Amendments Nos. 2 and 3 are related to amendment No. 1 and they will be discussed together by agreement.
Health (Miscellaneous Provisions) Bill 2009: Committee and Remaining Stages.
SECTION 1.
Government amendment No. 1:
In page 5, subsection (4), line 31, to delete "section 62“ and substitute “sections 60 to 64“.
Amendment No. 2 corrects a typographical error in the Health Acts. The error in question is in section 53(1B) of the Health Act 1970, as inserted by the Nursing Homes Support Scheme Act 2009. That section incorrectly refers to section 6(2)(c) of the Nursing Homes Support Scheme Act. It should read section 6(1)(c), as that is the correct cross-reference. Amendment No. 3 is consequential upon amendment No. 2. It amends the Long Title of the Bill to reflect that the Bill will amend the Health Act 1970.
Amendment No. 1 is essentially a technical drafting amendment. The Bill currently provides for the commencement of provisions by ministerial order, with the exception of section 62 of the Bill, as passed by Dáil Éireann. It is proposed that certain other sections will also now come into operation on enactment. These are section 60, the proposed new section 61 and sections 62, 63 and 64 as renumbered.
Section 60 provides for the transfer of ministerial responsibility for the local government superannuation scheme, health sector, from the Minister for the Environment, Heritage and Local Government to the Minister for Health and Children. Section 61 is the proposed new section which corrects a typographical error in the Health Act 1970. Section 62 — section 61 in the most recent printed copy of the Bill — amends the Hepatitis C Compensation Tribunal Act 1997 to remove age limits for travel insurance benefit provided in accordance with that Act. Section 63 — section 62 in the most recent printed copy of the Bill — provides for an amendment to the Mental Health Act 2001 in order to address difficulties in the operation of the Act that have arisen following a recent High Court judgment. Section 64 — section 63 in the most recent printed copy of the Bill — makes technical drafting amendments to the Health Act 2007.
The Minister believes that these particular provisions should come into operation as soon as possible and is therefore proposing that the Bill provide for this to facilitate timely and efficient commencement. Other provisions of the Bill are different in nature and will come into operation at different times and by ministerial order. I ask Senators to support those technical amendments.
If I correctly understand what the Minister of State said, the amendments will bring those sections into play immediately the Bill is passed.
Yes.
We support much of what is in the Bill. I did not get an opportunity to speak during the debate on Second Stage. I pay tribute to the work of those agencies that will come under the remit of the Department. The work of the board and staff of the Crisis Pregnancy Agency has been exemplary in recent months and years.
Hear, hear.
The rate of abortion has gone down in this country, which is a very welcome development. The initiatives the agency has taken have been superb. Its work has been based on research and its literature has been excellent. I hope the Minister of State will ensure that the kind of work the agency did, and the initiative that it was able to show, will continue within the structures under which it will now operate. That is important in respect of the issues with which it is dealing, and that it will have that kind of freedom and support to do the kind of work that it did. The agency's work showed a lot of initiative, it was proactive, positive and sometimes cutting edge. Cutting-edge initiatives are needed in this area to have an impact and the agency certainly had that. I hope that will continue.
The same applies to the Women's Health Council and the work the other agencies have done. They have certainly put in a huge effort, but there is one area about which we have concerns, which were well articulated in the Dáil and in the Seanad when Senator Twomey spoke on the Bill. Perhaps the Minister of State will come back to us with further information on this section, the implications of which we expressed concern about given, in respect of sectioning, we are speaking about a vulnerable group of people. Effectively, this service is being privatised. How will issues such as standards, safety and procedures be dealt with? These issues are not dealt with anywhere in a statutory manner.
Is the Senator speaking about the Mental Health Bill?
No, I am speaking about section 63 of this Bill.
I apologise, I lost track of what the Senator was saying.
The changes being made in this Bill are being made on foot of the High Court case. The Bill does not set out in statutory form the qualifications required by personnel in this area. I do not wish to cast any aspersions on the people currently carrying out this work but there have been many scandals in the UK and elsewhere arising out of the privatisation of parts of the health service, particularly when issues such as standards have not been addressed. This problem has also arisen in respect of patients in other countries with mental health difficulties. There is huge scope for poor quality service and for potential abuse.
We are discussing amendment No. 1 to section 1.
The Minister of State said it references the other amendments and has spoken to them.
The Senator wishes to discuss the other amendments now.
Yes. The Minister of State said the amendments relate to sections 62, 63 and a number of others. I am addressing them now as the Minister of State said these sections are to be implemented immediately after the Bill has been passed.
