Commencement Matters

I understood the Minister of State, Deputy Helen McEntee, was to take the first three matters; however, she has no briefing material on the first matter. Therefore, we will deal with the second matter first. I must be strict on time, given that last week somebody complained that I had given five minutes to one speaker and less time to another.

Mental Health Services Provision

I am honoured to be a Member of the Seanad and grateful to have the opportunity to serve my country and be a representative of the most vulnerable people in the country. It is no secret that I do not have a political bone in my body, which perhaps might be good. However, I take the role of Senator very seriously and for however long the Government is in office, I will work tirelessly to help the mental health groups which are trying to bring about change in the mental health system and will support them every step of the way.

I am setting up meetings with various interest groups which have been relentless in their quest to bring about change. I have pledged to be their voice on the inside and that I will highlight to all political parties the need to implement the recommendations made. However, because of my experience in recent weeks in the House, I am sure all political parties are united in their consensus and support and belief that the needs of the most vulnerable people in society must be addressed.

Besides highlighting and helping mental health groups in pushing their agenda and expressing their concerns, I also have an agenda. My heartfelt desire is to address the problems concerning children. The Taoiseach once said Ireland was a great country in which to grow old. I hope, following his term in office, he will be able to say that for children Ireland is a great country in which to grow up. However, to do this, we must begin with the most defenceless - children with emotional and mental health problems. They rely on existing mental health services and turn to the State for treatment, support and a brighter future, but I am sorry that we are very much letting them down.

Before I focus on the issues and difficulties facing us, I emphasise that my concerns do not relate to the hard-working men and women in clinical services such as the child and adolescent mental health services, CAMHS, because they, equally, are frustrated at the ever-increasing waiting lists and poor staff levels. I am outraged by the grinding slowness of promised changes that children have to endure, changes which expert groups have recommended but to which no one has listened. It is not only these groups that have demanded changes. In 1997 the European Court of Human Rights, ECHR, found that Ireland was in breach of its commitments in the temporary placement of mentally ill minors in adult institutions owing to the lack of age-appropriate care places. Despite these findings, the Mental Health Act 2001 has still not been reformed to provide for the children concerned.

Let us consider the seriousness of the lack of urgency or a commitment to change the existing admission procedures. The Government may argue that, at the end of 2013, there was a 5% decrease in the number of admissions of children to adult units, but the Mental Health Commission reported yesterday that there had been an increase at the end of 2015. Five more children were admitted to adult psychiatric units, giving a total of 95. There will be reasons to justify their placement in these units - the lack of beds, the difficulty in accessing beds outside office hours and the difficulty in conducting assessments outside office hours and at weekends. However, these are the same excuses that have been expressed for the past seven years since the Mental Health Commission issued an amendment to the code of practice on the admission of children. Meanwhile, 15 years later, the Mental Health Act still ignores the fact that children are being placed in adult units and, 19 years later, the Government continues to ignore the ECHR.

While the Minister of State's advisers may suggest children are placed in these units for their own safety, many of them are placed in the psychiatric wards of general hospitals in which there are patients experiencing significant mental health difficulties, ranging from addiction to schizophrenia to dementia and eating disorders. Everyone will recall the terrible tragedy on a psychiatric ward in a general hospital in Dublin when one patient stabbed another. However, the Government is stating children are being transferred to a safe place.

Many Senators have young children and teenagers and I call on them to imagine one of their children having an eating disorder, being depressed or having suicidal thoughts. If they were told that they needed to wait almost two years before being seen, what would they say?

Many of us were fortunate to enjoy a healthy childhood without having to experience the inadequacies of the mental health system, yet most of the children in the mental health system are waiting for us to help them and we can. We can help them to grow up and become well balanced individuals, despite their earlier difficulties. With the right support and care children can put these difficult years behind them. All of us, at some stage in our lives, have had a second chance. I am asking that these children be given just one to lead a life like every other child.

I appreciate that the Minister of State has come to listen on these issues and hope she realises I do not see my role as criticising her, the Department or the Government; rather, I see my role as helping her to achieve what the Government has promised for years, namely, a loving nurturing society in an environment that is full of dignity and respect and that will allow children to look forward.

The Senator needs to be careful. She was allowed four minutes and usually Members take two, but she took seven. When I ring the bell, it indicates that her time is up. The trouble is that if I grant her latitude, someone will come along the next day and say I gave her seven minutes.

It is the Senator's first time and I did not want to stop her. She is very passionate about the subject.

The Cathaoirleach was very gracious and the Minister of State is extremely welcome. On a point of order, is it not a little unusual that there are no civil servants present?

Not during the Commencement debate.

