are cut off and directed to the adult system.

Last night, Teachtaí David Cullinane and Mark Ward and I met with Families for Reform of CAMHS. Their experiences are heartbreaking. One distraught mother told me about her ten-year-old daughter, Maggie. She had already endured cancer and she now suffers with depression, anxiety and self-injurious behaviour. Maggie was on the urgent list for a year before she received a CAMHS meeting. She received an assessment for an intellectual disability but she was not accepted into the service because there is no specialist in the area. Maggie is in a full-blown mental health crisis. She receives no care. She is in distress and she does not leave the house apart from going to school.

Another mother told me about her teenage daughter who suffers from severe anxiety, depression and constant panic attacks. She would not leave the house and withdrew from her friends. She deteriorated by the day. When referred to CAMHS she was told she would have to wait a minimum of six months. It then took a further two months to get a reply from her first meeting and another three months for a follow-up appointment. This mother had to chase and chase to get care for her daughter. After a 15-month ordeal,there has been some improvement but this young woman has missed almost one year of school. These children are not alone. Their stories are replicated in the thousands. Children deserve better.

Tá níos fearr tuillte ag páistí. Níor chóir go mbeadh orthu fanacht cráite agus trína chéile le haghaidh sheirbhísí meabhairshláinte. Ní mór don Rialtas gníomhú anois láithreach. Sinn Féin's Mental Health (Amendment) Bill 2023, which is before the Dáil this evening, calls for change as a first step. It gives the Mental Health Commission the statutory power to regulate CAMHS. This would empower the commission to implement its 49 recommendations for improvement, tackle the waiting lists and end the scandal of children being inappropriately admitted to adult acute psychiatric wards.

Will the Minister support the Sinn Féin Bill tonight? Will the Government vote in favour of the Sinn Féin Bill tonight?

I thank Deputy McDonald for raising what the Government accepts to be a very important issue. The Deputy in her question made reference to Maggie and other families who have approached Deputy McDonald. They have also approached Deputies on all sides of the House. Through our constituency work, of course, we are all deeply familiar with the challenges that are there for families and carers looking after young children, teenagers and young adults who are experiencing mental health difficulties and, at times, many other vulnerabilities and needs in their lives.

The Government will continue to act to make available resources to make a difference to those who need additional support and help in their lives. It is the reason that in community CAMHS teams we have seen an increase to 820 fully-funded posts. These are jobs funded by the Government throughout the length and breadth of the country to respond to Maggie and all the other young men and women who need the help that we, as a Government and an Oireachtas, want to give them. If I look at how this figure stands, it is an increase of 68 roles versus where we were last year. This will be further added to by an additional €10 million, which was announced by the Minister of State, Deputy Butler. That will look at how we will provide additional roles and posts throughout the country where we accept they are seriously needed.

In terms of the budget available to respond to these many important needs, for the CAMHS element of the health services alone, it now stands at €146.5 million. In addition, a further €110 million is being provided to community-based organisations to help them to respond to the needs we know are there and to add to the services that are directly provided for and directly funded by the State.

In her very important question, the Deputy covered all the issues that we know are continuing. As I speak about these figures, and in acknowledging Maggie and all of the other lives that Deputies on this side of the House encounter too, I know, as we all know, the many stories of needs that need to be better met and of young lives that need additional support. This is why, for example, the Government has now ensured that, for the first time in the history of the State, we will have a national office for young mental health in the HSE. It is why the Minister for Health, Deputy Donnelly, and the Minister of State, Deputy Butler, have ensured we now have a national clinical lead in the HSE and an assistant national director for children and youth mental health. These roles have been put in place to ensure this additional funding and these additional roles translate into the additional services the Government wants to see provided.

In terms of the additional measures that were provided in the budget this year to make a difference to those whom we know need further help, this is why we will expand multidisciplinary teams, led by CAMHS with all of the various health professionals in them, to respond to the lives we want to further help. It is why there will be made available, on a trial and pilot basis, the development of a central referral mechanism to better ensure the resources, money, jobs and posts we are making available go to those who need them most.