Is it agreed to take amendments Nos. 1, 2 and 3 together? Agreed.
There are implications for the sections to which I am speaking arising out of those amendments. That is the key concern we have about this legislation. We are also concerned this is being introduced separate to mental health legislation and does not put on a statutory footing the issue of standards. Can the Minister of State reassure us that there will not be future difficulties or abuses about which we will all be concerned?
I take on board the Senator's initial point and understand her fears in regard to amalgamation of certain services such as the Rape Crisis Centre and Women's Health Council. I reiterate the point made by the Minister on Second Stage that we are in changed economic circumstances. We must remember that mission statements outside of these groups must remain intact regardless. I will take up with the Minister the Senator's request for the provision of reassurance to this House in regard to the future role and input of the agencies.
It is important to clarify the position in regard to the "privatisation", for want of a better word, of admissions. There are some safeguards in this regard. While I share the Senator's concern in regard to when these safeguards will be given legal status and recognition, it is important to first consider why admissions are being carried out by people not previously associated with the provision of State services. This arose as a result of an increase in the number of involuntary admissions during the past couple of years. It is also important to point out that the privatised service came about not as a result of staff shortages and difficulties not of the making of PNA or SIPTU nurses, but as a result of extra demand from professionals to bring in voluntary staff due to a lack of adequate staffing. I accept that explanation may not be sufficient.
I will move on now to the next part of the Senator's question. This is an "interim" — a word that arose last night and keeps cropping up — arrangement.
It is a little bit like Government.
I believe it to be a most generous interim arrangement. I understand that aspects of the Mental Health Act are to be reviewed next year. The measure currently being introduced is an interim measure. I agree with Senator Fitzgerald that — I do not say this just to get off the hook on this one — we must ensure the necessary safeguards and protocols are put in place. In the meantime, we must examine what type of personnel are involved. When one uses the word "privatisation" it is presumed one is talking about a group of competitors in the field who are vying for this work.
The reality is that only one company is doing this work. All of the staff of this company are trained psychiatric nurses whose terms of employment are reviewed on a yearly basis. This, I believe, places a certain level of responsibility on the private provider to ensure its staff are at all times clued into mental health support in terms of the Mental Health Act. Also, all of the staff work in close liaison with the Garda Síochána, which itself infers the Garda will be aware of the personnel with whom it is working. Most important, by way of the provision of comfort to Senators and families and patients, will be the fact that all of the regulations operated by the private company are in tandem with the recommendations of the Mental Health Commission. While they do not have legal status, the private company has a specific professional interest in ensuring that its employees comply with the safeguards laid down. I fully accept that safeguards and protocols have no legal status and I understand the Senator's concern in this regard.
I ask Members, while accepting that a day can be too long when something is wrong, to be patient in the context of this being an interim measure which will be properly legislated for. I do not foresee a situation arising whereby we will have adequate personnel in the nursing profession to assist in voluntary admissions given we are moving towards a community support service in terms of mental health as set out in A Vision for Change. I assure Members that matters such as the type of personnel that can work in this area, their terms of reference and what legal standards will apply will be legislated for.
Where a dispute or incident arises about which there is concern will this be investigated by the Health Service Executive or the Mental Health Commission? The Minister of State said that the Mental Health Commission does not have a statutory responsibility in this area but it does have an interest here. When the legislation in this regard is being drafted it will be important to ensure someone has statutory responsibility to deal with difficulties or serious incidents that may arise in this complex area.
The Minister of State said there is only one company involved. I presume there is nothing to prevent another company getting involved, in regard to which a question of vetting arises. I want to make it clear that I am not making any suggestions in regard to the current company that is involved. Vetting of personnel in this area could equally be an issue. Does the Minister of State expect this issue to be addressed by way of legislation, given the sensitive nature of the work and the need for the highest standards and understanding of the issues involved from a legal and mental health point of view?
I understand from where the Senator is coming in this regard. Senator Fitzgerald asked who would bear responsibility for any difficulties that arise for patients, their families or the hospital concerned. Responsibility would lie with the HSE rather than the commission because the company involved is contracted directly to the HSE. Some time ago there was a change whereby the employees of the company became employees of the HSE for the sake of regulation. No cost factor was involved, it was purely a transfer of responsibility. There is nothing to stop another company vying for part of the market but the HSE would have to be satisfied that the other contractor would have equal status and responsibility.
