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Dáil Éireann díospóireacht -
Tuesday, 1 Jul 2003

Vol. 570 No. 2

Written Answers. - Psychological Service.

Jack Wall

Ceist:

425 Mr. Wall asked the Minister for Health and Children the position regarding the psychological services within the proposed new health reform programme; the sector under which this will operate; the plans and timescale of the proposed changes; and if he will make a statement on the matter. [18732/03]

The health services executive will be the first ever body charged with managing the health service as a single national entity. As the Deputy will be aware, the executive will be organised on the basis of three core divisions: the national hospitals office; the primary, community and continuing care directorate; and the national shared services centre.

The new structure set out in this reform programme will provide a clear national focus on service delivery and executive management. It will achieve this through reduced fragmentation and the creation of clear and unambiguous accountability throughout the system. This is not a centralisation of services, it is a streamlining of the management of the system to create greater efficiencies.

Psychological services are currently delivered as part of broad primary, community and continuing care umbrella. Within the new structure, services will be delivered under the primary, community and continuing care directorate. However, it should be noted, that the integration between the directorate and the national hospitals office will be a vital aspect which will be underpinned in the legislation and management structures of the health service executive.
I intend to put in place an interim board of the health service executive as quickly as possible. The full reorganisation of the sector will take some time to implement fully. For example, while it may be possible to introduce some elements of the reform programme on a non-statutory administrative basis, a key element in the programme in the medium to long-term will be the development of a coherent legislation and regulatory framework for the new structures. This is likely to take a longer period and will depend on the legislative timetable.
I intend establishing robust structures to drive the implementation as soon as possible. This will include a national steering committee and a project office to oversee and progress implementation. One of their first tasks will be to prepare a detailed project plan setting out a timetable for the various elements of the reform programme.

Jack Wall

Ceist:

426 Mr. Wall asked the Minister for Health and Children the plans his Department has or the recommendations which are in the new heath service reform programme to overcome the fact that 40% of psychology posts nationally are currently vacant; and if he will make a statement on the matter. [18733/03]

Jack Wall

Ceist:

427 Mr. Wall asked the Minister for Health and Children the funding available as proposed in the new health service reform programme for the training schemes for clinical psychologists as the mechanism to be used as part of the reform programme to overcome this serious shortfall; and if he will make a statement on the matter. [18734/03]

Jack Wall

Ceist:

428 Mr. Wall asked the Minister for Health and Children the plans his Department has to overcome the serious shortage of trained psychologists; the plans in the new health reform report to rectify this serious shortage; and if he will make a statement on the matter. [18735/03]

Jack Wall

Ceist:

429 Mr. Wall asked the Minister for Health and Children the plans incorporated in the new reform programme to include the review of the psychological services within the health services review group recommendations; and if he will make a statement on the matter. [18736/03]

Jack Wall

Ceist:

430 Mr. Wall asked the Minister for Health and Children the cost of the joint review of psychological services within the health services to his Department; the number of meetings of the review group; the number of meetings he attended in regard to the review group; if he has satisfied himself with its findings; and if he will make a statement on the matter. [18737/03]

Jack Wall

Ceist:

431 Mr. Wall asked the Minister for Health and Children if all of the recommendations of the review of psychological services within the health services have been implemented; if not, the recommendations which have not been implemented; the timeframe of the implementation; if the recent announcement of his Department's reform programme will affect these recommendations; and if he will make a statement on the matter. [18738/03]

Jack Wall

Ceist:

432 Mr. Wall asked the Minister for Health and Children the number of psychologists within his Department for each of the past three years; if he has satisfied himself that this number meets the requirement of his Department; and if he will make a statement on the matter. [18739/03]

Jack Wall

Ceist:

434 Mr. Wall asked the Minister for Health and Children the structures that prevail at present in regard to the management structure for psychology services; the position with regard to the structure taken within the new health service reform programme; and if he will make a statement on the matter. [18742/03]

Jack Wall

Ceist:

436 Mr. Wall asked the Minister for Health and Children if health boards will be permitted to advertise vacancies within the psychological services in the interim of the introduction of the new health service reform programme; and if he will make a statement on the matter. [18744/03]

Jack Wall

Ceist:

437 Mr. Wall asked the Minister for Health and Children the number of meetings he has had as a result of the recommendations of the joint review group report on psychology; the groups he met; the decisions arrived at in relation to the implementation of the recommendations; his views on the importance of the recommendations in the new health reform programme; and if he will make a statement on the matter. [18745/03]

I propose to take Questions Nos. 426 to 432, inclusive, 434, 436 and 437 together.

