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JOINT COMMITTEE ON HEALTH AND CHILDREN debate -
Tuesday, 9 Sep 2008

Central Mental Hospital: Discussion.

We are meeting representatives from the Department of Health and Children and the Health Service Executive. I welcome Ms Bairbre Nic Aongusa, director; Ms Dora Hennessy, principal officer; Ms Joan Regan, assistant principal officer; Mr. Brian Gilroy, national director of estates; Mr. Hugh Kane, assistant national director of primary, community and continuing care, PCCC — a section of the HSE, and Mr. Jim Ryan from the same section. They are all very welcome. Before we begin, I draw their attention to the fact that while members of the committee have absolute privilege, the same privilege does not apply to witnesses appearing before the committee. Members are reminded of the long-standing parliamentary practice to the effect that members should not comment on, criticise or make charges against a person outside the House or an official by name or in such a way as to make him or her identifiable. Members may ask questions at the end of the briefing.

I invite Ms Nic Aongusa to introduce the delegation members and to make the presentation.

Ms Bairbre Nic Aongusa

Ms Dora Hennessy is principal officer in the mental health division of the Department of Health and Children and Ms Joan Regan is the assistant principal officer. I am the director of the office for disability and mental health which is part of the Department of Health and Children.

I thank the committee for the invitation to me and representatives from my office to appear before it to put into context the Government's decision to relocate the Central Mental Hospital to Thornton Hall. I am aware that the joint committee has met several interest groups regarding the redevelopment of the Central Mental Hospital. While some of those groups are opposed to the Government decision to locate the new hospital in Thornton Hall, it is fair to say that all of us, the members of this committee, the Government, the officials charged with implementing Government policy, the clinical director and staff of the hospital and all the various stakeholder groups share a common concern. We want and strive for the best possible care to be given to the residents of the Central Mental Hospital.

I am the director of the recently established office for disability and mental health. I also served as principal officer in the mental health division of the Department of Health and Children from July 2000 to January 2006. In that role I was involved in some of the considerations and consultations that led to the Government's decision to relocate the Central Mental Hospital.

The office for disability and mental health was established by the Government in January of this year to support the Minister of State with responsibility for disability and mental health in exercising his responsibilities across four Departments. The office is based in the Department of Health and Children.

With regard to mental health, the office focusses on driving the implementation of the recommendations of A Vision for Change, the report of the expert group on mental health policy which was accepted by Government on its publication in 2006 as the basis for the future development of the mental health services. A Vision for Change recommended that the Central Mental Hospital be replaced or remodelled to allow it to provide care and treatment in a modern, up to date and humane setting and that the capacity of the hospital be maximised. The office for disability and mental health, therefore, is clearly charged with the responsibility to ensure that the Central Mental Hospital is redeveloped.

In May 2006, the Government approved the development of a new national forensic mental health facility at Thornton Hall, County Dublin. Since then, the focus of the Department of Health and Children and more recently, of my office, has been the implementation of this Government decision.

I will set out the chronology of events that led to the Government's decision. In February 2003, the then Minister for Health and Children, Deputy Martin, visited the Central Mental Hospital. This was the first visit to the hospital by a Minister in 50 years and it signalled the desire on the part of both Minister and Department to address the needs of the hospital, which had been neglected for many years. During his visit, the Minister referred to his recent establishment of a project team, chaired by the then East Coast Area Health Board, to progress the redevelopment of the hospital. The project team consisted of a broad range of stakeholders including the clinical director of the hospital — Professor Harry Kennedy, the director of nursing at the hospital — Paul Braham, myself representing the Department and representatives from the National Development Finance Agency, the Irish Prison Service and the other health boards.

The project team worked intensively, meeting on ten occasions over the course of a year and holding numerous additional meetings of sub-groups set up to examine specific tasks within the remit of the team. Various options were examined for the provision of an appropriate facility for the hospital, including refurbishment of the existing facilities at Dundrum; building a new facility on the existing site at Dundrum; building on a new greenfield site; and a combination of these options. In its final report, delivered to the Minister in May 2004, the project team recommended that the most appropriate option for the optimum delivery of patient care was for a new hospital to be built on a greenfield site with ready access to the M50 motorway. It recommended that a site of 20 acres be acquired to provide capacity for 300 admissions per year and to provide conditions of high, medium and low security for acute, medium and longer-term treatment and rehabilitation. The Minister accepted the recommendations of this report and the officials in the Department, including myself, set about considering how it might be implemented.

At approximately this time, the Department of Justice, Equality and Law Reform was engaged in a search for a suitable site on which to build a replacement facility for the Mountjoy prison complex. It must be emphasised that, at this point, no specific site had been identified, but the Department of Justice, Equality and Law Reform was concentrating its search around the M50 radius. It was suggested by that Department, with the support of the Department of Finance, that locating the new prison and the new Central Mental Hospital on the same site would deliver considerable operational and cost benefits. The Department of Health and Children responded cautiously to the proposal, suggesting that further study was required. Accordingly, when the Government agreed, in November 2004, to purchase the site at Thornton Hall for the new prison, it was agreed that the proposal to locate the Central Mental Hospital on the same site should be subject to further study.

There was no doubt in my mind at this time that it was open to the Minister to decline to locate the Central Mental Hospital at Thornton Hall if the official advice indicated that it was not the best available option. Two key elements informed the advice that was given to the Minister and to the then Minister of State, former Deputy Tim O'Malley. The first was the reality that an alternative site in the greater Dublin area, which would meet the criteria set out by the project team, was not readily available. Furthermore, it appeared that planning permission would be required for the new hospital and this would be difficult to obtain in any urban location, but might be less difficult for the Thornton Hall site.

The second key element informing the official advice given to the Minister was the opinion of the clinical director of the Central Mental Hospital, Professor Harry Kennedy. On 1 February 2005, a meeting took place between Minister of State, former Deputy Tim O'Malley, and Professor Kennedy, at which I was present. The Minister of State informed Professor Kennedy of the proposal to locate the new hospital at Thornton Hall and asked him for his views. Professor Kennedy's response, as I recall it, was that while the location of the hospital adjacent to a prison complex was not ideal, the key priority was that a new hospital be provided as soon as possible.

The following week, on 8 February 2005, the Minister of State, Professor Kennedy and I travelled in the Minister of State's car to Thornton Hall and we walked the site together. At that time, Professor Kennedy was optimistic that the difficulties posed by having the hospital adjacent to the prison could be overcome by ensuring that a clear boundary existed between the two facilities. He proposed that they should be managed separately and that the hospital should have a separate entrance and a separate address from the prison. He suggested that new governance arrangements be put in place to strengthen the independent identity of the hospital.

The then Minister of State, Tim O'Malley, issued a press statement in February 2005 to respond to concerns about the proposal to locate the Central Mental Hospital at Thornton Hall. The statement made it clear that the concerns expressed by Professor Kennedy, who had asked for certain safeguards to be put in place, had been fully taken on board by the Minister of State and the Department. The then Minister of State emphasised that the hospital would retain its identity as a therapeutic health facility and would remain under the management of the HSE. He stated that the Department would commence discussions with the HSE about governance arrangements for the hospital. He repeated such reassurances in a press statement in May 2006, following the Government's final decision to approve the Central Mental Hospital development at Thornton Hall.

The Government's decision to locate the new hospital beside the new prison complex has received much attention since it was made. Concerns have been expressed that the proximity of the prison to the hospital will lead to the criminalisation of the hospital's client population and the further stigmatisation of the mentally ill. It has been suggested that the decision to locate the Central Mental Hospital beside the prison is the first step towards subsuming the hospital into the criminal justice system. I assure the committee this is not the case. As most admissions to the hospital come from within the prison service, the location of the hospital adjacent to the prison will have operational benefits. Having acknowledged that, I emphasise that the new hospital will retain its identity as a separate therapeutic health facility. There will be clear boundaries between the Central Mental Hospital, the primary function of which is to provide care and treatment, and the prison, the primary functions of which are incarceration, correction and rehabilitation.