I cannot remember a time when a Minister defended a point on her own.

I chaired the Commencement debate many times in the previous Seanad. It would be more unusual if advisers were present for it.

That is new. I was just curious.

The officials will be here with me tomorrow for the debate on mental health services. I hope the Cathaoirleach will not take time from me.

I apologise to Senator Joan Freeman; I was not aware that I was to take the first matter also. I hope we will be able to resolve the issue. I thank the Senator for her contribution. She has represented the people on the matter of mental health services for some time and I know that she will continue to do an excellent job in representing them in her new position in which I wish her the very best. Mental health services continue to be a priority for the Government and, as the Senator correctly pointed out, all people within the Seanad and Leinster House. This is reinforced by the fact that funding for mental health services this year will increase by €41 million, or just over 5%, to approximately €826 million, as indicated in the HSE's national service plan.

The reduction in the number of children admitted to adult psychiatric units has been a priority in recent years and I assure the Senator that it continues to be a priority. Progress has been significant. The Senator mentioned that the number had increased by five last year. However, in 2008 it was 247 which declined to approximately 95 last year. We are making progress, albeit there was a slight increase last year. This is despite the increasing demands placed on child and adolescent mental health services overall. Such admissions are made for a number of reasons, including distance from particular centres, with families not wanting their children to be sent 40 km, 50 km or 60 km away; the timing of admissions late at night; possible medical issues; substance misuse issues; family concerns and overall safety.

It is the policy of the HSE to provide an age-appropriate service, with a significant majority of young people now being treated by child and adolescent mental health services, CAMHS, teams. While figures for 2015 show that there were 95 admissions of children to adult psychiatric units, the number of admissions does not necessarily equate to the actual number of children admitted, as a child may be admitted on more than one occasion in any given year. In 2015 there were 356 CAMHS admissions, of which 73% were to age-appropriate units and 27% to adult units. The HSE works proactively to reduce both the number and length of stay in such admissions.

We are certainly not ignoring the issue. While there was a reduction to 95 in the number of admissions of children to adult units, it is not acceptable for any child to be in that position. Admissions of this nature should only take place when absolutely necessary. We need to reach a position where zero children will be admitted to adult units.

There has been a significant increase in CAMHS bed numbers in the past 12 months - that is where we can see an improvement - with 66 operational beds at present. This improvement has been assisted by the weekly management of available beds nationally. An example of progress is that an additional consultant resource has recently provided for the Eist Linn unit in Cork which will bring capacity closer to 20 in the coming months. I hope the number will increase and surpass 66, which will help to improve the position. The HSE continues to roll out protocols for the placement of 16 to 18 year olds in line with age appropriate placements as local operational issues allow.

On youth mental health services, there will be a continuation of investment in primary care responses to mental health issues, including counselling services, Jigsaw projects, of which three are being rolled out this year in Cork, Limerick and Dublin, as well as early intervention approaches. The question of further enhancing youth mental health services in the forthcoming budget will be considered in the context of the forthcoming Estimates process for 2017. I am establishing a youth mental health task force to consider how best to assist young people in developing resilience and coping skills to support their emotional well being at an early stage. I hope the task force will be launched in mid-July before the recess.

I assure the Senator that I have taken on board her concerns. I understand where she is coming from and look forward to working with her to, I hope, improve the service.

A debate is due to take place tomorrow on mental health services when the Senator will be able to contribute again. If she wishes, she may ask a brief question. The problem is that 12 Members requested permission to raise matters in the Adjournment debate this morning and I had to refuse eight of them. If the system was structured correctly, we would be able to take five matters instead of four.

I thank the Cathaoirleach and the Minister of State for-----

In other words, the contribution made on this issue was probably more appropriate on Second Stage of a Bill rather than asking the Minister a question.

I am more than happy to meet the Minister of State to come up with a short-term response to the problems that are being encountered. We could address some of them very quickly, but we need to meet other interested parties also. I hope the Minister of State can agree to do this.

Hospital Staff

Can I have seven minutes, too?

I thank the Minister of State for her attendance. On behalf of nurses, midwives, medics and other health care staff, I welcome her to her post and hope to work collaboratively with her and the Minister for Health, Deputy Simon Harris. I refer to the first phase of industrial action next week by the Psychiatric Nurses Association and ask the Minister of State to intervene.

