Seanad amendments Nos. 1 and 3 are consequential on Seanad amendment No. 2 and these amendments will be taken together.
Seanad amendment No. 1:
Section 1: In page 5, subsection (4), line 31, to delete “section 62” and substitute “sections 60 to 64”.
Health (Miscellaneous Provisions) Bill 2009: From the Seanad.
Notice taken that 20 Members were not present; House counted and 20 Members being present,
The Dáil went into Committee to consider amendments from the Seanad.
Amendment No. 1 is a technical drafting amendment to allow certain sections of the Bill to come into force when it is enacted and assist the commencement process. These are sections Nos. 60 to 64, inclusive, of the Bill as amended by the Seanad. Other provisions of the Bill will come into operation at different times by ministerial order.
I will outline the four sections referred to in amendment No. 1. Section 60 provides for the transfer of ministerial responsibility for the local government superannuation scheme in the health sector from the Minister for the Environment, Heritage and Local Government to the Minister for Health and Children. Section 61 is a new section included in the Bill during its passage through the Seanad and is provided for in amendment No. 2.
Section 62 amends the Hepatitis C Compensation Tribunal Act 1997 to remove age limits for travel insurance benefit provided in accordance with that Act. Section 63 provides for an amendment to the Mental Health Act 2001 to address difficulties in the operation of the Act which have arisen following a recent High Court judgment. Section 64 makes technical drafting amendments to the Health Act 2007.
I accept that this amendment is essentially technical and allows for the coming into effect of sections 60 to 64, inclusive, but I must raise my concerns about the implementation of section 62. This section was introduced as a Government amendment on Committee Stage and we objected at the time on the grounds that it was a substantial measure that in this Deputy's view and that of others required separate legislation.
The Minister of State will agree that the involuntary admission of patients with mental illness is a very delicate and sensitive issue. The effect of the section is to authorise the personnel of a private company to carry out this function and I am not happy with the fact that a private firm is being used for what is quite clearly a public health function. The Minister of State indicated in the Seanad yesterday that this is an interim arrangement, if I am informed correctly. He also stated that all the staff of the firm involved are trained psychiatric nurses.
That is certainly a reassurance but before we agree to this amendment I ask the Minister of State to indicate what further legislation is expected in this regard. When will it be forthcoming? Will the Minister indicate this to the House with the clarity that this Deputy requires to build on the reassurance I have already referred to with regard to the confirmation of the staff involved in the cited firm? Will the Minister give an assurance that the staff not only today but also tomorrow and into the future will have that basic required standard of trained psychiatric nurse?
The concerns about this Bill revolve around the new section which has been added. When the House last discussed it, we raised our concerns about the manner in which this was included and the Minister gave us the rationale behind it. The section was rushed in because of a court case so while we can accept a certain logic to this and a need to address a legal problem, rushed law often transpires to be bad law.
The Minister has told us the Mental Health Act will not be reviewed until 2011 at the earliest, which is two years away. In the meantime there is no regulation governing inspection, selection of these private companies, police vetting, regulation of hygiene requirements or the type of vehicle which can be used in the transport of disturbed patients, or the training of individuals concerned in restraint and talking-down techniques.
It is reassuring to know that the current company consists mainly of psychiatric nurses who would have all that training. There is no guarantee, particularly in light of the current economic climate, that other companies will not seek to become involved in doing the same sort of work or that individuals who are not suitably trained may join the employ of the company which holds the contract at present.
I am disappointed the Minister of State did not take on board what Members said on Report Stage and did not take the opportunity to introduce amendments which could have addressed the issues about which we are concerned. It would have been preferable if the Bill had been amended in such a way as to give the Minister for Health and Children the power, by way of introducing a statutory instrument, to impose regulations that will set standards in respect of the issues to which I refer. I do not have an ideological difficulty with a private company being involved in this area as long as the public can rest assured that proper standards and procedures relating to training, hygiene and the nature of the transport used will be adhered to. In addition, the company in question must be subjected to regular inspections and the public interest must be served by its being frequently monitored by HIQA or some other agency.