I endorse the view of Professor Kennedy that the Central Mental Hospital is not a prison but a hospital. My office supports his position, which is that the hospital must retain its culture of care, consent, engagement, rehabilitation and recovery, as well as its patient-centred focus. In this regard, I refer the committee to the UN principles for the protection of people with mental illness and the improvement of mental health care, which state that "all persons have the right to the best available mental health care, which shall be part of the health and social care system". The principles apply to everyone who needs mental health care, including those who are serving sentences or have been detained in the course of a criminal investigation.

I am aware that members of this committee visited the Central Mental Hospital in July. They have seen for themselves the conditions that pertain there. There is no need for me to go into great detail about the hospital's unsuitability as a location for the provision of modern psychiatric care. Many eminent authorities, including the Office of the Inspector of Mental Health Services and the European Committee for the Prevention of Torture and Inhumane or Degrading Treatment or Punishment, have repeatedly criticised the facility at Dundrum, specifically its unsatisfactory physical environment and sanitary conditions.

It is easy to understand that many people feel a certain attachment to the hospital in its current location. As it has been there for well over 150 years, some people think "Why fix it, if it is not broken?". Unfortunately, it is broken. A strong case has been made that it cannot be fixed. As the new hospital will be built on a green field site, it will be substantially different to the existing facility, which has become part of the fabric of the community in Dundrum over the years. The issue of access to the community, as part of a programme of rehabilitation for patients, will present a challenge at the new location. I am confident that the highly qualified, highly skilled and deeply committed staff of the hospital, including its clinical director, will respond to this challenge in innovative ways to ensure that patients receive the best possible care. I assure the joint committee that my office will work with our colleagues in the Health Service Executive to support them in this regard.

We all agree on the need to build a new hospital. While we engage in ongoing debate on its location, there is a danger that the immediate needs of the patients residing in poor conditions in Dundrum are forgotten. There is a danger that we will also lose sight of those people in our prisons who are urgently in need of admission and treatment and cannot be accommodated in Dundrum owing to a shortage of beds. I know the Minister is concerned that a prolonged debate regarding the location of the new hospital could result in the development of a modern, much needed facility being unnecessarily delayed and the opportunity to develop a new hospital quickly could be lost. My wish is that we can all somehow embrace the change and move forward together to secure, at the earliest possible date, an appropriate facility for the hospital.

The position of the office for disability and mental health is that the decision to locate the Central Mental Hospital in Thornton Hall, while not ideal, constituted the best option available to the Government at the time. We see our task as one of ensuring the decision is implemented. Should the Minister ask us to examine other options, we would be pleased to do so. However, the priority at this time must be to minimise delays in order that a new hospital can be built as soon as possible. The alternative, which would result in patients continuing for several more decades to endure the conditions prevailing in Dundrum, is not acceptable.

Mr. Hugh Kane

The Health Service Executive presentation is in two parts. I will discuss the service and provide background information, while my colleague, Mr. Brian Gilroy, will discuss estates.

The Central Mental Hospital, which was founded in 1850, is on a 30 acre site. Responsibility for the management of the hospital moved in 1972 to the Eastern Health Board, as it was then known. In 2005, it transferred to the Health Service Executive.

The patient population over the decades is set out. In the 1950s, the hospital had 165 patients, whereas the current figure is 89. On the profile of the service, the hospital has 89 beds, of which 81 are designated for males and eight for females. The hospital's catchment area is the entire country, including 13 prisons and the generic mental health service.

The breakdown of beds in the hospital, including specific dependency levels and the breakdown of patients, is shown, as is an aerial view of the existing site.

The Central Mental Hospital has a good client and patient focus. It has a carers' group and works with the Irish Advocacy Network. In addition, members of the organisation, GROW, work with some of our clients, as does Alcoholics Anonymous. We also have a management and service user forum. The hospital has a strong focus on quality and has established policy, clinical audit and risk committees. It is also a member of the quality network for medium secure units and is an approved centre under the Mental Treatment Act.

On staffing, the model of care in the Central Mental Hospital is multidisciplinary and seven consultant-led teams are in place. The hospital has an approved employment ceiling of 257 people and annual budget of €22.3 million. Each consultant team consists of a consultant forensic psychiatrist, psychologist, forensic community psychiatric nurse, social worker and occupational therapist.

The Irish Prison Service refers most of our clients, 95% of whom are remand or sentenced prisoners. The range of patients' index offences is shown, as is the major diagnosis of all patients in the hospital. The legal status under which patients are detained in the hospital is also shown in the presentation. It shows the service activity across the numbers of admissions and discharges from 2005 to 2007, inclusive. There is a prison inreach and outreach programme for the community. It provides a daily inreach clinic to all Dublin prisons, weekly clinics in the Portlaoise and Midlands prisons. We provide a daily outpatient clinic at a day centre facility at Usher's Island. We take referral assessments from all other prisons and the local psychiatric inpatient services as required.

The activity levels by our medical colleagues and community psychiatric nurses come to 4,600 contacts within the prison, outpatients, 261 and 40, other mental health units. The prison inreach team comprises a consultant psychiatrist, a senior registrar for three days a week, two registrars and three community psychiatric nurses. That team provides a daily service to Clover Hill, Ireland's main remand prison. Services have been enhanced since March 2007. All remand prisoners are screened for mental illness on intake. An assessment is made of patients identified and they are triaged according to treatment needed either in prison, hospital or community services. Part of that team has a court liaison service.

We facilitate the transfer of persons with significant mental illness from custodial settings to hospital or community treatment settings. We identify those on remand who present with minor illness or minor offences who may be suitable for bail. We do detailed assessments and court reports. We also liaise with local mental health and psychiatric services to arrange inpatient and outpatient treatment. Through the hospital, we attend the courts to address issues such as fitness to plead and treatment options. We then assist the Garda in transporting patients to receiving hospitals.

The relocation and development of the Central Mental Hospital is a major priority for us. It is a key priority as it is impossible to maintain currently the level of care required for patients. We would like to develop the court and prison diversion and liaison. We need to increase our admission capacity to meet existing and anticipated future service demand and to enhance partnership relations with local service providers. As part of our development we need to increase our capacity within the community.

We have to recognise that the current facility is inappropriate. We need additional capacity to meet the service demand. It is important to develop regional structures to complement the National Forensic Mental Health Service so that when people are ill they do not have long distances to travel to receive appropriate services. It is important to develop additional community rehabilitation projects, community residences and the integration of the forensic and community mental health service to allow for the smooth transition of patients from one service to the other.

Following on the recommendations of A Vision for Change, we see the development being a spoke and hub model with the new Central Mental Hospital facility being a key piece, supported in the four regions with regional intensive rehabilitation units. As part of that overall piece, there would be community and low-support hostels in the community. We have support people in independent living sites and community high-support hostels for those with higher levels of need.

Moving to the new site would provide an additional 37 inpatient beds with additional community places. The whole therapeutic environment would be improved. It would enhance the rehabilitative pathway of care for both male and female patients. There would be improved facilities for patients and staff. The new facility would fully conform to the regulations set out in the Mental Health Act 2001.

Mr. Brian Gilroy

The project team has finalised on the scope of the project in question. There are four separate elements to this. The 120-bed facility at the central hospital in Thornton Hall, four regional intensive care rehabilitation units of 30 beds each, two 15 sub-bed units, one specialist ten-bed unit for children and adolescents and one ten-bed specialist unit for intellectual disability.

Progress to date on the project team includes the appointment of a nurse planner, which is the practice for any type of large hospital development project. This is one of the key elements that inform the design team. We can bring designers in from anywhere in the world but the nurse planner is vital in terms of identifying local nuances and ensuring the operational model is tied to that design.

The cost benefit analysis has been completed by the project team and is with me for consideration. All proposals were found viable, with the move to Thornton Hall the preferred option. The procurement brief, which is a document suitable for the procurement process, is complete for the Central Mental Hospital. It has issued to the market and we have received the returns on that. The procurement brief for the other units, including the four intensive care rehabilitation units and the two specialist units, is in the process of development. In regard to the appointment of a project manager, which we went to the market to procure, the short-listing is under way and a decision will be made by the end of next week, to be announced shortly afterwards. The invitation to tender will then issue to those parties and we hope to appoint the successful applicant no later than March next year.

