Dáil Éireann díospóireacht -
Thursday, 10 Dec 1998

Vol. 498 No. 3

Adjournment Debate. - Health Care Centres.

Mr. Stagg

I thank the Minister for coming to the House to respond to this matter. St. Raphael's in Celbridge cares for people with learning disabilities. Its core values are respect, excellence, hospitality, compassion and justice. It cares for 312 people, varying in ages from birth to retirement. The disabilities of these people vary from profound to moderate. I compliment the staff and the voluntary helpers who care for these, the most deserving of our citizens.

Sufficient resources are not provided to cater for existing pupils and patients and the order is forced to rely on various charities, including bingo, flag days and an annual fete. It is an insult to these, our special citizens, that they are required to depend on the coldness of charity for their rights. It is also a waste of very valuable professional time as professionals must get involved in organising these charity events to barely make ends meet.

To cater adequately for the numbers now at St. Raphael's, a further 80 nurses are required. These are not additional nurses as the centre is 80 short of its complement. The additional annual cost would be £500,000. The centre has long waiting lists, 25 people on which are acutely in need of residential places. Pressure for respite from parents who care for these patients and children who are on the waiting list is increasing daily. Currently there are only three respite places at St. Raphael's. This lack of places leads to emergencies and a crisis for both parents and providers of the service. There is a requirement to provide a 20 bed respite unit consisting of a ten bed unit for children and a ten bed unit for adults. This would require £600,000 in capital expenditure and an annual revenue of £400,000.

Another 30 to 40 patients who are suitable for sheltered community living could be provided with that thereby freeing places in the centre for those on the waiting list. This would cost £200,000 in capital expenditure and £60,000 in revenue.

Traditionally the St. John of God's centre provided for boys and men only. It is now required to provide services for females, but the centre has no facilities for females. Funding of £5 million would be necessary to provide places for these women who are now in the centre's catchment area and who are entitled to the services available to males.

I ask the Minister to face up to the reality of the changed situation concerning learning disability. These people are now living much longer and as a result require a new range of services.

St. Raphael's also has an acute problem as some of its patients with learning difficulties are psychiatric patients. When these are sent to psychiatric institutions, they are returned to St. Raphael's as they have learning disabilities. St. Raphael's simply has no suitable facilities for psychiatric patients.

I know the Minister visited the centre and gave certain general undertakings at the time. I am not asking him to put his hand in his pocket this evening and create a miracle, but to examine the very special needs of the centre's catchment area which was previously serviced in various ways and is now required to be served by the Order of St. John of God. I ask the Minister to examine how the additional top-up provision, which is not large as much provision has already been made, can be provided to meet the gap between the very large number of services being provided and what is required. In particular I do not want the Minister to say everything is okay at St. Raphael's as this is not the case. A crisis exists there due to a shortage of staff and the waiting list.

Minister for Health and Children (Mr. Cowen)

I thank the Deputy for raising the matter. I visited St. Raphael's and put on record my admiration for the work being done there. As the Deputy said there is always room for improvement in all these services and only a fool would suggest everything is rosy in the garden in all respects.

My Department's "Assessment of Need for Services for Persons with a Mental Handicap 1997-2001", which is based on information from the National Intellectual Disability Database, provides information on the current and future needs of persons with a mental handicap. We are aware of the requirement it has identified and the amount of money — £63.5 million — which needs to be spent over the period 1997-2001.

I was pleased to be able to allocate additional funding of £21 million in 1998 to continue the process of delivering the services identified in the assessment of need report. This funding, which includes £10.75 million revenue and £5.25 million from the new national capital programme, is being used to meet identified needs in existing services and to provide new residential and day care places. I provided a further £5 million capital funding this year, over and above the national capital programme, to accelerate the process of providing the facilities required to deliver both the necessary volume and quality of services. In total we have spent about £25 million since late 1997. This compares with £12 million allocated in the previous year.

The 1998 allocation to the Hospitaller Order of St. John of God for services to persons with a mental handicap included additional funding of £250,000 specifically for service issues relating to the changing profile of existing clients in St. Raphael's, Celbridge, referred to by Deputy Stagg.

In relation to the development of new services additional revenue funding of £432,500 was provided for the order's services in the eastern region in respect of 20 new day places and six new residential places. This includes funding of £81,000 provided to meet the full year cost of additional services put in place in St Raphael's in 1997.

A sum of £600,000 of the £3 million additional funding provided to the Eastern Health Board region for service developments in 1998 was set aside to assist in the management of any emergency cases which occurred during the year. This fund worked very well and thankfully we have not experienced the perennial problem which arose at this time of year in relation to this and other facilities. I understand from the Eastern Health Board that approximately £36,000 of this funding was allocated to St. Raphael's in Celbridge for this purpose.

Capital funding of £340,000 was also provided to the order's services in the eastern region in 1998 for the development of new facilities and the up-grading of existing buildings.

Additional funding of £12 million is being provided in 1999, with a full year cost of £18 million in 2000, for the further development of services to persons with a mental handicap and autism. This £12 million is in addition to the £6 million already allocated to the services in 1999 to meet identified needs in existing services. This brings the total additional funding provided in 1999 for the services to £18 million, with a full year cost of £24 million in 2000. The 1999 allocation to the St. John of God Order includes additional funding of £150,000 to meet identified specific needs within the order's services in the Eastern Health Board region.

The additional revenue funding of £18 million will provide approximately 320 new residential places, 80 new respite places, 200 new day places, health related support services for children with autism, the continuation of the programme to transfer persons with a mental handicap from psychiatric hospitals and other inappropriate placements. It will also provide for additional specialist and other support services. I will be providing an additional capital funding of at least £10 million to support these developments.

Details of the precise services to be put in place in the Eastern Health Board region from this additional funding and the individuals who will benefit from these services are agreed by the central mental handicap planning committee, which includes representation from the Hospitaller Order of St. John of God. Officials from my Department will meet the various voluntary mental handicap agencies, including the St. John of God Order, during 1999 to identify issues within existing services which are of concern to them, in the context of the transfer of responsibility for the direct funding of voluntary mental handicap agencies from my Department to the new Eastern Regional Authority in 2000.

The additional funding being provided in 1999 will bring the total additional revenue and capital funding allocated by me to these services to £53 million in 1999 and £59 million with effect from January 2000, which underlines the Government's commitment to meeting the needs outlined in the "Assessment of Need 1997-2001" within the specified timeframe.

Apart from that report, which gives an indication of the amount of unidentified need that must be met, I am aware that other needs arise all the time. I have taken note of Deputy Stagg's points regarding St. Raphael's, and I will take the matter up with my Department to see what, if any, progress can be made on those matters.