Vol. 357 No. 7
asked the Minister for Health the action he proposes to take to provide more cost-effective treatment for alcoholism in view of the finding of the Report of the Study Group, The Psychiatric Services—Planning for the Future, that costly specialised in-patient programmes for alcoholics give poor value for money.
18.
asked the Minister for Health the action he proposes to take in view of the comment in the report The Psychiatric Services—Planning for the Future, that the volume of prescription of sedatives and hypnotic psycho-active drugs by general practitioners is clearly evident from the General Medical Services (Payments) Board data.
I propose to take Questions Nos. 17 and 18 together.
The report in question has been circulated to all the interested parties and I have asked them for any comments they wish to make by the end of April. When these comments are received, I will review the report to formulate future policy for the psychiatric services, taking account of the views expressed.
As the greater part of the cost of such specialised in-patient programmes are funded by the State, does the Minister agree that immediate action should be taken? I should also like to ask the Minister if he was concerned at the findings in this report.
Overall, it is a very good report and has given considerable hope for the future development of our psychiatric services. Last week, when I met my European colleagues at a conference to discuss the question of mental treatment in Ireland, that report was widely referred to as one of the outstanding reports. It was carried out by the professional psychiatric staffs of the hospitals and by the Department of Health and is regarded as a blueprint for implementation.
Does the Minister require health boards to have an ongoing evaluation of those programmes?
I do, but unfortunately many of the health boards evaluate it in terms of local interest rather than in terms of global requirements.
The main thrust of the report is to transfer much of the service out of the institutions into the community and I should like to ask the Minister if he intends to allocate special funding to the health boards in order that they may build up their community services in psychiatry?
I do not think any special funding is required. We are currently spending a sum of £160 million per year on psychiatric hospital services. Plenty of money is available and that money can be redirected and we should now be thinking not just of selectively closing down psychiatric hospitals. If we were really prepared to grasp the nettle we would close them all down, and, of course, Deputies can use that is any political frame work they want to in the local elections.
What the Minister is saying is a fallacy if one looks at the experience in the US and in Italy where they did what the Minister is suggesting. They did not fund the community services properly and now they are left with patients who left the psychiatric hospitals and are living rough, so to speak, in not having any suitable service available to them. Indeed, recently the House of Commons committee on the social services reported in an exactly similar way.
Let me point out with respect to the Deputy that the psychiatric services in the Republic of Ireland are light years ahead of what the UK have, thanks to successive Ministers and the change that has occurred, particularly in the past ten years. Therefore, when we open up the hostels, the workshops, the day care centres and the out-patient services the only way to fund them is to close permanently the beds from which those patients will come. We have £160 million to do this work and if we keep all the psychiatric hospitals open with about 40 per cent occupancy in them we will never be able to do it. Therefore I urge that the local communities and the health boards face up to the implications of that new strategy.
Will the Minister agree that to provide this community service will take a great deal of funding from funds which the health boards are not getting at present before he can start to talk about the institutionalising of these patients?
No. Let me put the strategy before the Deputy. On behalf of 11,500 patients with 6,500 nursing staff and several thousand more ancilliary staff we are spending £160 million a year. We could comfortably take about a third of those patients out of the residential institutions they are in, put them out into the community and take about £40 million of the £160 million and use it outside the hospitals, but there is no way that we can keep all our psychiatric hospitals open with a 40 per cent bed occupancy with no staff being taken out into the community. My ambition is that we open up residential hostels, residential outpatient services, residential treatment workshops and do all that can be done. We are now working on this to great effect with no increase in costs, but the concomitant of it is that as we do it we close our beds for ever. That is my ambition.
It is not as simple as the Minister says.
The remaining questions will appear on tomorrow's Order Paper.