I will briefly outline the remaining steps in the process. The form of application and contract notice for the design team will be published by the end of this month, with the invitation to tender issued by the end of December. The successful applicant will be appointed by May. The appointment of the project manager will kick-start the design brief process. He or she will work with us in putting together the final design brief which the design team will use to develop our exemplar design. This is a high level design which will eventually allow us to procure the buildings.

The form and application of contract notices for the construction phase will be issued during the design stage, with the completed drawings and specifications available for issue for the construction tendering period. The successful applicant will be appointed in the first quarter of 2010 and the construction process will be complete by the end of 2011. The hand-over and commissioning will overlap with the final stages of the construction process and will be complete by the first quarter of 2012.

Many members wish to speak. As we have already had many statements on this issue, I ask that speakers confine their contributions to specific questions.

I have no issue with that, assuming that we will have a full discussion after the guests have left. I thank the delegates for their presentations. However, my reservations remain. Namely, they have not dealt with the stigmatisation or isolation issues. Nor do I accept that rehabilitation opportunities for patients will be enhanced. The Department seemed to acknowledge in its presentation that there will be difficulties in this regard. In addition, the issue of the loss of key personnel has not been addressed.

Notwithstanding the reference to Professor Harry Kennedy, I understand he has written a comprehensive letter to the Department outlining his objections to the decision taken. What is the departmental delegates' response to this? I understand the nursing representative supports Professor Kennedy's views. Having spoken to the nursing staff, I cannot see how they could have favoured this decision. It seems the opinions of two of the members of the consultative group did not filter through. The other weakness in that group is the lack of representation for patients and families. All those independent bodies for which patient care is to the fore, including the Mental Health Commission, Schizophrenia Ireland, Amnesty Ireland and carers groups, do not support this decision. I accept that the delegates must implement Government decisions and that is what they are doing.

Reference was made to completion of a cost benefit analysis of the project. I note the terminology used. Does this cost benefit analysis include an examination of the opportunity to redevelop the existing site? What is Mr. Gilroy's opinion of the value of the site? Given developments in the property market, it seems inevitable that the value has diminished in the past 18 months.

We will be told that this money will be ring-fenced for psychiatry, which is what we all wish. However, we are all aware that money earmarked for psychiatry in the past under A Vision for Change was not spent for that purpose. The same is true in the case of money allocated for palliative care.

If the overriding principle is that day-to-day spending will ultimately dictate where money goes, there is very little security for people to believe the money realised by the sale will be ring-fenced for psychiatry. We are building a flagship hospital for the next generation beside a prison and concerns have been expressed by all the stakeholders. I think this is the wrong decision and in five or ten years time we will look at this and wonder how we let it go through. I would like to have the questions I asked answered, particularly on cost-benefit analysis and in respect of others, who all have patient care to the fore, who have opposed this project.

I will take all the questions because there may be a certain degree of overlap.

I thank both delegations for coming in. I take the point that we are to ask questions rather than make statements. We have had many opportunities to make statements. I want to respond to the implication that there may be an intention to delay the provision of a new hospital. Nobody around this table has any intention of delaying the necessary replacement of a hospital. Ms Nic Aongusa mentioned that the group that discussed this in 2005 looked at the possibility of rebuilding on the site in Dundrum, as well as the possibility of the greenfield site and renovating the current building. I would like to know more about that process.

Was professional or written advice received on the possibility of staying on the Dundrum site? Were discussions held with patient and family representatives on that proposal rather than the one to move to a greenfield site? What was the process that led to the decision to go for the greenfield site? It is a major financial decision. In addition, the Central Mental Hospital has been in place for over 100 years and it is a major decision to move it out a long distance from an existing community. There are some individual houses in the area but it is not a community in the same way that Dundrum is. We need to know how that decision was taken. On what basis was the idea of staying on the site in Dundrum rejected? Has the subsequent proposal from economist Mr. Jim Power been examined? This proposal suggests the hospital could stay on the current site, sell off some of the land and rebuild on a portion of it. This could be financed by the profits that could be made from selling off a portion of the land in Dundrum.

It is a political decision and policy decided by Ministers is implemented. However, has there been any reconsideration of an alternative before a sod is turned, in view of the opposition from patients whom we met, families, interest groups referred to by Deputy Reilly, support groups and people working in the hospital including nursing and medical staff? This could still be done within the timeframe and in accordance with the proposal drawn up by Mr. Jim Power. He is a respected economist who is normally fairly cold-headed in his suggestions. It has been suggested to me there may be some court challenges on this, which may hold up the development and mean it may not proceed in accordance with the timeframe suggested, which Mr. Kane said was 2012. It has been suggested to me that there may be Supreme Court challenges in regard to the site and, particularly, in regard to whether the environmental impact assessment was in respect of the full site. There may also be issues in respect of EU directives. I am not saying I know the detail but it was suggested to me that there might be some court challenges. Is the delegation aware of any such court challenges and, if so, whether they will delay the process? I understand they concern the Thornton Hall complex, primarily the prison site, but presumably they may have an effect on the hospital site.

I appeal for consideration to be given to building a new hospital on the site in Dundrum for all the reasons we have heard in the presentations made at this committee and, particularly, during our visit to the Central Mental Hospital. Many of them are outlined in Harry Kennedy's letter to the committee. Certainly, his views, as expressed in the letter, appear to be strongly against any move to the Thornton Hall complex and particularly any move to a development adjacent to a prison site. Is it feasible to consider rebuilding on the site in Dundrum?

I welcome the delegation and thank it for its presentation.

In her presentation Ms Nic Aongusa mentioned that the project team consisted of a broad range of stakeholders which she listed. Have all the stakeholders been listed or were others consulted? I think we all agree, following our visit to the Central Mental Hospital, that it is inappropriate for the treatment of patients. It is mentioned in the presentation that the hospital is patient centred and focused and that the patient has to be at the heart of all this. I would welcome the building of a new hospital and would not wish to see it delayed. We owe this to those who need such treatment and those who are in prison and cannot avail of such a service because of lack of capacity. Their needs have to be taken into consideration.

The prospect of there being four regions is also mentioned in the presentation. Is there a timeframe for the creation of such regions and has provision been made for the commitment of finance?

The issue of community care is becoming more important. We are all aware of the psychiatric facilities provided in the past into which people went and never came out. Certainly, that was inappropriate. There is a need for greater investment in community care services.

Mention was made of the site at Dundrum and its value but that may change in the current economic climate. I would like to hear again a clear commitment that the moneys realised, if the sale goes ahead, will go towards the cost of providing a new central mental hospital and that the remainder will be invested in improving psychiatric services. There is not a Deputy, or Senator who does not hear the pleas of those engaged in the provision of such services which for far too long have been the Cinderalla of the health service and received the very few crumbs that fall from the master's table. I want a clear commitment that the moneys will not be subsumed but will be reinvested in the provision of psychiatric services.

Throughout her presentation Ms Nic Aongusa mentioned the meetings and conversations she had had with Professor Kennedy. Has there been any dialogue between the Department and Professor Kennedy in the recent past?

When we met the parents and friends of patients in the Central Mental Hospital, concerns were expressed in regard to its location beside a prison. The witnesses have dealt with some of those concerns today. It will be a totally separate facility. There were also concerns about the interchangeability of staff. The Central Mental Hospital must be solely managed and run by qualified health professionals. I am anxious to secure a clear commitment on that. These were the two most important concerns people mentioned.

I welcome the delegation. Ms Nic Aongusa outlined the composition of the project team, which included the director of nursing and the clinical director. Were any lay people on the team? Were the friends and the parents of the patients considered? If not, why not? Ms Nic Aongusa spoke about the various options examined for the provision of the facility. They included refurbishment, development of a greenfield site or a combination of a few options. Will she outline what they were?

I was surprised by Ms Nic Aongusa's presentation and how she brought the clinical director into a position I have not seen him in previously. The Chairman can correct me if I am wrong but I got the impression from the clinical director some time ago that he was never involved in any negotiations and that nobody had consulted him. Suddenly, he is now in the thick of it. Not only is he in the thick of it, but he has agreed to the site in Thornton Hall. Where did it all go wrong between May 2005 and September 2008? Where did Professor Kennedy fall off the train or wagon, as it were, and what happened to him? According to one paragraph in the submission, Ms Nic Aongusa, the Minister of State and Professor Kennedy walked the greenfield site and Professor Kennedy outlined the options, advising it could work if A, B and C were put together. It appears that the Minister and Ms Nic Aongusa referred back to him and told him that these were together. Then, however, it all seems to have fallen apart. If the project goes ahead in its present form, who and what Department will be responsible for the new hospital on whatever site is chosen?