With regard to the specific question Deputy McDonald ended on, we will be putting forward this evening a timed amendment. The specific reason is that the Government will bring forward for, we hope, the summer legislative session-----

It has had four years

------a further mental health Bill with 35 different sections, all of which will be focused on the regulation of mental health services. We believe the Bill, which will be brought forward shortly, will provide a different and more effective way of responding to the regulation needs that we acknowledge are there.

With respect, that is all just rhetoric. The problem is the Government is not responding to Maggie. She is ten years old. She is receiving no services. She is in a full-blown crisis and her mother is desperate.

That is Maggie's story. The Minister's assertions do not change that fact at all. What is the response for Maggie? Is it a Minister taking to his feet and rattling off figures and budgetary arithmetic? That is all well and good, but the problem is it is not responding to Maggie. It is not answering the needs of that family. I appreciate that Deputies across the House, including the Ministers, have heard these stories. I can only imagine their frustration listening to that. If I were sitting where they are, I would be frustrated by a Government that clearly has large resources at its disposal but is failing and whose only response to reasonable and important legislation to ensure that CAMHS is regulated appropriately is to kick the can down the road for six or nine months. I asked whether the Government would support this important step forward. The answer to that is “No”. The Minister just did not have the heart to answer me directly.

Deputies

Hear, hear.

The Deputy is not getting away with that. In my answer, I responded with two points. First, I acknowledged that we as a Government felt every bit as much as the Deputy the needs that existed.

However, we correspond that with a commitment to make a difference. I will not allow Deputy McDonald to paint a familiar trope, which she seeks to paint regularly, of all the compassion in the House sitting over there. We are as aware as anyone else in this House-----

The Government does not show it.

-----of the difference that needs to be made.

Second, I outlined something with which Deputy McDonald is clearly uncomfortable. I outlined the detail of what the Government was doing. I outlined the resources, jobs and reform measures that are in place to help Maggie and others. We acknowledge that our efforts are not reaching Maggie in the way we want them to.

And thousands of other Maggies.

Deputy, please.

They are reaching others, and what we are determined to do through the measures I have outlined is help even more. There is nothing rhetorical about the fact that, since August 2023, the waiting list for CAMHS has fallen. It has not fallen by as much as we would want, but it has fallen. There is nothing rhetorical in the fact that approximately 94% of all urgent cases raised with CAMHS are responded to within 72 hours. We know that more needs to be done, but-----

The Government is just not prepared to do it. Okay. Thanks for that.

-----we are supplying resources and roles and we are corresponding that with the reform measures to make a difference and help even more.

There is a great deal of hurt and anger in the country at the moment. Many disabled people and their carers feel forgotten and abandoned by the Government and the referendum. The proposed amendment only gives recognition to care within the family. The Social Democrats attempted to amend this wording to include care in the community and ensure that the State had an explicit obligation to provide that care, but the Government rejected our amendment and guillotined the legislation. Despite this, the Social Democrats have opted to support both constitutional amendments because we have ultimately been left with a choice between leaving misogynistic language in the Constitution and replacing it with language that is an improvement but should have gone much further. The new wording is better than the old and, unfortunately, that is all we have an opportunity to vote on.

I acknowledge that there are people who disagree and are hurt by our decision. I wish to tell those people that I am listening. Disabled people are rightly asking questions of the Government and the Opposition. They want to know what their rights mean to us and how we intend to vindicate those. For years, the State has failed to provide the basics for 22% of the population. This State neglect is ruining people’s lives. Is it any wonder that the proposed wording of the new amendment makes it feel like people’s rights are being further disregarded? Constitutional recognition means something. It means something for lone parents, who would be recognised as families. It means something for carers, whose work would finally be acknowledged. It would mean something for disabled people to have their rights recognised too. However, the Government refused to do that.