Is the Minister of State in a position to provide assurances in this regard? As stated previously, this is the only aspect of the Bill about which we are concerned. I do not want to be obliged to vote against the legislation. However, if we do not obtain some guarantees in respect of this matter, then we will be failing in our obligation to patients who are vulnerable and who will be completely at the mercy of those arrive to assist in their being brought to hospital. We all know what the word "assist" means in this context. Basically, it refers to the forced removal of patients — against their wishes — from wherever they are to a place of care. These people usually require to be forcibly removed because they are psychotic or unwell and certain procedures have to be followed for their safety and for the safety of others.
When we take extraordinary powers onto ourselves, we must be absolutely certain that the appropriate personnel and means of transport are in place. I await the Minister of State's response in respect of the matter.
I also have serious concerns with regard to this aspect of the Bill and I ventilated them on Report Stage. Like Deputies Ó Caoláin and Reilly, I am disappointed that an additional amendment was not introduced in the Seanad so that provision could be made for the extra safeguards we are seeking.
It is fine to state that Nationwide Health Solutions employs trained psychiatric nurses. However, there is no safeguard in the legislation which will ensure that this continues to be the case in the future. In addition, there is no indication with regard to how long this legislation will remain in operation.
Is it not the case that the contract relating to the kind of work done by Nationwide Health Solutions must be put out to tender? If so, is it not possible that another company might tender for the work and that said company, because there would be no obligation on it to do so, might not employ trained psychiatric nurses? When other aspects of health care, such as, for example, the cleaning of hospitals, were privatised, companies competed against each other in order to obtain the work at the lowest price. This sometimes prompts concerns with regard to the standards that might apply. In this instance, I do not know if there is an obligation to open up the work in question to companies other than that which possesses the contract at present. However, that is often the case with regard to work which is paid for out of public moneys.
Assurances must be provided to the effect that a range of other companies will not seek to be given this work. All such companies would need would be a few strong men who are able to hold people down. If the latter were the case, we would not be protecting the interests and well-being of the patients concerned who, by their nature, are vulnerable because they are being taken against their will to a place in which they have no desire to be.
This is an extremely delicate matter and I am concerned about what we are allowing to happen in the legislation. While I accept that amendments Nos. 1 to 3, inclusive, do not deal with the substantive issue we are concerned about, one of them relates to the commencement of the relevant section of the Bill. It would be appropriate, therefore, to deal with the substantive issue in the context of that amendment. Will the Minister of State indicate if there is a date in respect of the commencement of the section to which I refer? As I understand it, various sections of the Bill will be commenced at different times.
Our concerns are genuine. I do not know if in-depth consideration was given to them prior to the rushed introduction of the relevant amendment on Report Stage. We were only informed of this at the end of Committee Stage because the amendment did not arise out of Committee Stage proceedings. We did not, therefore, have the normal opportunity to debate it at length. I hope the Minister of State is in a position to provide the assurances we are seeking. However, I would much prefer to have those assurances included in the legislation so that they might act as a safeguard and protect the well-being of the vulnerable patients concerned.
I thank the Deputies for their contributions. I will try to deal, in as clear a manner as possible, with the points they raised. I sympathise with people's concerns, particularly in view of the fact that we are dealing with mental health issues. Given the perception that the legislation is being rushed, I will try to show that due consideration was given to all relevant matters.
As stated on Report Stage in this House and on Committee Stage in the Seanad, the Bill is an interim measure. I accept the fact that it was introduced on short notice but, on foot of a High Court judgment delivered on 21 May, there was a need to amend the position prior to the summer recess. The difficulties which gave rise to the legislation arose on foot of events that occurred in Dublin, in other areas on the east coast, in Clonmel and in Cork, where over 90% of involuntary admissions were carried out by an external agency. I wish to stress that these amendments to the Mental Health Act are necessary to ensure the continuation of externally assisted admissions. No one wants a situation to develop whereby vulnerable people cannot be assisted, albeit on an involuntary basis, to enter health facilities.
I referred to the Bill as an interim measure because I wanted to clarify the position and assure people that we were not rushing through legislation. I accept Deputy James Reilly's point that the major review will not take place until 2011. All mental health legislation will form part of that review. In the context of safeguards, I wish to inform Deputies Jan O'Sullivan and James Reilly that a number of other amendments will be introduced later in the year. These will contemplate the matters now under discussion.