I emphasise the point made by Deputy Conlon. Nobody here wishes to block a new central mental hospital. Psychiatric services have been moved into general and regional hospitals throughout the country. I live in Sligo, beside the old St. Columba's Hospital. It was barbaric as well as antiquated and historic. I live in an old health board house, which previously belonged to the psychiatrist who worked in St. Columba's. When I moved into the house 20 years ago, patients often came to the house looking to clean the windows and cut the grass. They wanted to do everything for me. My children were very small at the time and were hugely frightened by them. The Department is to be congratulated on the steps it has taken to bring the mental health issue where it is today but we have reached a huge impasse on this matter. Heads must be put together to try to sort it out, both for the patients and the parents and friends of the patients.

I also welcome the delegations. We have been consulted extensively, both as a group and individually, on this issue. In fact, the joint declaration on the proposed move of the Central Mental Hospital was made by 21 major authorities on psychiatric illness. It gave eight reasons disagreeing with that move. I will not go into the details but it is worth stating that these eminent organisations, including Amnesty International, Schizophrenia Ireland and the Irish Penal Reform Trust, have declared that it would impede rehabilitation, increase stigmatisation of the mentally ill, create social isolation, be against Government policy as previously stated, be against the best international practice which was demonstrated to us at a meeting in the Mansion House, and be against international human rights obligations. As well as this, there was no consultation with users and their families.

Three additional serious organisations also have made detailed statements, some of them to us. The Mental Health Commission clearly stated to us that this decision is inappropriate. The Inspector of Mental Health Services also said this decision is wrong. These are all very prestigious organisations. The Mental Health Commission is a statutory body charged with ensuring mental health provision. People as diverse as the former President, Mary Robinson, and Dr. Charles Smith, the former director of the Central Mental Hospital, have stated clearly that it is inappropriate.

The Health Service Executive, the Department and the Minister are the only people who have said to us that this is appropriate. I do not understand that. No one outside of those in the system has said it is appropriate. I put that forward for a response.

I would like to be associated with the welcome extended to the officials. The presence of Mr. Hugh Kane jogs all our memories because my first visit to the Dundrum facility was as a member of the Eastern Health Board in 1994. I have had a number of opportunities to visit the facility since then. I have noticed improvements, although I heard Deputy Conlon give a view on the conditions. They were far worse in 1994. Any time I have visited since then, including during a visit I made with Deputy Reilly last year, I have felt it is a place that needs to be closed. I do not know its condition in 1850 but in the late 1990s, it was a place that needed to be closed. I have no doubt that remains the case. We have acknowledged that there have been improvements and the director pointed that out to us. It is clear something must be done and that it is well overdue.

Many references were made to eminent bodies, groups and individuals who have said "No" to this proposal and said it is a bad idea. I do not know whether this is a political question but are the officials aware of any support? It would be interesting to know the type of people who have said this is a good idea.

It is also important to know if there have been any discussions with those I would describe as all our political masters in regard to current thinking. Before the recess, I chaired a debate in the Dáil in which the Minister of State, Deputy Moloney, was very clear about where he was going. Has that changed? We had hoped he would be present at the meeting. As other colleagues said, we need to talk to the Minister of State to see to where we are going before we dig too deep a hole.

Do the officials believe there is a climate of change? I genuinely believe the facility should be razed to the ground. It is important that money accruing to the State should be used as much as possible for patient care.

Senator Feeney made a point about Sligo and I would like to talk about Tallaght. The psychiatric unit in Tallaght Hospital is second to none. It is important we all understand we have made significant progress with regard to psychiatric care, which is as it should be. There have been improvements for people in all sorts of situations. Many people are afraid to say, however, that there are people in the Central Mental Hospital in Dundrum who need to be there although there is reference in the reports to the Courts Service. This will probably never change. People who have had the opportunity to visit the hospital know of those people and of the demands on staff. I wonder why there is an issue about people who need to be confined, but presume that need will not change. It was important to have this discussion, but we need to see the Minister at this committee as soon as possible.

We all recognise the need for a new hospital. We also recognise the fact that some people are so mentally ill that they must be confined. We know too that some people only need to be confined for a short period of time, perhaps a number of years, and can on recovery leave hospital. We can all name the organisations that are against the relocation decision. However, having read all the evidence, the vote for or against the location of the new facility comes down to each politician's personal opinion on the matter.

The catchment area of the Central Mental Hospital is the entire country, not just the Dublin area. The catchment area includes Cork, the Beara Peninsula, Kerry, Donegal, etc. When I went out to visit the site in Thornton Hall, all I could think about was what it would be like for one of my nearest and dearest to be confined there — not an impossible scenario. I wondered how I would feel about coming all the way from Cork and about how I would get there. If I had a relation confined there who regularly got temporary release, accompanied or alone, to come out into the community to go to the cinema or go for coffee with a visitor — something that happens in Dundrum — how would that be achieved in the middle of the countryside? All I could think of was banishment.

We all agree about the need for a new hospital and that it should be on a new greenfield site rather than a refurbishment of the old facility. However, there is enough land within the Dundrum site to provide that. Was the decision to locate the facility at Thornton Hall made in order to reduce the costs at Thornton Hall in respect of the new prison? Was that the reason? Despite all the expert opinion, no matter how I look at it, I cannot understand how we can justify putting people, who through no fault of their own need to be in an institution, out in the middle of the countryside. How can this be justified? No answer has been provided for this question and I do not understand how this can happen. The only argument that makes sense to me is that putting the two institutions on the one site will bring down the cost of the site, which was outrageous, in respect of the prison.

It has been stated that there will be challenges. We all know that in this context challenges are matters to be overcome that will cost significant amounts of money. In respect of challenges for people who must come and go to Thornton Hall and for patients who would like to mingle with the community, how will those challenges be met and will there be sufficient funds to meet them? Money, transport and additional facilities will be required to meet those challenges. If all this is about the patient, why are we banishing them to the wilds of the country? This will ensure they will receive fewer visits than now and have fewer opportunities to re-integrate into normal society. These are not questions relating to treatment or the experts. If I have a loved one in the institution in its new location and I do not drive, how do I get there and how do they manage to re-integrate into society? How does one stop the stigma attached to being a patient in Dundrum?

How was this decision arrived at by the Department? Was it related to the original cost of Thornton Hall and an attempt to reduce the cost per acre? This makes sense to me. It is not right but it makes sense and it is the only reasonable argument I can come up with. I doubt I will be given a truthful answer to my questions.

I am sure the members of the delegation will do their best to give the Deputy a fully truthful answer.

It could be that they do not know the answer.

I have full confidence in them.

I welcome the delegations and I thank them for the presentation. The committee has been examining this issue over recent months. The central questions have always related to how this decision was made and the reasons for it. This has led the committee to visit the two sites and to hold discussions.

I commend the excellent presentation, some of the content of which was quite surprising. It shows that one never knows the full story until one has heard all sides. I therefore welcome the delegation's visit to the committee so that we have an opportunity to ask our questions.

I refer to the process by which the decision was arrived at. Ms Nic Aongusa referred to the project team. It decided that the ideal option was to build a new mental hospital on a greenfield site. I presume the team took all the issues into consideration at the time, such as the community involvement that exists in Dundrum and access to the hospital. I presume all the various stakeholders considered these issues and arrived at a decision that a greenfield site was the most appropriate solution. Was it a unanimous decision by all the stakeholders and was it acceptable to all of them?

With reference to community involvement and access, some questions have been raised by my colleagues. I note only 89 beds are available in Dundrum and there are no facilities for women, with only eight women patients in the hospital. There is no step-down facility in the hospital for women so the facilities for women are inadequate.