The dispute concerns the 30% shortage of psychiatric nursing staff, which means that there are no community services available and that there is a chaotic health care system in place in inpatient units. The recommendations made in A Vision for Change on community input have not been implemented, but that is a matter for consideration in tomorrow's debate. In fact, more than 75% of the recommendations made have not been implemented. As the approved inpatient centres need to be staffed, there is no one available in the community to provide modern health care services to take us from the Victorian age to providing fit-for-purpose services for the young, the old and newborns. There is not one mother and baby bed in the entire country. Post-natal depression or post-natal psychosis which has a huge impact on the bonding of mother and child is prevalent among women.

I am aware that the Minister, Deputy Simon Harris, is meeting the Psychiatric Nurses Association tomorrow with a view to having A Vision for Change implemented. I hope the Minister of State will be able to intervene and set out a meaningful programme to build up staff to stop the chaos in hospitals and prevent overcrowding. When somebody sent on therapeutic leave is doing well, he or she is telephoned on the Sunday and asked not to come back which enables somebody else to take the bed.

However, they are all registered as using that one bed. We need the sharing of bunk beds at this stage. I would appreciate the input of the Minister of State in that regard. We need to bring our nurses home from abroad and respect them and give patients the quality of care they deserve.

I thank the Senator who has balanced the books somewhat because she took less than three minutes.

I thank the Senator for her question and contribution and wish her the best in her role. I will touch specifically on the planned industrial action this week. It is timely, therefore, that the Senator has asked the question. While it was directed to my colleague, the Minister for Health, Deputy Simon Harris, it falls within our collective remit. The Minister sends his apologies for being unable to be here.

As the Senator pointed out, the Minister met representatives of the Psychiatric Nurses Association earlier this month prior to the completion of the ballot on industrial action. Unfortunately, I was unable to attend, but I hope to meet them tomorrow or later this week. At the meeting representatives of the association outlined the concerns of their members about current and pending staff shortages and the need to focus on recruitment, retention and service development issues. The Senator has outlined many of these issues. Since the result of the ballot was announced there has been engagement between the HSE and the Psychiatric Nurses Association with a view to averting the industrial action which is due to commence on 29 June. Following contacts between the parties, an initial meeting took place last Friday and another is scheduled for tomorrow. Obviously, representatives of the Department of Health will attend that meeting. At last week's meeting the representatives of the association again emphasised the significant recruitment and retention challenges mental health services faced, given the age profile of psychiatric nursing staff. They also expressed concerns about the capacity of the system to implement A Vision for Change.

I emphasise that the Government is committed to providing additional resources for mental health services. As I mentioned in my previous address, this is shown clearly in the increase in funding for mental health services from €785 million to €826 million this year, an increase of 5.2%. The Government is also committed to reinstating the full 2016 provision of €35 million in new development moneys to enable service priorities in the mental health service to be progressed in line with A Vision for Change. The additional funding will enable further recruitment to priority posts throughout the mental health sector and the ongoing development of community mental health teams.

We face a genuine implementation difficulty in some areas, a point which has been acknowledged. It does not relate primarily to a lack of funding and is far more a question of sourcing staff and reconfiguring services and structures. Only this morning I spoke to officials about a particular post, in respect of which there had been three recruitment drives, one of which was international. Despite this, it has been difficult to fill the post. There are, therefore, major challenges in this area. Having said that, some 1,550 new posts have been approved, of which 1,150 have been filled since 2012, but there are still have many gaps that we need to fill. The HSE is experiencing significant challenges in recruiting suitably qualified nurses in this area, with a significant gap between the number of nurses who are graduating and the positions that need to be filled. In that context, the HSE has made provision for the rehiring of retired mental health nursing staff. Some nurses have been rehired. I realise there are a number of issues about the pay scale, something the Department and the HSE are addressing with nurses. The HSE is focusing on facilitating the retention of these nurses and engaging to ensure this will happen. It is also focused on streamlining recruitment processes, increasing the number of student places available, recruiting graduating nurses and ensuring permanent contracts can be offered to all eligible psychiatric nursing staff. It is in the best interests of patients and nursing personnel that the parties engage constructively on the key issues involved in order that industrial action can be avoided at all costs.

The Senator and I share the same objective, that is, improving the delivery of services to ensure the health service delivers the services it is supposed to deliver. I am satisfied that the Psychiatric Nurses Association and the HSE are committed to continuing positive engagement and I will certainly do whatever I can to play my part in that process.

I do not want to be negative, but I have been involved in this game for a long time. In the 1990s the level of funding for mental health services was 14%. It is now somewhere in the region of less than 6%. I become cynical when I hear that it will be increased by 5.2% and when I hear talk year after year of the figures of €41 million and €35 million. We never actually get our hands on that money, but it is announced as a new input every year.