I accept that people have doubts with regard to the agency and its staff and Deputies Jan O'Sullivan and James Reilly inquired about the qualifications of the latter. I wish to point out that there is a tendering system for work of this nature. The company which secured the contract in this instance underwent a tendering process. If I were on the opposite side of the House, I would also want to clarify the position regarding the bona fides of such a company.
All the personnel of the company in question are qualified psychiatric staff and their qualifications are reviewed on a yearly basis. In addition, the company is obliged to meet the various standards laid down by the Mental Health Commission. The staff of the company work in close proximity with members of the Garda Síochána in all of their dealings.
It also is important to note that the suitably qualified people are vetted by the Garda Síochána. Moreover, on the initial vetting and clearance by the Garda, just as qualifications are renewed on a yearly basis, so also will the Garda vetting process continue on a yearly basis. This should bring some clarity towards ensuring that those involved in involuntary assisted admissions are properly trained. I wish to state specifically in respect of the vetting of staff that current practice regarding the contracting of this service requires the external agency to provide suitably qualified mental health professionals, such as psychiatric nurses or allied health professionals or both. All such professionals must have Garda clearance and the HSE protocols and guidelines for the external assisted service will be revisited in light of the amended legislation.
I have dealt with the perception that this legislation is rushed and will respond regarding the review. The review will not take place until 2011 and much work must be done between now and then. However, in respect of safety in this regard, I again refer to the ongoing Garda clearance and the level of professionalism of the staff. While one cannot dwell on the past to predict the future, it is important to note that of the 600 assisted involuntary admissions, there have been no complaints — nor should there be — from the patients, their families, the centres or anyone else involved. During the debate in the Seanad yesterday, I noted the HSE is the direct employer and through protocols or safeguards, the HSE has the responsibility to ensure that those who have been contracted live up to the required standard as laid down by the Mental Health Commission. I accept the point, to which Deputy Reilly also referred the last time, on the involvement of HIQA.
The standards will be set in the protocols and are set out in the contract. Whenever a contract is up for renewal, an open market competition will take place and other companies may vie for similar contracts. I am not in a position to provide Members with the number of companies that submitted tenders because I do not know. While I should know it for the purposes of this debate, the point only occurred to me a few minutes ago. I will revert to Members with this information as quickly as possible.
However, based on the historical involvement of this company, the Garda clearance, the HSE involvement, the absence of complaints and the requirement that the staff must be professionals, I am satisfied that all safeguards are present in respect of this agency. In future, this obviously must be firmed up in the forthcoming Bill in 2011 and there will be some further amendments before then.
I forgot to reply to the question raised by Deputy Jan O'Sullivan as to when the Bill will be enacted. It will be enacted immediately after its presumed signature by the President.
I thank the Minister of State for his helpful and useful reply. He has addressed all the concerns save one, which I am sure he also can address. He has assured Members that the standards of training of those involved are up to those obtaining for psychiatric nurses and allied professionals. While he did not refer to the regulation or inspection of vehicles to be used in transport, I am sure this can be done by way of a directive from the Minister. I seek assurance in the House that there will be regulation and regular inspection. During the previous debate on this issue in the House, I told the Minister of State about the regular ambulance service that was taken over by one company from another. The new owner discovered that 20 drivers of the company he took over did not have police clearance. This constitutes a glaring hole although it pertains to enforcement rather than to legislation. Nevertheless, although a law may not be required, a ministerial directive is. The Minister of State should provide Members with an undertaking today that he will ensure regular inspections and regulations pertaining to the training of companies and associated personnel that might apply in the future before Members have an opportunity to review this issue.
There also should be regulations in place in respect of hygiene training for both vehicles and personnel. This would be for obvious scenarios such as someone getting sick in the back of a vehicle, which then would require a thorough deep clean, or blood contamination. There also should be training in restraint and talking techniques, as well as Garda clearance. If the Minister of State provides an undertaking in respect of these measures, I certainly will not oppose the Bill.
The Minister of State has provided an assurance to Members on current staff numbers and the critical remaining concern is in respect of the future. Am I to understand that the legislation to which the Minister of State referred, which is scheduled for 2011, will place in legislation the standards of training to be reached and sustained by people involved in this line of work in the future? Will that be the means and method of guaranteeing the highest standards of those involved in such activities in the future? Does the Minister of State suggest some other means or method in the intervening period? On the basis of the assurances provided by the Minister of State and in expectation of what the Minister of State's response may contain, I also wish to indicate that I will not oppose the amendments as tabled.