Following the publication of the report of the joint review group on psychological services in the health service in March 2002, a major priority for my Department was to promote an integrated and co-ordinated approach by the health boards to its implementation over time. This applied in particular to the major recommendations of the report relating to the organisation and management of psychology services, entailing very substantial increases in the number of principal and director level psychologist posts.

Given the key role of the Health Boards Executive in fostering collective working and progressing organisational change and development in the health service, my Department secured the agreement of the executive to work with the directors of human resources in the health boards towards the implementation of the recommendations of the report. The present position is that the directors of human resources are in the process of individually considering the recommendations contained in the report and how their boards might propose to proceed with the implementation process in due course.
This work is being undertaken in light of: service imperatives; funding priorities; and the budget 2003 announcement on public service numbers. In this context, it is important to bear in mind that the overall budgetary and economic position in 2003 has had important implications for all aspects of public spending, and this is reflected in the Estimates and budget adopted by Government for 2003.
Moreover the health service reform programme was announced on 18 June 2003. The programme's priority focus is improved patient care, better value for taxpayers' money and improved health care management. The reform programme has drawn on the conclusions and recommendations of the two reports, the Commission on Financial Management and Control Systems in the Health Service and Audit of Structures and Functions in the Health System, which were also published on the same day. Psychological services are currently delivered as part of broad primary, community and continuing care umbrella. Within the new structure, psychological services will be delivered under the primary, community and continuing care directorate of the health services executive. Any implications of the new structures for the recommendations of the joint review group will be examined in the context of the implementation of the reform programme.
My Department, together with the directors of human resources in the health boards, is currently prioritising support for the implementation of a key recommendation of the joint review report relating to human resource planning through the provision of a substantial number of additional postgraduate training places in clinical psychology. This has resulted in a threefold increase from end-1999 to end-2002, from 26 to 84, in the number of trainee clinical psychologists employed in the health services. At present, there are about 105 clinical psychologists undertaking postgraduate training in the State. Over 60 students are enrolled on the Psychological Society of Ireland's clinical psychologist postgraduate training diploma, 24 are enrolled on the doctoral programme in clinical psychology at TCD – 12 in first year and 12 in second year – and 19 are enrolled on the doctoral programme in clinical psychology at UCD – ten in second year and nine in third year. It is understood that both the National University of Ireland, Galway, and the University of Limerick have plans to introduce doctoral programmes in clinical psychology in 2003 with an intake of a further 20 students in total. These developments, in enhancing graduate output, will help maintain an improved balance between demand and supply in human resource and service provision.
My Department remains committed to working on an ongoing basis, with health agencies, educational providers and the education authorities to ensure adequate provision of training places in clinical psychology, consistent with the medium-term human resource requirements of the health services as detailed in the important recommendations on investment in training and education detailed in the action plan for people management published in November 2002. A particular priority is to secure the best return, in terms of graduate output, on the significant financial resources currently being invested in the health services to support postgraduate clinical psychology training. Consequently, my Department, together with the health boards' directors of human resources, is currently examining the current model for postgraduate psychology training, with the objective of supporting training provision on a planned and sustainable medium-term basis.
In addition to measures to increase the supply of psychologists through the implementation of the recommendations of the joint review report, it should be recognised that other efforts have been undertaken to improve staffing levels in the psychological services, both at local and national level. Relevant developments include the recruitment of psychologists from overseas by the health boards, the introduction of a fast-track working visa scheme for health and social care professionals, the streamlining of procedures for the validation of overseas qualifications and the devolution of responsibility for recruitment of basic grade psychologist posts to health boards from the Local Appointments Commission. Ongoing pay enhancements through the implementation of the recommendations of the Public Service Benchmarking Body will make a further contribution to reducing current vacancy levels by increasing the attractiveness of employment as a clinical psychologist in the health services.
Responsibility for human resource planning, including the advertising and filling of vacant psychologist posts in each health board region, rests with the chief executive officer – chief executive officer – of each board. Each chief executive officer in managing the workforce in his/her region is responsible for determining the appropriate staffing mix and the precise grades of staff to be employed in line with service plan priorities, subject to overall employment levels remaining within the approved regional employment ceiling.
I understand that the Deputy is referring to the total number of psychologists employed in the health services. The table following sets out both the management/grading structure and the number of psychologists employed in the health services in whole-time equivalent terms for the period end-2000 to end-2002.