What will the Government do to improve the rights of disabled people in Ireland? It does not need a referendum to do that. It could act today. It could ratify the optional protocol to the UN Convention on the Rights of Persons with Disabilities. In 2018, the Government ratified the convention but for six years has refused to sign the part that means the Government can be held to account for failing to allow people to exercise their rights. It is disgraceful. Is it any wonder people do not trust the Government when it comes to disability rights? People have a right to more than platitudes and empty promises. Ratifying the optional protocol is something the Government could do now and that could be transformative.

Last week, the Taoiseach told me it is his intention to ratify the optional protocol within this Government's lifetime. It only has a maximum of 12 months to do that. When will the Government ratify the optional protocol? We need it to name the date.

I thank the Deputy and acknowledge the support she and the Social Democrats are offering in respect of the referendums and changes to our Constitution. She acknowledges and we are making the case that they will represent an important improvement on the current wording in our Constitution and will take an important step towards having a Constitution that is in line with the values and reality of modern Ireland.

On the specific question the Deputy put to me about the signing of the additional and optional protocol, the Taoiseach outlined last week the commitment that he and the Minister, Deputy O'Gorman, have to the signing of this protocol during the term of this Government. That means it is important that we continue with our efforts to get ready to sign this very important protocol, which we acknowledge will be important to those with disabilities in our country and to their carers.

On where the process stands at the moment, we had originally planned to progress ratification of the optional protocol after the conclusion of our first progress review in the existing convention. I understand that was not possible because the UN's own cycle of reviews was delayed post Covid. The Government has already indicated, and I wish to do so again here today, an openness to earlier ratification. Work is continuing to get us ready for that point. In August last year, the Department of Children, Equality, Disability, Integration and Youth commissioned external legal counsel to scope out the kind of legal reform and change that is needed to allow for Ireland to sign up to the optional protocol and to look at what domestic remedies and processes need to be in place to allow them to vindicate their rights when this protocol is in place. The Department of children will receive the scoping report on this very shortly and after that the Minister, Deputy O'Gorman, intends to bring a memorandum to Government. I mean, by memorandum, a proposal regarding how we can move this forward, outlining the kind of changes that are needed and how we will look to secure all of this and make this change within the timeframe I have already outlined.

The simple fact of the matter is that it is within the Government's power to address the issues faced by people with disabilities. It does not need a referendum to fully staff the children's disability network teams, to provide more personal assistance hours, to replace the transport schemes that Fine Gael scrapped over a decade ago or to ratify the optional protocol. Every year, when we come in here for the budget, I go straight to the section of the budget on disability. Year after year, there is no meaningful attempt to address the disgraceful and shameful absence of the provision of the bare minimum of services for disabled people.

I am sure the Minister has heard the expression, "Show me your budget and I will tell you your priorities." It is clear that disability services are not prioritised. Ratifying the optional protocol would be a clear signal of intent for a step change in the direction of this and successive Governments on disability services.

Ireland was the last country in Europe to ratify the convention. Six years after that and four years into this term of Government, the Government has said it will do it in this term. It has 12 months left and is talking about reports and all of these things. Are we any closer? In answer to my original question, can the Minister name the date?

I make clear the commitment the Government has made to do it inside its current mandate. We are making that clear.

What I will not do, in response to a sensitive and important question, is outline a date which the Government, in the process of dealing with a sensitive matter finds out it cannot deliver. We are committed to doing it. The Taoiseach, the Minister, Deputy O'Gorman, and I are emphasising our aim to do that. However, as the Deputy herself stated, it is not just in a referendum or by changing our Constitution or even just by ratification of this protocol that we can show the values and commitment we have to making a difference in supporting those with disabilities. That is why, in budget 2024 alone, a further €205 million was made available to support those with disabilities and to support the services we know need to be in place for them. It is the reason, for example, that disability and all the health services around it have been moved into a new Government Department to give it the focus it needs and deserves and to build on work that already has been done. It is the reason the Government now has an action plan to support those with disabilities to ensure the additional funding being made available in this and other budgets translates into improved supports and services. We are committed to doing that and in addition, to reaffirm what the Minister, Deputy O'Gorman, and the Taoiseach already have said, in the months ahead we are committed to moving ahead with this protocol.