The vetting of staff is the most important area. Current practice in terms of the contract for the service requires the external agency to provide suitably-qualified mental health professionals, such as qualified psychiatric nurses and allied health professionals. The professionals would have to meet the standards required by the Mental Health Commission. Often when we think of privatisation of services, we think of the quick buck merchant but this is far from that. They must conform with the regulations of the Mental Health Commission, they must be qualified professionals and, taken in context of the review each year, they must have Garda clearance.
The guidelines for the external assisted admissions service will be revisited in light of the amending legislation due shortly. To say something will arrive shortly in the context of mental health is never enough but the amended legislation will deal specifically with the questions of protocols, safeguards and the assurance that the people who will participate in this activity will be fully qualified, and monitored by the HSE, the Department and gardaí. HIQA standards will also apply.
From my time on An Bord Altranais, the regulatory body for nurses, I have a sense of checks and balances here. The regulatory body would have high standards, particularly in the fitness to practice area. If there was an incident related to patient care or safety, if the fault lay with the nurse, the checks and balances exist and he or she would be called before a fitness to practice inquiry of An Bord Altranais. It is comforting to hear the vetting of staff is so important and that there must be Garda clearance. The nurse would have to have a clean certificate of good practice to be charged with patients of this nature.
The issue revolves around people's qualifications and the company that employs them. The agency has been in existence since 2006 and more than 600 people have been involuntarily admitted since then. The contract for the external assisted admissions includes as a minimum requirement that the assisted admission team should comprise at least two skilled mental health professionals, one of whom must be a registered psychiatric nurse, with a minimum of three years' relevant experience working in a mental health setting within the last four years. Of the 600 missions supported by this agency, there have not been any complaints from the families, the patients or the centres.
It is important to recognise that this is an interim measure and that there will be proper protocols in the area when the Mental Health Act is reviewed.
Psychiatric nurses from institutions can participate in bringing in patients at present; not all of the work must be done by this team. The problem has often been that gardaí are not anxious to get involved with this type of work because no criminal offence has been committed; they are assisting someone to be placed involuntarily in a psychiatric institution. Gardaí do not like having to lead in this area. If the team is not available, and I have seen this myself, we must put together a team from the psychiatric institutions. That is what happens in the south east and I am sure the situation is the same elsewhere and that it works just as effectively.
In a situation where a hospital has been visited by the Mental Health Commission and found to be unsuitable for the purpose of modern psychiatry and caring for patients, how would this legislation apply? If the patients are kept in a place that is not fit for purpose and nurses are operating in almost medieval conditions, what effect will the legislation have?
I agree with Senator Twomey that psychiatric nurses frequently must escort patients from the community into the hospital, voluntarily or involuntarily, and they are well aware of the legislation covering that. Gardaí frequently assist for whatever reason. The systems operate, not everything is broken. How will the legislation affect those hospitals where the Mental Health Commission has identified deficiencies?
I did not mean to create the impression that all of the involuntary admissions were being conducted by private agencies. Involuntary admissions are still being carried out with the support of existing staff in the services. The majority of cases where the outside agency assisted have occurred in the Dublin-Wicklow region. Throughout the country the demand for staffing in the psychiatric area is not as great as it is in Dublin. To ensure people who might harm themselves are brought to the centre in the absence of staff numbers, the HSE decided to involve the external agency.
There has been some confusion about the role of gardaí. Gardaí cannot be called to assist at an admission because the clinical director does not have sufficient staff to effect the admission. In other words, the Garda cannot be used. If a clinical director wants to take an involuntary admission and there are difficulties in providing staff, he or she cannot rely on the Garda. While I know the Senator is aware of this, it is important to realise that gardaí cannot be called on their own. The 2001 Act provides that where a clinical director believes a patient is likely to cause immediate and serious harm to himself or others the Garda can be requested to assist members of staff to admit or return the person to an approved centre.
The proposed amendment simply provides that the Garda may be called upon to assist members of staff or authorised persons. There are no changes proposed with regard to the power to enter a premises by force. Such power is confined to the Garda and is not available to members of staff of the approved centre or the authorised officer. We are talking about approved personnel who have been properly vetted. The Garda is there as a stand-by and its members' particular professional expertise is relied upon.
I take the point made by Senator Prendergast. I presume she is asking about the process of involuntary admission whereby external agents or existing psychiatric nurses are asked to escort somebody, if that is the right word, to a centre that is below standard.
All I can say is that there is legislation dealing with admission procedures, which includes guidelines in this regard. If, for example, the Mental Health Commission has designated a centre as not being fit for purpose, I doubt somebody would be assigned to it, although I am only voicing my own opinion. I find it difficult to believe somebody would be assigned to a centre that was not up to the minimum standards required.