2000

2001

2002

Psychologist, Basic

202

205

213

Psychologist, Principal

9

20

28

Psychologist, Senior

119

148

168

Psychology, Director

8

8

7

Total

338

381

416

The Deputy may wish to note that the Health Service Employers' Agency was responsible for the organisation and management of the work programme of the joint review group. My Department has therefore written to the chief executive officer of the HSEA to obtain the information requested by the Deputy and this information will be furnished to the Deputy as soon as it is available.
Finally, in addition to ongoing contacts with the directors of human resources group in this matter, officials of my Department have over recent months met with the representatives of the heads of psychology services and the Psychological Society of Ireland to discuss progress in implementing the recommendations joint review group.

Jack Wall

Ceist:

433 Mr. Wall asked the Minister for Health and Children the number of persons on waiting lists within the health boards for psychological assessment for each of the past three years; if he has satisfied himself with the progress made to eliminate such waiting lists; if not, his plans to address the problem; if proposals exist in the new health service reform programme to do so; and if he will make a statement on the matter. [18740/03]

Information on waiting lists within health boards for psychological assessment is not routinely collected by my Department.

Work on the development of a national policy framework for the further modernisation of mental health services is to commence shortly. The provision of psychological services will be examined in the course of that work.

Question No. 434 answered with Question No. 426.

Jack Wall

Ceist:

435 Mr. Wall asked the Minister for Health and Children the number of psychologists attached to the primary care sector of each health board; if he has satisfied himself with the numbers available; if there is a shortfall, the plans his Department has to overcome the position; and if he will make a statement on the matter. [18743/03]

At present, psychological services are provided within the acute hospitals and, in the community, primarily in the mental health, disability and child care services. There are no positions currently designated as primary care posts. However the whole-time equivalent number of psychologists employed – excluding student psychologists – by health board, is as follows:

2001

2002

ERHA

134.17

139.80

Midland Health Board

28.05

27.46

Mid-Western Health Board

31.30

32.60

North-Eastern Health Board

20.00

27.81

North-Western Health Board

24.90

27.27

South-Eastern Health Board

40.84

51.39

Southern Health Board

50.84

57.29

Western Health Board

50.79

51.89

Total

380.89

415.51

The primary care model, as outlined in the primary care strategy, is a competency-based model, responsive to the assessed needs of the community being served. In accordance with the model, primary care providers will come together to form interdisciplinary primary care teams, serving the needs of an enrolled population. Wider primary care networks, comprising additional health professionals, including psychologists, will provide services to the population served by a number of primary care teams.
Primary care teams will be comprised of general practitioners, nurses-midwives, health care assistants, home helps, physiotherapists, occupational therapists and social workers. Psychologists will be members of the primary care networks, which will also include chiropodists, community welfare officers, community pharmacists, dentists, dieticians and speech and language therapists.
The development of the new primary care model will require a reconfiguration of existing services and some additional resourcing to support the delivery of generalist services by primary care teams and networks in the community. The future human resource requirements for the overall implementation of primary care policy will be informed by a process of ongoing needs assessment within each health board. The development of a comprehensive human resource plan for primary care has commenced. This process aims to identify short – to medium-term competency requirements and plan for longer term human resource needs of primary care.
Questions Nos. 436 and 437 answered with Question No. 426.
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