Other members asked about people coming from Cork or different parts of the country, but the majority of patients in the Central Mental Hospital are from Dublin. It is supposed to be a national hospital and a facility for everyone but 70% to 80% of the patients are from Dublin. The plan is to set up regional centres and this demonstrates the hospital is not meeting the needs of the country as a whole. It certainly is not dealing with the people in the regions. When I hear some of the questions being asked and I study the facts, I wonder about the situation with so few people from the country in the Central Mental Hospital.

Ms Nic Aongusa referred to the meetings of the subgroups. When these groups met prior to the decision being taken to locate on a greenfield site, did these meetings include any representatives of patients or their families? This decision was made in May 2004 but it was not until November 2004 that Thornton Hall was purchased. I note the Department was notified by the Department of Justice, Equality and Law Reform that it was looking for a site. In light of the decision in May 2004, did the Department of Health and Children take any steps to identify any other suitable sites, in line with the recommendation of the group?

There has been considerable criticism of how the decision was reached. To be fair to everybody, on reviewing the thought process it is hard to criticise much of what happened here. When the Department of Justice, Equality and Law Reform notified the Department of Health and Children about the site, it greeted it with caution and did not buy into it straight away. Ms Nic Aongusa made the point that she had the impression that the Minister could always decline to be involved in the Thornton Hall site.

I feel the next bit is critical. While I know we are going back over old bones, it is important to nail the issue. The then Minister of State, Deputy Tim O'Malley, has come in for considerable criticism in this regard. However, based on Ms Nic Aongusa's presentation today it seems clear that his decision was made on the basis of two key matters. While Professor Kennedy said he felt the location of the site was not ideal he felt the priority was to build the hospital. We can all make a decision in the heat of the moment and agree as soon something is suggested that it sounds acceptable. However, it was a week later when he visited the site. In the meantime presumably he had time to mention it to colleagues — perhaps not in great detail but nonetheless using them as a sounding board. One week later he still seemed enthusiastic.

Has Professor Kennedy notified the Department in writing of his change of heart or his feelings on the matter since? The committee received a detailed submission from him on 22 August. In the first paragraph of his letter he stated: "I am concerned that you should have the benefit of advice relevant to your decision." The Minister of State sought advice and got it, and if what Ms Nic Aongusa said in her presentation is the position, it seems that he gave it his blessing. If that position changed in the meantime it would be fair to everyone concerned, particularly in light of all the discussions that have taken in place in the Dáil and the public debate, if the Department were notified of a change in his position in the interim. I would appreciate if Ms Nic Aongusa could let us know whether that was in writing or verbally.

Like my colleagues, I welcome the delegation and thank the witnesses for their presentations. Ms Nic Aongusa has outlined clearly the procedure that was followed. I have no difficulty with the decision. I hold the view that regardless of the site selected there will be pros and cons. People have suggested that it should be located in Athlone as it is a national facility. Everybody has their own view. We witnessed the debate over a children's hospital and there is still not unanimity on where it should be placed. What is significant is that it was February 2003 when then Minister visited Dundrum and it is now five and a half years later. We have made some progress in that the post of programme manager has been advertised. However, everybody around this table agrees that we should have a facility as soon as possible for the people at present in Dundrum. We need a new facility urgently.

I would not like to see anything done at this stage that would delay the project. As Ms Nic Aongusa said, after the Minister accepted the decision in 2004, the Minister of State, former Deputy Tim O'Malley, took a further two years to review that decision in the light of the involvement of the Department of Justice, Equality and Law Reform and where it was coming from. It would appear that when the decision was made in 2006 it had been well thought out by people with considerable expertise.

One question keeps coming up and is of great concern to the public. While it has been answered today it is no harm to reiterate the question and have it answered once more. What is the division between the prison and the hospital? It needs to be made absolutely clear at every occasion that the hospital will be run and managed by its own staff of health professionals. It has been suggested at this forum that prison workers might be used to staff the hospital. That needs to be put to rest because it is, understandably, causing concern to those who are anxious to see that the best possible treatment is offered to patients at the new facility.

Mr. Kane has mentioned that the hospital's 89 beds are all occupied by patients. Is there pressure on bed capacity? If so, how can it be alleviated? I presume that a programme manager will be appointed soon, as all applications will have been received by 12 September. How soon will the programme manager and his or her team be able to address the various issues, particularly those raised by Deputy O'Sullivan? She asked about the possibility of objections being made to the site on the basis of its environmental impact. It does not matter where the site is. It is important that the issues pertaining to it are addressed as rapidly as possible. We need to get on with building a facility for those who need assistance.

I thank the officials from the Department and the HSE for their presentations, from which it seems that the Government's decision to relocate the Central Mental Hospital is to be implemented. Will the representatives of both bodies confirm that is the case? The Government has not indicated that it has any reservations about the decision, even though concerns have been expressed by many expert groups. Many involved in this area believe the Government's decision is contrary to international best practice. Will the officials confirm that it is to be implemented? Having listened to their presentations, that appears to be the case. The decision has not been reviewed, despite the concerns expressed by a variety of groups and political parties.

Ms Nic Aongusa mentioned that when this proposal was originally made, Professor Kennedy made it clear that he was keen for a new building to be provided. It is understandable that he was keen because we all knew that a new building was needed. Leaving aside the comments he made in the first week, it is clear from the comments he has made subsequently that he has altered his position somewhat. I believe the officials present are familiar with a letter sent by Professor Kennedy to the joint committee, in which he said:

I have below listed the many reasons why health gains, operational matters and service quality would suffer from a move to a remote and isolated location where community rehabilitation could not easily proceed. This would lead to seriously worsened health outcomes due to longer length of stay and a return to a custodial culture over and above the obvious stigma.

It is obvious that Professor Kennedy has serious reservations about this move which he expressed in the letter he sent to the committee. How do those present who are experts in the mental health area and charged with implementing the Government's decisions in this regard respond to the points made by Professor Kennedy?

I wish to ask about the decision made by the project team. Are details of the team's deliberations available publicly? How many meetings did it have? Who did it meet and consult? Did it receive expert advice? I would like to get as much detail as possible of the work of the team which decided in 2006 to recommend to the Minister to proceed with the move to Thornton Hall.

I will conclude by asking about the development of the Dundrum site. What is the current value of the site? Has the possibility of developing a new hospital on it been assessed? Has the HSE applied for planning permission for the new hospital? If not, when does it intend to do so? I would like to get some responses to these key questions.

Like other members, I welcome the presentations made by the Department and the HSE. They brought clarity to the debate on questions raised in previous presentations. What is the best environment for mental health patients? It is argued that hospitals located in areas such as Dundrum provide better settings for patients as they allow them to mix in society. I believe, however, that it would be preferable for patients to be placed in a calm environment as opposed to a location in a bustling city. I ask the witnesses to comment.

Deputies Caoimhghín Ó Caoláin and Joe Behan who are not members of the joint committee wish to comment.

I welcome the delegations and thank them for their interesting presentations. Many of the questions arising have already been posed. I will reflect a concern which I ask members of the panel to address. We talk about perception and association and the idea that broader society will see having the two facilities in close proximity as representing a smear or slur on the patients in the mental health facility. What consideration has been given to the effect on those who are patients in this facility in terms of measuring, on the one hand, the current location and the whole thrust towards a community focused approach and, on the other, the isolation of a rural setting and having as an immediate neighbour the single largest prison on this island? The issue here is to focus on what is best for those who will find themselves in the Central Mental Hospital in future. I appreciate and share the very well articulated concerns expressed by the various representative non-governmental organisations.

What, if any, address has been given to the very definite impact that will apply to the 89 bed holders — or whatever the number the new facility will cater to — of their immediate association with a prison environment on their doorstep? This issue must inform our consideration of what is involved in all of this.

On an issue alluded to by Senator Fitzgerald, as the aerial representation of the current site of the Central Mental Hospital in Dundrum shows, there are significant unutilised or under-utilised land banks on the site. What consideration has been given to the potential to dispose of a section of the current site to provide a cost neutral solution to financing the provision of a new state-of-the-art facility? Why does this option not appear to have been given the same serious consideration by the various departmental interests that has apparently been the case in relation to the Thornton Hall co-location proposal? This strikes me as strange. There could be a number of reasons for this, including that the Thornton Hall proposal is perhaps convenient. Maybe, as has been the case with so many psychiatric facilities around the country, there is an opportunity to realise bonus time not only in terms of cost of replacement, but also in generating funding to be directed into other areas which, as we have all too sadly seen in the past, certainly do not include mental health support services. Has any evaluation, preplanning or assessment of the Thornton Hall site been carried out? Has there been any examination of an alternative plan for the Dundrum site that might yet present as the favoured option?

