Austin Currie
Ceist:12 Mr. Currie asked the Minister for Health his views on whether there is an imbalance in the health care budget as applied to psychiatric care; and if he will make a statement on the matter.
Ceisteanna—Questions. Oral Answers. - Funding of Psychiatric Care.
Paul McGrath
Ceist:29 Mr. McGrath asked the Minister for Health his views on whether there is an imbalance in the health care budget as applied to psychiatric care; and if he will make a statement on the matter.
Andrew Boylan
Ceist:61 Mr. Boylan asked the Minister for Health his views on whether there is an imbalance in the health care budget as applied to psychiatric care; and if he will make a statement on the matter.
I propose to take Questions Nos. 12, 29 and 61 together.
I do not accept that there is an imbalance in the health care budget as applied to psychiatric care. Following publication of the report of a study group on the development of psychiatric services, Planning for the Future, in 1984 a policy of diverting patients from a predominantly institutional form of care to more appropriate community-based care facilities has been pursued vigorously in line with a key recommendation of the report. During this period many elderly patients and persons with a mental handicap were transferred from psychiatric hospitals to more appropriate accommodation. For instance in 1981, 2,170 patients with a mental handicap were receiving in-patient care in psychiatric hospitals. In 1992, this total had reduced to 950. With the transfer of these categories of patients to more appropriate care programmes and settings, expenditure on the care of these patients transferred to either the mental handicap or elderly services. Obviously it had an impact on the total level of funding for psychiatric care.
In line with a second key recommendation of Planning for the Future, psychiatric units are being provided in general hospitals. There are currently 14 of these units in operation and seven more are planned to open. The operating budgets for these units are included in the general hospital programme and not in the psychiatric services programme.
The psychiatric budget does not include expenditure arising from the care provided by general practitioners for the mentally ill. I am confident that the funds to be made available to my Department under the health commitments of the Programme for Competitiveness and Work will ensure the continued development of community psychiatric services.
Is the Minister aware of the concern expressed by people working in the psychiatric services that while the proposals are acceptable, there is a gap in that the Minister's intentions are genuine and he is providing the outlines of the original proposals but there seems to be an area where he falls between two stools in that the diminution of the institutional care services is not being automatically replaced with the required facilities in the community-based area?
I do not accept that that is the case. We were careful to learn from experiences, particularly in the UK, in this regard. There has been a dramatic shift in the psychiatric population base. Many people with mental handicap who should not have been in psychiatric hospitals are now being properly treated in the mental handicap sector. I was pleased this year to significantly increase for the second year the resources available in mental handicap services up to an additional £25 million, as promised in the Labour party manifesto for the last election.
That is what concerns me.
The balance of modern opinion is that other categories of people, for example those with alcohol problems, are more properly treated in the community setting. We are trying to do that more and more, although such people still constitute a significant proportion of psychiatric hospital admissions. In the past, people who had become a bit senile were inappropriately put into psychiatric hospitals and that is being addressed. The numbers in psychiatric institutions have fallen because people are more appropriately placed in the expanding health services in the community. Also, the development of acute psychiatric units in the general hospitals is welcome.
I do not want to get into a political argument with the Minister when he refers to manifestos and programmes for Governments but I would ask him to be more aware that the rush from institutional care into community-based care is not working. We see the evidence of people discharged from institutional care in our cities and towns. There is inadequate community care and back up services. The Minister should be more sensitive to the required balance, which is not being achieved. There are many unfortunate victims of modern day thinking on psychiatric care. The Minister should be aware that there is now a shortage of long term acute beds in our psychiatric services. There are places in private institutions but not in the public health services. Will the Minister ensure that in future psychiatric services are not the Cinderella of the health services?
I am aware of the growing number of services at community level and that is something I want to develop and to fund. Significant new community facilities have been put in place, particularly in the child care area, in the last 12 months. Psychiatric services must be addressed and additional funding is needed. There is a balance to be struck and I do not envisage that all the psychiatric patients currently in psychiatric institutions will be appropriately placed in the community. Many people who have spent the greater part of their lives in psychiatric institutions would find such a wrench too great, but there are a number of people who could be appropriately placed in the community and I am trying to phase that in as effectively as I can. I had two meetings in recent times with the representative organisations of psychiatric nurses and with SIPTU, who have been supportive and co-operative in this development. I understand some of their real fears. I will be mindful of the Deputy's comments and I agree that there is some basis for us to hasten slowly in some regard. I am not aware of a shortage of long term acute beds. That problem has certainly not been brought to my attention.
Has the Minister visited any psychiatric institutions since the publication of the Labour Party manifesto? If so, will he confirm that he has seen at first hand the need for the provision of adequate facilities for the patients in institutional care, even on a scaled down basis, in tandem with adequate facilities in the community care sector, to ensure that patients discharged into the community are adequately catered for? Will he also confirm that satisfactory patient-staff ratios are being maintained?
The manifesto refers to the mentally handicapped services. I am very pleased that a significantly underfunded area received a significant increase in funding during difficult times since I became Minister. I am very proud of that and I make no bones about it. However, we have a long way to go and a range of services are required to meet the needs of the mentally handicapped in the community. The numbers are increasing because mentally handicapped people are living longer, their life expectancy has increased remarkably during the past ten years.
I take the opportunity to visit as many centres as I can across the country. I have certainly visited centres in every province and virtually every county in the past 14 months and I will continue to do so. The provision on the mentally handicapped side is the responsibility of the co-ordinating committees which were established in each health board area to identify needs, to determine the best mix of services and, subsequently, to apply for funding for them. I am doing my best to provide the funding on the basis of demand.
Since the publication of the Green Paper on mental illness we have been working on a strategic approach to the psychiatric services. Having received over 100 submissions and evaluated them we are very close to publishing a White Paper and I hope to introduce legislation shortly after that.
What about the question of the patient-staff ratio?
I take issue with the Minister on this matter as I do not accept that the requisite facilities have been put in place in the community. The Minister's statistics show a huge drop in the numbers in institutional care but these people have been discharged into the community. The Minister is making the mistake of thinking it is a satisfactory solution to discharge people from hospital into the community when in fact a great deal of trauma and stress is caused not only to the patient but to the families trying to look after them. Does the Minister agree? Community facilities to deal with these people on a day-to-day basis do not exist throughout the country and some patients are falling through an invisible hole as a result.
The Minister made a direct statement that the Tallaght Hospital project will go ahead even if Euro funding is not available. I hope he will not take money from much needed investment in community facilities throughout the country to cater for patients discharged into the community — a move we all applaud.
The Deputy opposite is trying to look both ways, if not three or four ways at once.
I am not referring to the manifesto.
The Deputy would be lucky if he had one.
The Deputy cannot criticise me for enacting all the progressive reports on appropriately placing people who are inappropriately placed in psychiatric hospitals. That accounts for the fall in numbers. Most of these people are now appropriately placed and resources have been significantly increased for the community services I listed. The Deputy cannot say there is insufficient funding for community services and yet refer in the same breath to a pool of money I can rob to invest in Tallaght Hospital. The Deputy cannot argue both ways at once. If a pool of money is provided for community services, the Deputy must acknowledge they are provided. I am determined to make advances, not only in the area of community care for the elderly and children but for mentally handicapped and community psychiatric half-way houses in a planned way. A very good division in the Department is resourcing, monitoring and enacting the programme.
I have already indicated my gratitude to the health service workers and their representative organisations for being so co-operative in this significant change in their work practices.
The staffing ratio.
The Simon Community is taking the pressure.