Former Deputies John Deasy, Paudie Coffey, Pat Deering, Phil Hogan, Liam Twomey and Michael D'Arcy and Deputies Paul Kehoe and John Paul Phelan all are or have been Fine Gael TDs from the south east. All have either fallen or are on the precipice. Fine Gael, remarkably, won 50% of the 14 seats in the 2011 general election in the south east of Ireland. Once this Dáil has been dissolved, all these people will have left national politics. It is an incredible reflection, actually an indictment, of Fine Gael's decade in power that these candidates either were not returned or chose not to face the electorate. The south east is not remarkable. The north west and the midlands are also walking away from the traditional parties of government. People are basically being forced to seek out new homes because of their political anger.

The Minister will be familiar with the movie, "The Hunger Games", a possible characterisation of Boris Johnson's levelling-up strategy. An insanely out of touch capital acts as a parasite on the rest of the country. Provinces are divided and conquered. When you look at what is getting done in the national development plan, it is somewhat instructive. This year, we will spend €13 billion on publicly funded capital projects and it is projected that by the end of this decade, we will have spent €165 billion. The south east has 8.9% of the population but in the past decade has received less than 1% of all major capital spending. The region has turned away from Fine Gael because the educated view is that Fine Gael is not living up to its promises. According to the first iteration of the Department of public expenditure's capital tracker, Dublin, with 29% of the population, is drinking in 65% of the spending on major projects. In the second iteration it was 56%. For all the talk about spending codes and business plans, when big projects hit Cabinet, it is to Dublin and Cork they go and the rest of the country can wait. All of this is before the absolutely ludicrous price tag of metro north or the finalisation of the children's hospital bill. As a country, we apparently just have to close our eyes and cough up billions. In 2011, Fine Gael's promise to deliver a full national university to Waterford, similar to Maynooth or UL, was erased, with WIT left to starve for a decade and then forced into a complicated and underfunded merger. The new technological university, TU, has no new courses, no new academic disciplines, no ability to borrow and no capital projects awarded. Every TU is now contracting against a growing university sector. What happened to Fine Gael's promises to the south east? In 2013, it similarly promised that being part of the Cork-led buyer hospital grouping would not be to the disadvantage of University Hospital Waterford.

This has resulted in that hospital getting fewer resources than every other model 4 hospital in the country. Can the Minister tell me what the new messages from Fine Gael to the people of Waterford and the south east are and why anyone should believe them?

Given the Deputy's great interest in Fine Gael representation, I am pleased to tell him that come the next election, I have every confidence that Senator John Cummins will get elected to the Dáil. The Deputy seems to be focused on the past. We are focused on the needs of today and are confident about the story we will be putting forward. We will be confident about the ability of someone like Senator Cummins to make our case in this regard, while other Government representatives will be doing the same.

When the Deputy stands up again, perhaps he will again be able to explain the analogy of "The Hunger Games" he used to me. He appeared to be painting some kind of vision of some kind of aggression and competition for life in the way he described it. I do not get it, so perhaps he might explain it to us a bit more. While he is busy painting these kinds of stories and trying to explain the story he has put to me, let me tell him the kind of case that Senator Cummins and I will be making, along with other public representatives from the Government parties, to the proud people of the south east and beyond.

In the Deputy's question to me, I did not hear any reference to the fact that the number of jobs in companies supported by the IDA has increased by 25%. There was no reference to this point. There are more jobs and these are better and improved ones that are making a difference to the people of the south east and beyond. In the points the Deputy was putting to me, I heard nothing about the progress being made in the North Quays development. This is a project that has been enabled by the Government and that has the ability to transform the city of Waterford and beyond it. I also did not hear in the question put to me by the Deputy an acknowledgement of the difference the national broadband plan is making to towns and villages outside our cities and the role it is playing in allowing jobs to be moved out of our large cities and to counties and towns where people can do their work nearer to home. This is benefiting everybody. In South East Technological University, SETU, it is and remains the case that the Government is fully committed to how that institution can be developed in the time ahead and how we can ensure the young women and men the Deputy is referring to have the education, higher education and university services and supports they need closer to home. This is the reality of how we are looking to make a difference to the communities the Deputy is referring to.