I welcome the delegations from the Department of Health and Children and the Health Service Executive. I also welcome the families and carers of some patients in the Central Mental Hospital who are in the Visitors Gallery. They also attended previous committee meetings. Their deep concern is for the welfare of their family members. While what we are dealing with is a political issue to us, for them it is a personal one. We must bear in mind when discussing this matter that real people are involved. We all want to ensure the outcome will benefit patients both now and in the future.

From my observation, the core issue for families and carers of patients is the association of the new Central Mental Hospital with the Prison Service and that it will be coupled with a prison institution. More than anything else that sends the message that patients will be cast into a prison system when, in fact, they are ill. They may have offended but it was because they were ill. All the patients' families want is that their family members will get better or be cared for in the best possible therapeutic setting. On that basis, I understand why patients' families are concerned about the decision.

Bairbre Nic Aongusa confirmed that the Department of Justice, Equality and Law Reform first proposed Thornton Hall as the location of the new mental hospital. Deputy Flynn asked what was done by officials in the Department of Health and Children to source an alternative site before Thornton Hall was first proposed. There was a period of several months during which other sites could have been sourced.

The Department of Health and Children stated the reasons for the Minister considering Thornton Hall as an acceptable location were an alternative site was not readily available and that planning permission might be less difficult to secure for the Thornton Hall site. This sounds like a weak effort was made in sourcing alternative sites before the Department of Justice, Equality and Law Reform proposed the Thornton Hall site.

Professor Harry Kennedy has spoken to the committee. In his letter, dated 22 August, he stated the Department of Justice, Equality and Law Reform had repeatedly expressed the view that the Central Mental Hospital should be incorporated into the Prison Service. He has maintained this is the real reason for the proposal in respect of the Thornton Hall site and the lack of consultation regarding the announcement of the decision.

Bairbre Nic Aongusa has stated the proposal was initially greeted with less than warm approval by the Department of Health and Children. It seems the Department of Justice, Equality and Law Reform has set the agenda.

Is the location of the new Central Mental Hospital the subject of a proposal from the Department of Justice, Equality and Law Reform or the Department of Health and Children? This is key to the patients' families' understanding of how the project will evolve.

As a Fianna Fáil Senator I am totally opposed to the siting of the Dundrum mental hospital at Thornton Hall. If there is a vote on this later, I will, however, be supporting my party as these are the rules of engagement in this business. I am speaking on behalf of the patients in the hospital in Dundrum and of those who will be there in the future. As I said at the last meeting, people were born with a disability that they were not able to handle themselves in society and ended up in trouble. Nobody can know the day nor the hour when they could be in that situation. I was privileged to visit the hospital in Dundrum and talk to the patients. I was also privileged to visit the site at Thornton Hall. I thank Deputy Flynn for proposing the committee visited both sites.

If the hospital is sited beside the future prison, there is no doubt the stigma of prison will be attached to it. In the rehabilitation of many of the patients in Dundrum, it is critical they can visit the local community and take up educational opportunities at the local technical school. I have lived in the Dundrum area since 1972 and I can categorically say that I have never heard any criticism of the mental hospital. I have met the patients who love going out to Dundrum and on the Luas when they are in a position to be rehabilitated.

A cold-hearted and mercenary decision was made to move the hospital to Thornton Hall. It was made purely for financial reasons because that was the culture at the time. When we visited the Thornton Hall site, we asked how on earth patients' families could get there with such difficult access. Ms Bríd Clarke, chief executive officer of the Mental Health Commission, the regulatory body responsible for licensing, setting standards and good practice told the committee that locating the hospital cheek by jowl with the prison was not right.

It will be political failure if the hospital is located beside a prison. This decision should now be left to politicians and not civil servants. As a businessperson, I do not have a problem with Professor Kennedy having second thoughts. Too many business and Government decisions are never re-examined. The best decisions can be revised. One can change one's mind. The condition of the Dundrum hospital, as an institution for mentally ill people and people who had been through the courts, was notorious. The man's back was probably against the wall.

There have been many political and business failures because people did not have the courage to say they changed their minds. If more Ministers and senior politicians had the courage to change their minds about certain decisions, we might have better policy in those instances. Therefore, I have no problem with the fact that this individual changed his mind. However, I do not like what has happened today. It causes me unease that the director of the hospital is being exposed in this manner. I have a difficulty with this. If I were a civil servant, I would not have put it in writing in this fashion. I apologise for being so emotional. It is a question of integrity and character. This individual is perfectly entitled to change his mind if he believes a better solution can be found for the hospital, of which he is director. There is nothing wrong with this.

Will Ms Nic Aongusa confirm that Professor Harry Kennedy was not presented with a fait accompli when he offered to do the best he could with what was presented to him? Will she confirm that the site on which he commented is the same part of the site we are examining, that is, with the prison overlooking the hospital, rather than another part of the site which is higher up and looking down on the prison?

I thank members for their questions, some of which overlapped. Deputy Behan raised an issue of concern to many of the groups which made representations to the committee, namely, the involvement in the process of the Department of Justice, Equality and Law Reform and the Prison Service. It was extremely unwise to announce the construction of a prison and a hospital in the same press release. Will Ms Nic Aongusa advise us why the Irish Prison Service was involved in the project team that was set up following the initiative by the then Minister for Health and Children, Deputy Martin? Will she make clear what, if any, role the Irish Prison Service has in the project as now envisaged?

Members alluded to the proposal made by Mr. Jim Power but it appears from the documentation provided that the option of disposing of part of the site and building ab initio on the remainder was examined. Is it the case that the proposal to dispose of the site in its entirety was considered necessary in order to fund the new hospital and to release sufficient funds to deliver the four regional centres, the adolescent centre and the centre for people with learning disabilities?

In terms of the planning process, does Mr. Gilroy envisage taking this project forward, if it proceeds at Thornton Hall, via the conventional planning process, through Fingal County Council, or would it be more appropriately advanced within the terms of the critical infrastructure Bill?

Given that some members are under pressure of time and that we have two motions to debate the issue, I ask delegates to answer as succinctly as possible.

Ms Bairbre Nic Aongusa

I thank members for their comments. Senator White remarked that if she were a civil servant, she would not say what I did. It is most unusual for a civil servant to put something in writing as I have done. However, what I am putting on record are the facts. The Senator mentioned the word "integrity". It is the case that Professor Kennedy has been making public statements on the issue and the impression may have been given that there was no consultation. I am setting out the facts. Professor Kennedy can speak for himself.

I have known Professor Kennedy since he was first appointed to the Central Mental Hospital and I have great respect for his clinical expertise. He has done a remarkable job since his appointment as clinical director in the Central Mental Hospital in turning around the hospital from what was a very traditional, custodial type of hospital to a first-class, modern psychiatric service. He has built up links with the universities and has developed it as a centre of excellence for the training of staff. There is no doubt that under the clinical leadership of Professor Kennedy the quality and quantity of care provided to the prison service and the health service for forensic mental health services has improved. It is because we value his advice that he was consulted and met the Minister and me.

Senator Feeney asked, "What went wrong?" I do not know what went wrong. From February 2005 until the final decision of Government in May 2006 I continued to have regular meetings and dialogue with Professor Kennedy. At that stage he did not tell the Minister or me "Do not go ahead with this". I moved to other responsibilities within the Department in 2006, so I do not know what happened after that. I know public statements were made which were not in accordance with the facts and that is why I have laid out the facts here today.

Regarding dialogue between Professor Kennedy and me, he has had an ongoing relationship with the Department on other policy matters. He engages regularly with us on different issues and we have a very good working relationship.

Questions have been asked about the project team set up in 2003. The membership of the project team was quite extensive. In addition to the people I mentioned, it included the deputy CEO of the East Coast Area Health Board, who was chairman, the hospital manager, a programme manager from the South Eastern Health Board, some staff from the Eastern Regional Health Authority, technical staff, a director of architectural services, an engineering adviser, Sheila McManus, mental health services from the East Coast Area Health Board, a quantity surveying adviser and an analyst from the National Development Finance Agency.