There is cynicism in that regard, but I hope the Minister of State will be able to write down in black and white where the money is coming from and will be allocated and confirm that it will be handed over as opposed to being retained. There was outrage when the sum of €12 million was diverted from the mental health budget and lost in other services that are seen as being less in the background. Mental health services have always been seen as the Cinderella of the health service.

The Health Service Executive recruitment drive in recent years has been miserable. At most, one or two psychiatric nurses have been attracted from abroad. Most psychiatric nurses are too angry to come back as they were forced to leave - that is a quote from the HSE - as were other medical staff and doctors. They were forced out by the yellow pack, degrading contracts. There is not one such contract available in the country now, of which we are very proud. The then Government realised its faux pas in that regard.

Hiring retired staff is a possibility, but I can tell the Minister of State that most psychiatric nurses cannot wait to get out the door owing to burnout. It is a physically, mentally and emotionally demanding job. We try to do our best, but when one is working in chaotic, understaffed conditions and watching the effects on patients and their families, it causes burnout. We, too, are human, but it is to be hoped there will be some thinking outside the box that will allow us to improve the health service, especially in mental health services, to ensure it serves the needs of the people.

There seems to be a problem with the matter Senator Trevor Ó Clochartaigh wishes to raise. Does the Minister of State have some information on the matter?

I apologise and ask the Senator to resubmit the matter he wishes to raise.

Gabh mo leithscéal. There seems to be a problem, I believe at departmental level, even though Senator Trevor Ó Clochartaigh submitted the matter he wished to raise last week. I accepted it in good faith and rejected five others. There will be a debate today and tomorrow on health issues and we might be able to find another way to raise the matter, but if the Senator resubmits it either this week or next week, I will try to give him priority.

I thank the Cathaoirleach and the Minister of State. I appreciate a mistake has been made and will resubmit the matter. I will talk to the Cathaoirleach or the Seanad Office about when it would be most appropriate to do so.

I thank the Senator and the Minister of State. Does she want to respond briefly to Senator Máire Devine?

Only last week I signed off on a figure of €18 million of the €35 million development fund. We are clear on where it is going, namely, to fill new posts but also to develop older services to ensure the environment in which staff are working is modern and appropriate to the work they do. There is much more to do. More emphasis needs to be put on recruitment. We must ensure the number of places available in colleges matches the number of places we need to fill. I look forward to working with the Senator and will engage with her on every matter, where possible.

Senator Máire Devine will be on the Minister of State's case regularly if no progress is made.

Air Services Provision

The Minister, Deputy Shane Ross, is taking the final matter. He is welcome.

I thank the Cathaoirleach for allowing me to raise this matter of importance. I welcome the Minister, Deputy Shane Ross.

I raise the important issue of Cork Airport and the link with the United States of America. As the Cathaoirleach is well aware, last year Cork City Council, Cork County Council and the tourism bodies lent support to the publication earlier this year of the Growing Tourism in Cork strategy, central to which is the importance of Cork Airport and the need to see it connected with routes to North America. Last year was a good one for Cork Airport which saw the opening of 12 new routes and improved passenger numbers. With the EU-US Open Skies agreement, this is the opportune time to have a transatlantic link between Cork Airport and North America. Norwegian stepped in and offered to provide a service between Cork and Boston. Prior to the dissolution of the Dáil and the general election, ongoing efforts were made at Government and EU level to have this link established. However, there is an impasse on the American side.

The European Commission's Director General for Mobility and Transport was in Washington recently to negotiate and plead with the US authorities on the need to have this transatlantic link established.

I commend the Minister for his earlier comments on this very important issue. It is economically important for job creation, tourism and to increase footfall in Cork and the wider Munster region, but it also concerns the EU-US Open Skies agreement which is meant to stimulate the sector and increase passenger numbers and make more options available to passengers. Norwegian is willing to provide this link and the United States cannot be allowed, for whatever reason, to pick and choose or engage in selectivity in how it allows airlines or carriers to become involved.

I appreciate the fact that I am raising it as Leader of the House, but this is a very important economic matter which concerns the granting of a licence. It is about ensuring people in the areas in which the Cathaoirleach and I live have that choice and that we can continue to grow numbers in Cork Airport. To be fair to staff at the airport, they have been putting together a submission based on the creation of jobs and the provision of new routes. In the week when the Vice President of the United States, Mr. Joe Biden, will visit Ireland, would it not have been opportune for him to come on the new transatlantic route out of Cork Airport? I hope we can raise the matter with him during the course of his visit.