Turning to the point the Deputy made about our hospital services and where they stand in the south east, of course we are aware of how much more needs to be done and of the pressures our health services are facing. It still remains the case, however, that for the hospital and the people working in it, there are now more staff working there, with a bigger budget, due to the changes being made by the Government to expand the health budget and to bring more nurses and doctors into the hospitals that can make a difference to the health of the people of the south east and our country overall. This is the story of the difference we are making and the proposition we will be bringing to the people. This is the message I am sure Senator John Cummins will be communicating with great vigour and gusto in the time ahead. I say this given the Deputy's fixation on Fine Gael.

The Minister obviously did not listen to me if he said I did not listen to him. If the Minister wishes to talk about commitment to the south east, he might put on the Dáil record now if the Government is prepared to endorse the €350 million project plan issued by the SETU president. This would be something like a game-changer. Is the Minister prepared to announce the development of the engineering building, which was first promised in 2009?

It is out to tender.

It is still sitting in a public private partnership, which has still not been approved. Perhaps the Minister might approve that. Perhaps he might like to go down to the hospital and explain why it was cut out of the €650 million in capital funding given to the other eight model 4 hospitals last year. Perhaps he might answer the question of why in a decade that hospital received just one third of all the capital funding given to each of the other eight model 4 hospitals. The Minister can shake his head and think he has heard all this before, but he has not. I can promise him that his colleague in the constituency will be hearing about this when he stands on the doorsteps. People in Waterford and the south east are growing tired. After all the talk in this House of trying to improve cardiac services, we still do not even have a seven-day emergency heart attack service in University Hospital Waterford. This is the only region in the country without such a service. To be frank, this is what it looks like to me and I did not hear anything in his response to change this view.

I responded to all the different points the Deputy made. Every point he put to me regarding investment in different parts of the south east I responded to. I outlined what the Government is doing.

The Government did not do much for SETU.

I responded to his question. I laid out what we are doing. I remind the Deputy that it does not stop him from turning up to all the different announcements made by Government. He is there.

I have to be there to make sure they are announced.

He is eager enough to get into the photo and to take the credit for all the progress the Government is making-----

They are easy to count.

-----while of course we know, we need to do more. In 2019, the budget for University Hospital Waterford stood at €201 million. It increased to €268 million, an increase of one third in four years, meaning that 2,758 people are now working in University Hospital Waterford, an increase of 809 since December 2019. I have little doubt that when all of these measures were being announced the Deputy was there standing beside a Government representative looking to take credit for it as well.

With respect, I am not taking credit. I pointed out to the Minister that it was the least funded and it remains the least funded.

I answered Deputy Shanahan and he was too busy with his Hunger Games. I am outlining the difference that has been made and what has happened. It is also the case that other measures the Government was committed to have happened. St. Declan's Way, the development at Cappoquin, the work that has happened at Mount Congreve are only just a few of the examples of the commitment of Government to make a difference for the south east-----

Those are walkways, not roads.

-----just as we have a commitment to make a difference to every other part of the country.

I have the name of Deputy McNamara contributing for the Independent Group, but I take it Deputy Pringle is speaking.

It has been nearly a year since the publication of the damning report into St. John Ambulance, which included findings such as the following. The organisation’s structure and culture left the organisation vulnerable to grooming and sexual abuse of children within the organisational context. The hierarchical structure facilitated predatory behaviour within the organisation in the past. There was a significant degree of organisational awareness of serious threats to children, with the organisation failing to undertake any meaningful investigation into known or suspected threats to children prior to 2000. These are just some of the many shocking findings in the 333-page report.

