We now come to deal with the second item for consideration on the Adjournment. Deputy Proinsias De Rossa gave me notice of his intention to raise the subject matter of the provision of residential care and other facilities for Samantha Webb. The matter is in order. The Deputy has ten minutes to present his case.
Adjournment Debate. - Residential Care for Mentally Handicapped Person.
Thank you, a Cheann Comhairle, for the opportunity to raise this matter on the Adjournment. Surely the hallmark of any civilised society is the way it treats its weakest members. It would be hard to think of a more vulnerable and defenceless group than those with mental handicap who are generally not in a position either to defend themselves or fight for better conditions or medical care on their own behalf. If it were not for the thousands of parents, relatives and care workers who look after them they would indeed be in a dire situation.
The appalling case of Samantha Webb, a 22 year old woman with severe mental handicap whose plight has been highlighted recently in the media, shows that not even people in this category have been spared the lash of the health cutbacks.
The case shows that the promises made by the Minister for Health during a Dáil debate in December, to provide additional resources for the care of the mentally handicapped, have not been honoured.
In the Dáil on 5 December last, the Minister stated that Government policy "aims to ensure that services appropriate to their requirements are available to people with mental handicap". He added that he accepted there were gaps in the service and that "further developments in the services are required to bring about the full realisation of the aspirations of that policy". He also insisted, however, that he could not envisage a situation where, if a parent died or something happened suddenly, that a mentally handicapped child or adult would not be looked after.
This case shows that what the Minister cannot envisage is actually happening. Since her mother's death before Christmas, it has not been possible to find a permanent residential place for Samantha Webb. Care workers have, on occasion, had to accommodate her overnight in their own homes and she has also had to sleep in the day care centre which she has been attending for the past 18 years.
Neither is this just a temporary crisis. One month after her mother's death the problem still has not been resolved. The case shows clearly that the claims made by the Minister that there is no crisis in the health service is pure nonsense. The Minister indicated last night that a place would be available quite soon for this young woman. Yet St. Michael's House have categorically denied that and have said that if a place becomes available there are at least six urgent cases on top of a list of 112 criticial cases with which she will be competing for a place.
The allocation in yesterday's budget in no way addresses the problem. What is required is an allocation sufficient to provide an additional 330 residential places in Dublin and another 800 places across the country. It has been estimated that that would run to something like £7 million, not the £2 million that the Minister has allocated. Indeed, St. Michael's House have pointed out that it would cost something like £2.5 million simply to cope with the demand on them for urgent placements, never mind the demand for places right across the country.
The allocation in yesterday's budget of £2 million in the current year is welcome in so far as it goes and in so far as it recognises that there is a problem. There are however, 16,000 families caring for mentally handicapped people and at least 2,000 of those are severely mentally handicapped. Most of these require almost 24 hour care. There is a serious problem which £2 million cannot hope to address.
I therefore call on the Minister to make immediate arrangements to ensure that provision is made, in the first place, to cater for the needs of Samantha Webb and, indeed, to cater for the other critical cases. St. Michael's alone have six critical cases for which they are awaiting places on top of a list of 112.
In addition to funding residential care, according to the Commission on Health Funding, a majority of the 2,000 people in psychiatric hospitals are suitable for transfer to community hospitals and residential centres and about 1,900 of the 5,000 in special residential centres require only hostel accommodation or, in some cases, day care. These again are services which are not being provided and will not be covered by the £2 million the Minister has allocated. Institutional care has been cut back and, presumably, will continue to be cut back and starved of resources. The community care services we were promised as an alternative form of care have not been developed.
In December the Minister also referred to the question of legislation to give specific rights to persons with mental handicap. If the case of Samantha Webb is not an example of deprivation of rights, it would be hard to find one. There is urgent need for the kind of legislation the Minister referred to and I would urge him to address that matter as well. If the Minister or other Members of the Cabinet were unaware of the problem, then clearly this case, which has come to the public attention as the problem has never come to their attention before, must surely demonstrate for them that there is a real problem. There is an obligation on the Government to act now and to act decisively.
I agree with Deputy De Rossa about the importance of providing for the needs of the disadvantaged, including the mentally handicapped. As the Deputy is aware the provision of services to people with mental handicap is the statutory responsibility of the health baord, in this case the Eastern Health Board. Services which are provided directly by the health board and a number of voluntary organisations which are funded by the Exchequer are co-ordinated by a central co-ordinating committee.
