Michael McGrath
Question:24. Deputy Michael McGrath asked the Minister for Health when critical vacancies in Cork child and adolescent mental health services will be filled; and if he will make a statement on the matter. [12119/17]
View answerWednesday, 8 March 2017
Questions (24)
Oral answers (7 contributions)
I wish to raise with the Minister of State, Deputy McEntee, the question of child and adolescent mental health services. I realise there is a serious issue nationally. I am raising the question especially in the context of Cork city and county, where several vacancies have arisen in critical staff positions. This is now having a direct impact on the waiting lists and the ability of families to access services. I am keen to know what the Minister of State and the HSE are doing to get the vacancies filled in order that we can start providing the services that children and young adolescents need.
I thank the Deputy for raising this issue. As the Deputy is aware, the child and adolescent mental health services in Cork have eight community-based teams. This requires eight consultant positions as well as nursing staff, occupational therapists, social workers and other posts.
The Deputy is well aware that two of the consultant positions have been vacant for some time. Unfortunately, recruitment efforts are still ongoing. Local and international advertising for a locum consultant is ongoing but unfortunately the efforts have been unsuccessful.
As the Deputy has stated, there is currently a serious shortage of consultant psychiatrists specifically for the child and adolescent mental health services. This is the case not only in Ireland but throughout the globe.
Engagement with voluntary providers has occurred and has been explored but, again, this has not yielded any results, unfortunately. I assure the Deputy that the recruitment process is under way and we are trying to fill these posts as quickly as possible.
In the interim, despite the difficulty, the HSE is working to provide the best possible service with the staff available. A key focus is to manage the clinical risks and to prioritise referrals accordingly. Referrals are prioritised according to their acuity and severity. Essentially young people and children who have psychosis, severe depression and high-risk behavioural issues or eating disorders are generally seen within 24 hours. This is not only the case in Cork.
All efforts are being made to support the teams with additional therapy and administration resources. The HSE acknowledges – as do I - that the lack of consultant cover is having a considerable impact on access to services. We know 76 beds are available. However, with some of the vacant consultant posts, only 66 of these are operational. This causes major problems. I emphasise that while there are difficulties in recruiting and retaining staff, this is not a funding issue. Funding has been made available and has been approved. Additional funding of €15 million will move to €35 million next year. These have been approved in the budget, which is now at €853 million.
I assure the Deputy that while we face challenges, this recruitment process is ongoing and everything is being done to try to fill the posts.
I respect what the Minister of State has said. I have no doubt the HSE is trying to recruit consultants not only for Cork but throughout the country. However, it is not working, unfortunately. I do not have the answer for the Minister of State in respect of how to solve this. The HSE is going to have to prioritise this issue. This is having a serious impact on the people who need to access services. Let us consider, for example, the child and adolescent mental health services team C based on Western Road in Cork. The team has been without a permanent consultant psychiatrist since May 2016. The post still has not been filled. A locum was recruited but resigned in October 2016. To date, no one has replaced that person.
As with much of the work we do, individual cases are brought to our attention. When we dig, we find out the information. One case has been brought to my attention. Someone was referred to CAMHS in July 2016 and was seen shortly afterwards following a necessary visit to the accident and emergency department. Six cognitive and behavioural therapy sessions were recommended but they have not materialised. No care plan or service plan is in place for the young child in question. The family are distraught. What am I to say to them? What answer has the Minister of State to their plight today?
I will read an extract from a letter sent from a medical centre in my constituency to the HSE about the same issue:
My colleagues and I at the [health centre] are extremely alarmed and worried at the lack of a Consultant in Child and Adolescent Psychiatry in our area [the north Lee area] ... we have no access to appropriate Psychiatric intervention for the seriously distressed child or adolescent. Our referrals are being added to a paper pile awaiting a new Consultant. If a child or adolescent is suicidal and or is exhibiting self harm we have been advised to send them to [the emergency department] which is not only unacceptable but grossly inappropriate. These high risk young people and their families are traumatised and need help urgently to avoid a serious event. Delays are simply not acceptable in these incidences.
Many thanks for your urgent attention.
That letter was sent from a large general practice in my constituency to the HSE. It highlights the challenges and problems facing young people and adolescents in terms of accessing urgent psychiatric services. I concur with everything Deputy McGrath has raised.
I thank both Deputies. We face two difficulties. One is the recruitment in respect of the consultant posts.
Unfortunately, there is a very high turnover in our mental health services, particularly in the child and adolescent mental health services. As it is high-intensity work, it can be very challenging so people tend to move on more quickly than they might elsewhere. Another difficulty is that there is a huge number of young people on lists who possibly need not be on the lists. The child and adolescent mental health services are for those who are at most high risk and who have the most severe problems with psychosis, severe depression and eating disorders. Due to the lack of supports at primary care level we are finding that young people are being referred when they should not be, so obviously more supports must be put in place at that level. We have approved €5 million for 114 assistant psychology posts which will work within the primary care centres. Hopefully, that will take some younger people away from the CAMHS teams and their waiting lists, which will free them up for more severe cases. However, I must stress that those who present with severe issues either to a GP or an accident and emergency department and must be seen immediately are generally seen within 24 hours. The recruitment of staff continues to be a problem but it is a priority for the HSE.
It is true that they are seen relatively quickly to deal with the immediate crisis but the services they need to deal with the underlying issue are simply not being provided. It is not just about consultant posts. The CAMHS across Cork and Kerry currently have 84 posts, but 170 were recommended in A Vision for Change. It is 50% of the recommended level of staffing resources for CAMHS in Cork and Kerry. I do not know if there is a sufficient number of consultant psychiatrists working privately but if there is, should we consider outsourcing some of these referrals in order that children and adolescents can be seen? Ultimately, it is about them being seen and getting access to the services they require. That is the first priority we all share. Perhaps the HSE is examining that issue. We all wish to have investment and support for our public health service, but if these consultants cannot be recruited the important issue is to ensure that the people who need access to the services get such access.
I will take the Deputy's comments on board. As far as I am aware, where there are supports available through the private sector an arrangement is agreed between the HSE and those private consultants or centres. The problem is that we are all fishing from the same pool. If one has an arrangement with a private organisation, the organisation might well be able to pay the person more than we can at present so that creates a difficulty. Obviously, we wish to improve our own services. What we are trying to do is ensure that fewer of our young people are going into CAMHS. When one looks at the amount of funding spent on young people in the mental health services, one sees that 80% of it is spent on 20% of young people. We must start considering the other 80% and how we can prevent them moving further along the scale. Obviously, that means there must be continued investment in education services, primary care and in posts other than just consultant posts.
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