Unfortunately, for survivors, this report was far from shocking and I take the opportunity to commend survivors on their tireless work and bravery. The fact that they were forced to experience such abuse as children is horrific, but the way they were treated by St. John Ambulance following this is truly appalling. The organisation completely failed survivors first by failing to protect them and then by turning a blind eye, in some cases even accusing survivors of lying. It has only continued to fail them since. The lengthy process that survivors had to go through to ensure that this report was completed was unacceptable. Not only that, but once completed they had to fight to actually get it published. It was only published after daily protests outside the headquarters of St. John Ambulance.

This was a disgraceful way to treat abuse survivors and the lack of respect and care shown by St. John Ambulance should be noted. It is clear that this is not a case of failures by the organisation 20 years ago, this is a case of consistent and repeated failures by the organisation, as recently as last year.

As the Minister will know, the report made a series of recommendations, one of which was the employment of a full-time safeguarding officer, independent of St. John Ambulance. However, over a year after the organisation was given these recommendations, this has yet to be implemented, with the organisation now saying that it does not have the funding to employ a safeguarding officer. It is extremely disappointing that this has not been a priority for the organisation. Nothing should be more important to St. John Ambulance than ensuring sufficient child protection, especially in light of its many failures, spanning decades.

I know that the Minister, Deputy O’Gorman, said last week that the Government will make a contribution for the first year towards the cost of the safeguarding officer role and link that to an agreement with the organisation through a service level agreement. Can the Minister justify and outline the rationale for the payment of the role of safeguarding officer in St. John Ambulance and explain if this will be a mechanism available to other organisations in financial distress?

I thank the Deputy for raising this extremely important matter. We are all aware of the need to respect the voice of survivors and respond to the suffering and abuse that many have endured.

I know the Deputy has been raising this issue for some time and I know the Minister, Deputy O'Gorman, is very aware of its importance. His Department is working to make a difference to it.

On the particular point the Deputy put to me regarding the role of a child protection officer, the reason the role will be provided and funded by the Department of the Minister, Deputy O'Gorman, is we believe it is an important element in securing the continued safety of those working in that organisation or using its services. This will play an important role in safeguarding young people in the organisation. The Minister and Government believe it is an intervention we have to make and have to make quickly. It would also put in place an accountability relationship between the Department and St. John Ambulance through a service level agreement to give confidence the office is being used in the way we want.

To respond to the Deputy's question directly, it is because we believe it is the kind of change needed to help the Government and those involved in running St. John Ambulance to better protect and ensure the safety of young people in the organisation.

It is completely unacceptable that St. John Ambulance sat on these recommendations for a year, knowing it did not have the cash and, ultimately, putting more children within the organisation at risk. As well as this, the board of the organisation has largely remained the same, with the exception of someone who joined just before Christmas.

It seems that St. John Ambulance is not taking the recommendations of this extremely damning report into the organisation seriously enough. It is a major slap in the face for survivors of abuse that the organisation is now receiving €100,000 from the Government after sitting on its hands for over a year, while survivors received nothing but a few numbers to call if they were feeling suicidal.

Why has the organisation been allowed to repeatedly disrespect victims and fail to ensure adequate protection for the young people who continue to work there? What about the victims and survivors of the abuse? Who has the responsibility towards them? Should the Department not be in contact with them to let them know what is happening?

The Minister, Deputy O'Gorman, has indicated his concern regarding the delay in the appointment of the person into that role. He and the Government believe an important intervention is needed to respond back to the issues of public concern the Deputy referred to. The Shannon report into those issues was driven and supported by the Minister after he met survivors and had the kind of issues the Deputy referred to raised with him. I understand the Minister met with survivors as recently as ten days ago to hear their views and voice on this deeply important issue. He and the Government are committed to putting in place this role and the service level agreement to ensure the critical issues we have learned so much about in our country in recent years and the related risks are not in front of us and this office and role can make a difference to us. The Minister's officials are in contact with the survivors and stakeholders in the issue and will engage regularly to get this role in place and safeguard against the risks the Deputy referred to.

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