There were no service users or carers on the project team. The involvement of service users and carers on project teams and policy groups is a relatively new concept. A Vision for Change, published in 2006, put it forward as best practice and it has been our policy since then, to encourage the involvement of service users and carers in discussions. We are talking about history here and in early 2003 the carers group had not yet been set up in the Central Mental Hospital. It was a revolutionary thing to have done and credit must be given to Professor Kennedy for that. There has been more involvement since then but that was why we did not have service users on the project team.

Regarding the recommendations made by the project team, the possibility of building on the existing site in Dundrum was considered and appraised. The various options were appraised by the HSE group of technical experts. The proposal to build on the existing site was a viable option but not the preferred option. The project team, in particular the clinical director, said 20 acres were needed to provide the optimum space for the hospital. There is no way one could cut it with the existing site, particularly as the old buildings are listed. That was a key consideration.

The advice we got was that if we sold the site as a whole, we would get commensurately more for it than if we sold a small part of it and had a hospital on the other part. There was also the question of logistics. If we were to build on the existing site, we would have to keep the old hospital running in the old building at the same time. There were very valid concerns on the part of the staff of the hospital about the logistics of having a building site on the same site as a hospital which is functioning. Those are the reasons it was not the preferred option. I am not saying it was rejected but we were asked to provide a recommendation on the preferred option. The preferred option, as I said in my statement, was the 20-acre greenfield site with access to the M50. When the Department of Justice, Equality and Law Reform contacted us and said it also was seeking a greenfield site with ready access to the M50, on the face of it that met the criteria of the expert group.

Perhaps I can say one thing about weighing up the various issues. As civil servants, when advising Ministers on what to do, we have to weigh up a number of issues such as the needs of the patient and the concerns of the staff, but we also have to look at other aspects, for example, the reality about access to an alternative site. That was a very real concern. To answer one of the questions, we had looked at a number of alternative sites. There was a list of sites that we followed up but for various reasons none was available. I do not have that list to hand but I do remember making those calls.

I know the carers are very concerned about their loved ones in the hospital. I share those concerns. I would be very worried about the possibility of prolonged delays. No one wants to delay the project but it could happen by default. The other aspect is the many people who are on waiting lists for beds in Dundrum. We do not have enough capacity in Dundrum and the longer the commissioning of a new hospital is delayed, the more that issue will persist. That is also a major concern for us.

Perhaps I can address the issue of the Department of Justice, Equality and Law Reform and the idea that Department is taking over the hospital. Obviously I cannot speak for that Department. It is a fact that many of the patients, if not the majority, in the hospital come from within the criminal justice system. It is a fact that there is a close working relationship between the Central Mental Hospital and the justice system. For that reason, the Irish Prison Service was a member of the original project team. There is always contact, co-operation and meetings between our Department and the Department of Justice, Equality and Law Reform. While I cannot speak for the latter Department, I can speak for my office, the office for disability and mental health, which spans four Departments, including the Department of Justice, Equality and Law Reform. When our office was established, our aim was to foster closer co-operation and co-ordination on a whole-of-Government perspective.

My view is that the health service and the criminal justice service have different functions but in the area of forensic mental health services, they have to work together in the best interests of patients and clients. Working together does not mean one side taking over the other. I would be very clear about that. In my address, I have quoted the United Nations principles. Mental health care must be provided by a health service. I would agree fully with all the points made that it is a hospital, not a prison. However, I am not convinced of the argument that the hospital will be in close proximity to the prison. It will not be in close proximity but will be quite a distance from it. One could argue that the Mater is closer to Mountjoy prison and that Portlaoise prison is closer to Portlaoise hospital and so on.

There are many influences on the culture of a hospital. One of the key ones is the quality of its management and its clinical leadership. As the committee is aware, Professor Kennedy has given a lead and has been building up a culture of care and patient focus. That culture will continue under his leadership. With regard to the staff retention issue, the Central Mental Hospital has become a sought-after workplace due to the improvements there. I am not convinced staff retention will necessarily be an issue. However, these are issues that can be addressed. None of them is insurmountable.

We must distinguish between two issues. The first is the historical account of what happened and what led to the Government decision which I addressed primarily today. The second is what is happening at present and if there are considerations to be dealt with. As a civil servant, I must implement a Government decision. The Government decision has been made and it stands. I understand the committee is discussing inviting the Minister to address the committee. It is probably more appropriate that the Minister address the current position.

From my perspective, I would be concerned about a delay. I would be concerned that if the hospital did not proceed at Thornton Hall, the Central Mental Hospital would again be put on the back burner. If we wish to develop any capital project in the mental health service, we must compete with other capital projects within the health sphere, for example, in the acute hospital sector and in other sectors. The Central Mental Hospital would once again be put in the pot and have to compete for priority with others. It has always been a concern, and some Deputies referred to this, that mental health services always end up at the bottom of the pile. I am concerned that this could lead to delays.

My colleagues can respond on some of the other issues raised. Ms Hennessy can respond with regard to court challenges.

Ms Dora Hennessy

My recollection is that last year's challenge in the High Court related to the prison and the question of an environmental impact study being undertaken by the prison authorities and the justice sector. That was linked in some way to EU legislation; my recollection is that it was required to satisfy EU requirements. That challenge was lost in the High Court. There might be an appeal to the Supreme Court but it relates to the prison.

Did the project team meet or have any consultation with any expert mental health groups or receive any submissions? It appears to have been quite a technical group.

Ms Bairbre Nic Aongusa

Yes, it was a technical group. The expertise we had was in-house expertise from both the HSE and the Department. The appraisal was carried out by the HSE.

How many meetings did it have?

Ms Bairbre Nic Aongusa

There were ten meetings of the full group and numerous meetings of different subgroups. The subgroups were set up to address various technical issues.

Were there no submissions or consultations?

Ms Bairbre Nic Aongusa

No.

Several points were raised regarding Mr. Gilroy's area of responsibility. Does he wish to respond?

Before we proceed, I put a supplementary question directly to Ms Nic Aongusa.

Ms Bairbre Nic Aongusa

Yes. The Deputy asked if Professor Kennedy was presented with a fait accompli. I was present at the meeting and my recollection is that the Minister asked Professor Kennedy for his views. He said that if his advice was not to go ahead, the Minister would be prepared to take that advice. The proof of the fact that it was not a fait accompli is that the final Government decision was not made until 18 months later, in May 2006. During that period I was regularly in touch with Professor Kennedy in the course of my work and there was no indication that he had changed his view at that point. However, he may have changed it since.

The second question was whether we had walked the same part of the site. The proposal was that the hospital be located in the upper part of the site. We walked that part of the site. However, the proposal has been changed since because of various operational and technical issues and it is now proposed that the hospital be located at the other end of the site. We drove around the site and walked the part of the site on which the hospital would be located. The issues raised, including isolation, loss of staff and stigmatisation, would arise, if they were valid, regardless of where on the 150 acre site the hospital was built.

Mr. Brian Gilroy

The question of whether we will go through the normal planning process or avail of the provision of the critical infrastructure legislation will be determined when we have the project managers on board. At our last meeting with officials of Fingal County Council, which was held some time ago, they indicated that they would not object to us proceeding with the development. There are other reports on councillors' opinions, etc., but that is normal in the case of any development project. Now that we have a brief, we know the size of the development we will build. We will make the call in the spring of next year when the project managers are on board.

Developing on the Dundrum site was examined initially and covered in the cost benefit analysis. Developing on-site turned out to be €50 million more expensive. However, even that would be questionable because the value of the land would be determined by its location and development potential and one would only be selling a portion of the site. The location in Dundrum is good but its development potential would be restricted unless we were to allow a tower to be built next to the hospital. It would overlook the new hospital, something we would definitely not desire. If we were to impose constraints, as we would rightly do, it would drive down the value of the remainder of the Dundrum site. Therefore, it is not an option.