In cases such as that of Samantha Webb the policy of the Eastern Health Board is that the most appropriate permanent residential care would be provided as a matter of urgency and that in the meantime immediate crisis short-term residential care would be made available if necessary. In the case in question such immediate crisis residential care was available through the Eastern Health Board, if it was required. I have been assured that those are the facts and that this residential care is always available through the Eastern Health Board.
How does the Minister account for the fact that St. Michael's House have denied this?
I will tell the Deputy how I account for this.
Let us hear the Minister——
The Minister is directly responsible for St. Michael's House and they have denied that this care is available.
I gave Deputy De Rossa permission to raise this matter on the Adjournment and he has done so. He was heard devoid of any interruption and I must insist on the same courtesy being extended to the Minister. The Minister will be heard without any interruption whatsoever.
The Minister is presenting a distorted picture.
I resent the implications of what the Deputy is saying: I am not presenting a distorted picture.
St. Michael's House have said clearly that this care is not available.
St. Michael's House have stated correctly that they did not have a residential place available for Samantha Webb. Deputy De Rossa would be the first one to come into this House and complain——
There is no such place becoming available.
——if they had a vacant place on the off chance that it would be needed in an emergency. He would be the very first to come in here and complain that places which were needed by other people outside were being kept vacant.
Is the Minister denying that are there at least six critical cases in Dublin alone waiting for residential care?
Please, Deputy De Rossa. The Deputy has made his case and he must now restrain himself and listen to the Minister's reply.
The Minister should tell the truth in this House.
The Deputy must not allege that anyone is telling an untruth.
A place was available in a health board institution and perhaps this case raises one issue, that is, whether the co-ordinating committee are as successful as they might be. There are more agencies in Dublin other than St. Michael's House providing services for mentally handicapped. The Eastern Health Board who have premises of their own had a place available for Samantha Webb but because she was attending the day care centre in St. Michael's House and members of the staff voluntarily decided to take her home to their houses — she also stayed in the respite care facilities available in St. Michael's House——
Does the Minister think that is adequate?
——the Eastern Health Board accepted that short-term arrangement while she was awaiting a place in St. Michael's House. They believed this would be more appropriate and less disruptive to her than to place her in their own residential care centre, which was available.
Does the Minister think that is adequate?
Of course, it is not ideal——
It is not adequate.
——but as I have pointed out to the Deputy long-stay places cannot be kept vacant. I might add for the sake of the Deputy that since I came into Government the funding of services for the mentally handicapped has been protected in real terms over the past three years. Indeed St. Michael's House have been able to provide well over 100 new day care places as a result of the extra funding allocated by me as Minister. They have also been able to provide respite care facilities from which 57 mentally handicapped people have benefited. All of this has been done within the past three years despite the crying and wailing by the Deputy and others who have come in here and said there have been no developments, only cutbacks. The Deputy spoke about telling the truth in this House but he said this was the result of cutbacks. There are no cutbacks at all——
Is the Minister saying that there is no crisis in the care of mentally handicapped people?
The Minister must be allowed to reply without interruption.
The Minister is trying to whitewash the crisis.
Please, Deputy De Rossa.
The Deputy said that St. Michael's House had made a statement that no facilities were available. St. Michael's House has assured us that a number of people, including Samantha Webb, who are at present in short-stay crisis care will be offered full residential places in the very near future. My commitment to the mentally handicapped has been honoured. I would love to get £17 million or £20 million, if the economy of this country could afford it, because I could make very good use of it for the mentally handicapped. My interest in the mentally handicapped did not start when I came into this House; it goes back a long time.
The Minister could have got the money yesterday if he had wanted it.
The £200 million allocated yesterday will provide a wide range of facilities throughout the country, including the Dublin area. It will provide for an increase in the number of staff working with the mentally handicapped, more short-stay care, crisis care and long-stay places, a number of day places and many other facilities for the mentally handicapped. I will deal with these matters next week.
With regard to the question of mentally handicapped in psychiatric hospitals, it is now the policy that the mentally handicapped should not be admitted to psychiatric hospitals. That was never the ideal solution but it has been happening for the past 60 years since the foundation of the State. A decision has been made in principle that this will not happen any more and places will be provided outside. A number of new day and residential places have been provided in Dublin over the past three years. I will deal with these more specifically on another occasion.
While the availability of a place in St. Michael's House for Samantha Webb would have been the ideal solution it is understandable why one was not available; places are not left vacant waiting for a crisis to develop. The health board were prepared to offer her a place but in all the circumstances they accepted the arrangement made as the most appropriate in her case and the least disruptive to her. They put the patient's interest first.
It is a whitewash.
The Dáil adjourned at 5.30 p.m. until 2.30 p.m. on Tuesday, 6 February 1990.