I am aware that the Senator could speak about places close to where she and I live. All the centres will not be brought up to the required standard overnight, but there is a commitment in A Vision for Change to community mental health supports. I am due to come to the House again in September to reaffirm this, and I will explain how we will have centres that are up to standard. There is a certain doubt out there about whether we will be able to sell properties and keep the money in mental health. I take this opportunity to confirm to the House that I intend to review A Vision for Change in October and make clear commitments for the remaining six years of its lifetime. I am not presuming I will be in this job for six years, but whoever is will need to stick to those guidelines and ensure centres are of a particular standard. I take the point made by the Senator. Yes, there are centres that are not up to standard, but they are approved centres due to the personnel involved in them.
I ask the Minister to clarify one point. At the moment, if admissions are required to go into a unit that has been deemed substandard and not fit for modern-day psychiatry, there is no option. The staff are not doing anything wrong because there is nothing else in place.
Absolutely not. I did make the point that there must be an approved centre and that one can consider approved centres based on two criteria, namely, the structural condition and the staff. Of these, the staff are the more important aspect. We can both confirm that we have centres that are not up to a standard we would like to live in, but the staff are on a par with the best. We have a long way to go to ensure the required standards are reached.
Amendment agreed to.
Section 1, as amended, agreed to.
Sections 2 to 60, inclusive, agreed to.
If only all Bills were dealt with this quickly.
Keep going. The Acting Chairman is doing great.
The problems arise at a later stage.
There will be a bualadh bos at the end.
NEW SECTION.
Government amendment No. 2:
In page 20, before section 61, but in Part 8, to insert the following new section:
"61.—(1) Section 53(1B) of the Health Act 1970 (inserted by section 34 of the Nursing Homes Support Scheme Act 2009) is amended by the substitution of "section 6(1)(c) of the Nursing Homes Support Scheme Act 2009“ for “section 6(2)(c) of the Nursing Homes Support Scheme Act 2009”.
(2) The amendment (effected bysubsection (1)) to section 53(1B) of the Health Act 1970 is deemed to have been included in that provision with effect from the passing of the Nursing Homes Support Scheme Act 2009 and that provision (as amended by subsection (1)) shall come into operation in accordance with section 2 of the Nursing Homes Support Scheme Act 2009.”.
Amendment agreed to.
Section 61 agreed to.
Question, "That section 62 stand part of the Bill", put and declared carried.
Question, "That section 63 stand part of the Bill," put and declared carried.
Section 64 agreed to.
TITLE.
Government amendment No. 3:
In page 5, line 15, after "OF" to insert "THE HEALTH ACT 1970,".
Amendment agreed to.
Title, as amended, agreed to.
Bill reported with amendments and received for final consideration.
Question put: "That the Bill do now pass."
The Seanad divided: Tá, 35; Níl, 13.
Tá
- Bacik, Ivana.
- Boyle, Dan.
- Brady, Martin.
- Butler, Larry.
- Callanan, Peter.
- Callely, Ivor.
- Carty, John.
- Cassidy, Donie.
- Corrigan, Maria.
- Daly, Mark.
- de Búrca, Déirdre.
- Ellis, John.
- Feeney, Geraldine.
- Glynn, Camillus.
- Hanafin, John.
- Hannigan, Dominic.
- Keaveney, Cecilia.
- Leyden, Terry.
- Mullen, Rónán.
- Ó Domhnaill, Brian.
- Ó Murchú, Labhrás.
- O’Brien, Francis.
- O’Donovan, Denis.
- O’Malley, Fiona.
- O’Sullivan, Ned.
- O’Toole, Joe.
- Ormonde, Ann.
- Phelan, Kieran.
- Prendergast, Phil.
- Quinn, Feargal.
- Ross, Shane.
- Ryan, Brendan.
- White, Alex.
- White, Mary M.
- Wilson, Diarmuid.
Níl
- Bradford, Paul.
- Buttimer, Jerry.
- Cannon, Ciaran.
- Coffey, Paudie.
- Coghlan, Paul.
- Cummins, Maurice.
- Donohoe, Paschal.
- Fitzgerald, Frances.
- Healy Eames, Fidelma.
- McFadden, Nicky.
- O’Reilly, Joe.
- Regan, Eugene.
- Twomey, Liam.
Tellers: Tá, Senators Déirdre de Búrca and Diarmuid Wilson; Níl, Senators Maurice Cummins and Liam Twomey.
Question declared carried.