I thank the Senator for raising this subject. It is a good day on which to raise it and I hope the message will be sent to the Vice President, Mr. Biden, that we are not happy with the behaviour of various groups in the United States in the blockage of an airline from landing in the United States. The Senator will also be aware that the Taoiseach has raised the matter with the President of the United States, Mr. Barack Obama. It has been raised at various levels around the world, certainly at EU level. When I met the European Commissioner early last week, I mentioned it to her. She said she was sick and tired of making telephone calls about it and that I could make that information public and that they were tired of listening to her. However, they are making every effort to deal with it. The delay is totally unacceptable. It would be opportune if the American Government were to move on the issue promptly and it would certainly be opportune if the Vice President were to make a statement on it in the coming days. In that context, I thank the Senator for giving me the opportunity to address the matter which has been raised with me on a number of occasions and which I know is of importance to the people of Cork and surrounding counties. It is not just a Cork issue; it is an issue which affects us nationally and the international flying world.

Cork Airport is recognised by the national aviation policy as a unique gateway to the Wild Atlantic Way and Ireland's Ancient East, the two main tourism promotion initiatives under way. Passenger numbers have fallen at the airport each year since 2009 and been slower to recover than those at Dublin and Shannon airports. A total of 2.07 million passengers travelled through Cork Airport in 2015, a decrease of 3.4% on the figure for 2014. Significantly, however, passenger numbers began to recover in the final quarter of last year and this positive trend has continued in 2016, with growth of 8% up to the end of May. The airport will launch nine new routes and services in 2016 and believes the rate of passenger growth could be up by 8% for the year as a whole. I am hopeful one of the new routes will be the service to Boston by Norwegian.

Norwegian Air International was licensed as an Irish airline in February 2014. In August 2015 the airline announced plans to operate transatlantic services from Cork Airport, which was very welcome. However, in February this year the airline had to postpone the launch of these services because the US Department of Transportation had not yet granted it a foreign carrier air permit. This is very regrettable as the proposed Cork to Boston route would be the first such transatlantic service from Cork Airport and a very welcome boost to Cork and the wider region. It is my understanding this is the first instance since the EU-US Open Skies agreement was introduced in 2008 that an airline has been prevented from launching a new transatlantic service due to a delay in approval being granted by the US authorities.

We say this as a friend of the United States and are puzzled by the fact that it cannot reciprocate. The delay is clearly not in the interests of the many people on both sides of the Atlantic who intend to avail of the new service.

When the EU-US Open Skies agreement was introduced, it was an example for the rest of the world of the benefits of the open skies policy which had the interests of customers at heart. It was designed to encourage the new competition Norwegian Air International offers. A tentative decision was made by the US Department of Transportation on 15 April to grant a permit to Norwegian Air International. This tentative decision was the subject of a public consultation process which concluded in May, but there is no clear timetable for a final decision to be made. However, I look forward to the decision being confirmed as soon as possible in order that the airline can start operating on the new route from Cork to Boston and other new transatlantic routes.

This and the previous Government have supported Norwegian Air International and the introduction of the Cork to Boston route. My predecessor, the Taoiseach and the Minister for Foreign Affairs and Trade have all made the case for Norwegian Air International to the US authorities on many occasions. I delivered the opening address at the recent IATA AGM, my first aviation-related public engagement, and reiterated this support for Norwegian Air International. In my address I emphasised my deep regret at the delay in granting the permit to Norwegian Air International and the need for a continued move towards increased competition and further liberalisation in the aviation sector. The European Commission has also been supportive of Norwegian Air International from the outset. Most recently, as referred to by the Senator, the Director General for Transport made strong public statements in support of the airline. The Commission has confirmed that it reserves the right to take action under the agreement, including initiating a formal arbitration process. I hope that by confirming the tentative decision made to grant Norwegian Air International its permit there will be no need for this next step to be taken. In the meantime, the Department and I will continue to liaise closely with the Irish Embassy in Washington, the Irish Aviation Authority and the European Commission. We will continue to take the appropriate steps to help to secure this important new service for Cork Airport.

I thank the Minister for his support and the endeavours he has undertaken not only on behalf of the Department but also the people of Ireland. I speak as a friend of the United States, not as a foe, in promoting the EU-US Open Skies agreement and highlighting the need for the permit to be issued immediately. The Minister is correct. We need to see arbitration. This is about the EU-US Open Skies policy. I hope that during the visit of the US Vice President, Mr. Biden, that members of the Government will impress on him the importance and centrality of the new route from Cork Airport in promoting the country in North America.

I endorse and echo what the Senator said. I will not meet the Vice President, but I hope any member of the Government who does meet him will make clear our dissatisfaction at the attitude in the United States and highlight the fact that we, as a friend of the United States, expect an early decision to clear the blockage.

Sitting suspended at 3.15 p.m. and resumed at 3.30 p.m.