While the Minister of State's response is reassuring, I wish to tease out matters a little further. The Minister of State mentioned protocols and noted that specific standards are laid down by the HSE regarding vetting, qualifications, hygiene and so on. Are these protocols set in stone for the future and are they written down somewhere? Are they available for inspection in order that one may be assured that the standards will be maintained? In these times of cutbacks, I refer to the need to prevent another clever company from offering to provide the service more cheaply by cutting corners and by not complying with such protocols. I seek an assurance that the protocols will continue in force into the future, are not negotiable and must be conformed to by whatever company might undertake this work.
While the Minister of State referred to the major item of legislation scheduled for 2011, he also stated that further amendments would arise later in the year. He should indicate whether they are simply other amendments to mental health legislation in general or whether they relate specifically to the contents of this Bill.
I again thank Members for their questions. First, in response to Deputy Ó Caoláin's point, the commitment is that there will be a major review of the proposed Act in 2011. There also will be opportunity for amendments. As I am anxious to move in respect of other issues pertaining to mental health, which may require amendments, such an opportunity may arise before then. I make this point in the context of the issues that have been raised. I must apologise to Deputy Reilly in one context, that is, the points he raised regarding the ambulance issue were quite relevant and I should have started my initial response from that point. As for the major review of legislation in 2011, I will have opportunities before then to make amendments on this issue and possibly other issues.
In the context of the ambulance service, I recall the point made by Deputy Reilly last week regarding the conditions of some ambulances, the change of drivers and so on. Part of the contract between the HSE and this company stipulates there must be regular servicing of vehicles. While the word "service" may conjure up the image of mechanical servicing only, clearly far greater issues arise in this regard. I intend to strengthen this provision to ensure that it is not simply the motorised part of the ambulance that should be serviced. Clearly, the contract also should stipulate that areas dealing with patients or the public also must undergo strenuous and regular tests. I give that particular assurance as well.
I refer to the question as to what will happen in the Act. Since the Act and the establishment of the Mental Health Commission, submissions made by Members in the House and in the Oireachtas Joint Committee on Health and Children have raised a number of issues. There will be a root and branch review of the Act. That is why it will take so long. Many issues arise and I give a commitment to Members that such a review will take place. The contents of the Act will come from the review and from consultation between now and then. I give a clear commitment that there will be opportunity to debate this matter and there will be a full review.
Deputy Jan O'Sullivan asked me about protocols and staff. These must be professional staff and must be vetted by the agencies, including the Department of Health and Children and the Garda Síochána. The psychiatric nurse or the health professional contracted in this instance must have a qualification of three years in the previous four years. It is not a matter of bringing in someone who was a nurse years ago. The person must be an active participant who is clearly involved in current legislation, as well as being skilled to meet standards laid down by the Mental Health Commission. This will be included in the contracts prepared and signed by the company involved.
What about monitoring? Administration services were supposed to be monitored but were not.
I am not sure what the role of HIQA should be. The authority is assigned to centres. It is important that there should be independent authority to ensure this monitoring takes place. I will engage with HIQA to see if it will carry out this duty.
Seanad amendment agreed to.
Seanad amendment No. 2:
Section 61: In page 20, before section 61, but in Part 8, to insert the following new section:
"61.—(1) Section 53(1B) of the Health Act 1970 (inserted by section 34 of the Nursing Homes Support Scheme Act 2009) is amended by the substitution of "section 6(1)(c) of the Nursing Homes Support Scheme Act 2009” for “section 6(2)(c) of the Nursing Homes Support Scheme Act 2009”.
(2) The amendment (effected bysubsection (1)) to section 53(1B) of the Health Act 1970 is deemed to have been included in that provision with effect from the passing of the Nursing Homes Support Scheme Act 2009 and that provision (as amended by subsection (1)) shall come into operation in accordance with section 2 of the Nursing Homes Support Scheme Act 2009.”.
Seanad amendment agreed to.
Seanad amendment No. 3:
Title: In page 5, line 15, after "OF" to insert "THE HEALTH ACT 1970,".
Seanad amendment agreed to.
Seanad amendments reported.
A message will be sent to the Seanad acquainting it accordingly.