On the Thornton Hall lands and whether it was a reason to claw-back money, within the schemes for both developments, the value of the land we are taking is nearly negligible. I was not present at the time but I do not see how it would be a factor. If I could answer the question on site value, I would not be sitting here; I would be a multimillionaire. The question is somewhat irrelevant because we will not dispose of the site until after 2012. We cannot dispose of it until all of the infrastructure is built. It is an estimation of the site value in 2012. Our current assessment — most indications are that we will be out of the dip in which we find ourselves at present — is that there will be a recovery at that stage.

On the bigger question of A Vision for Change and reinvestment, there has been much misinformation. While many people have issued statements, etc., nobody has spoken to me about the matter. I can unequivocally state that since A Vision for Change, the proceeds from the disposal of lands are sitting in the Department of Finance for reinvestment. We have a proposal to be sent to the Department in the next two months in respect of the investment of €42 million in mental health services. That is the money raised from the sale of lands at St. Loman's and, I hope, the lands in Clonmel. No other lands have been sold since January 2006. We surrender all our receipts to the Department of Finance and have a commitment that the proceeds in respect of the site at Dundrum will be reinvested. As alluded to, it is not only reinvestment in the Central Mental Hospital. The four regional units and the two ten-bed units will also need to be funded. It is very important this is kept in mind when one talks about accessibility, the regions, etc. The regional units are very important in that regard.

I thank the witnesses.

When we visited Thornton Hall, we were informed that the watchtower of the prison would overlook the hospital. When Mr. Gilroy conducted the cost-benefit analysis, did he include an evaluation of the loss of social and intellectual capital of the move? We have seen such calculations done elsewhere.

Mr. Brian Gilroy

Yes.

We will take the replies to all the supplementary questions later or we will be here all day.

I welcome what Mr. Gilroy had to say about reinvestment in the mental health services. That is important in terms of sale of lands. Will Mr. Gilroy outline to the committee the €50 million estimate for the extra cost? What does that comprise and how much does Mr. Gilroy allow for the value of the remaining land in Dundrum?

One of the questions I posed was not addressed, but I accept that the response from Ms Nic Aongusa covered it in some respect. My query referred in particular to the evaluation of the impact on those who would be residents in the Central Mental Hospital if it were to relocate to Thornton Hall. What evaluation has been carried out on the impact on them of the close proximity to the prison? I do not refer just to the broad opinion or evaluation of the wider society but to the clinical and therapeutic view. One must conclude, unless otherwise corrected, that Professor Kennedy's current evaluation reflects this. In these circumstances, it is only a consultant clinician who can make that evaluation.

I would like to clarify something relating to when I was chairman of the East Coast Area Health Board. Ms Nic Aongusa stated a project team was established, but I understood a design team of architects was in place already at the time which was subsequently dismissed and a new team recruited. Is that the case? I recall there was already a design plan for the redevelopment of the site at the Central Mental Hospital site.

I seek clarification from Mr. Gilroy. He said, in response to Deputy Lynch, that with regard to the site for the hospital, the effect was negligible on the overall unit cost to the Thornton Hall site. I do not understand why the effect is negligible. Will he clarify that?

Will Ms Nic Aongusa clarify another issue for me? I understood the Minister for Health and Children, Deputy Mary Harney, announced on 1 February 2005 the purchase of the larger site to incorporate both Thornton Hall prison and the Central Mental Hospital, but perhaps I am wrong about that. However, I understood today from what Ms Nic Aongusa said that the decision to site the hospital there was not made until 2006. Will she clarify that?

A number of members referred to the site as being remote and isolated, but I suspect if a housing development were to be built on it, it would not be so described by those promoting it. How far from the city centre is the site? We will now take the responses to the issues raised.

When are we going to vote?

We must conclude the questions first and then we will vote, if we are going to.

Mr. Brian Gilroy

On the question of the site value in Dundrum, the cost benefit analysis was done with a figure of €6 million per acre and sensitivity analyses were done with it at €5 million an acre and up to €8 million an acre. In all cases, the ranking still turned out the same. One could take the position of asking what the site value is today. Site value is only what someone is willing to spend. Therefore, taking the position of 2012, the analyses made were reasonable scenarios to explore and still stand up.

On the question of clarification of ——

What is composition of the €50 million figure Mr. Gilroy cited for the extra cost of going to Thornton Hall?

Mr. Brian Gilroy

No, that was the extra cost of redeveloping in Dundrum.

I beg your pardon. What is the composition of the extra cost of staying in Dundrum?

Mr. Brian Gilroy

Part of it is that one does not get to sell the land in Dundrum, so part of it is the residual value of the land. There are also some operational costs gone through in the net present value. This is a net present value figure and it includes all costs, operational costs as well as capital costs.

Mr. Brian Gilroy

Yes.

Has the delegation a figure for rebuilding on the site?

Mr. Brian Gilroy

Yes. The figure on which the cost-benefit was carried out is just €45.5 million to rebuild in Dundrum.

How many beds would be provided?

Mr. Brian Gilroy

There would be 120 beds.

Could we deal with the other questions, please?

Mr. Brian Gilroy

With regard to the remoteness of the site, the figure taken in the cost-benefit analysis was advised by the AA. This figure was used in an attempt to measure the impact of visitors and staff. The off-peak time is 18 minutes from the city centre to Thornton Hall.

Is that in terms of kilometres?

Is that 18 minutes at 3 a.m. in the morning with no one on the road?

How far is it in kilometres? It is a simple question.

And at what speed?

The Deputy is making a facile argument.

I am not making a facile argument.

As a native of north County Dublin I call tell the delegation there are parts of Garristown that are only 14 to 18 miles from the city but in terms of getting to those places, one would be quicker getting out to——

(Interruptions).

The day the committee members went out to visit the site, Kilkenny native Deputy Bobby Aylward missed the bus and found his own way out. He arrived at the same time as the bus.

I doubt if a misfortunate person coming up from the country to visit a patient would be able to jump into a car as easily but that is beside the point.

On a point of clarification, what is the size of the Thornton Hall site and how many acres will the hospital site take up?

I suggest we finish questions and listen to the answers and continue with the remaining business.

Ms Bairbre Nic Aongusa

Deputy O'Sullivan and Senator Fitzgerald asked for clarification on when the decision was announced. I refer to a press release issued by the then Minister for Justice, Equality and Law Reform, Mr. Michael McDowell, on 26 January 2005, in which he announced the purchase of Thornton Hall. A final paragraph in that press release issued by the Department of Justice, Equality and Law Reform, refers to the Central Mental Hospital. As I recall, this was drafted by my office for inclusion.

The Minister of State at the Department of Health and Children with special responsibility for mental health, Mr. Tim O'Malley TD, welcomed the opportunity the site presents to further develop plans for a new Central Mental Hospital. The Government has agreed in principle, subject to further study, to the transfer of the Central Mental Hospital to the new site. The site chosen provides scope for the construction of a new hospital on its own grounds and with a separate entrance, access road and address. The Minister of State stressed that if the new Central Mental Hospital were developed on a separate site adjoining the Thornton campus, it would be adjacent to but not part of the new prison complex. Minister O'Malley confirmed that his Department was studying this option and would be having further discussions on it with the Department of Justice, Equality and Law Reform and the Department of Finance.

This press release was issued in January 2005. A further press statement was issued on 1 February 2005 by the then Minister of State, Mr. O'Malley which I alluded to in my opening statement and in which he spoke further about the Central Mental Hospital and explained the various safeguards.

On that day, 1 February, when that press statement was issued by the Minister of State, Professor Kennedy spoke on "The Last Word" programme on Today FM and he welcomed the statement made by the Minister of State. I have the transcript of the programme here.

I invite Mr. Gilroy to make any concluding comments.

Mr. Brian Gilroy

The hospital will use 20 acres out of the 150 acres at Thornton Hall. The exact figures are as follows: Dundrum is 6.5 km from the city centre and Thornton Hall is 13.5 km from the city centre.

I asked whether there was a design team of architects.

Ms Bairbre Nic Aongusa

Going on my memory, I believe a team had been appointed in 2000 or 2001 by the then East Coast Area Health Board to consider the possibility of refurbishing the existing buildings. There was a certain amount of work done there and then it was absorbed into the project team. I would need to check the files but that is my memory.

I think it overlapped.

I thank the witnesses for their detailed presentations and for their frank and forthright answers. They have helped us in our deliberations.

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