Léim ar aghaidh chuig an bpríomhábhar

Seanad Éireann díospóireacht -
Wednesday, 26 Jan 2022

Vol. 282 No. 4

Nithe i dtosach suíonna - Commencement Matters

Mental Health Services

I welcome the Minister of State at the Department of Health, Deputy Butler, to the House. She has had a busy few days and we appreciate her taking time to come to the House to deal with these Commencement matters.

I thank the Minister of State for being here this morning.

It has been a turbulent January. We had Covid spiking. Now a lot of people are nervous about society re-opening so quickly and that will be stressful for many. We also had the tragic events in Tullamore which rocked us all, as well as tragic suicides. I want to send my condolences to all families affected by loss and premature loss.

This is an opportune time to talk about our mental health and specifically, the resourcing and management of psychologists in the HSE, of which there is a shortage in acute care, in community health teams and in disability and social care. There also needs to be a wider focus, not just on HSE resources, but also on mental health resources in education, higher education, Tusla, the Irish Prison Service and acute hospitals. They all need psychologists and a HSE plan will not take into account the breadth of the resource requirements.

We must address the current shortages while also focusing on the future. A recent Government disability capacity review projected that in 2030 there could be a need for an increase of 107% in the number of psychologists for child disability services alone and a national project office report estimated that there was a need for 500 additional psychologists. That is an enormous number but at the moment, we have only 66 clinical psychologists coming on stream. The additional complication is that even if the allocated funding in this year's budget for additional training places on professional training programmes was to be increased, the psychologists would not be on the front line before November 2025. It takes four years to qualify so whatever we do, we must do it now.

When I raised this issue previously, I was told that a project team was tasked with considering the preparation of a workforce plan for psychological services in the HSE, including an examination of the current framework for training psychologists for the health service and the type and skill mix required for the future. The report would also set out the significance of a review of the current funding model for future psychologists. I note a report, entitled The Report of the National Psychology Project Team: Establishment of a National Psychology Placement Office and Workforce Planning, was published last January. What recommendations contained therein have been implemented or progressed since then? What is the plan?

It was recommended that a placement office be established to make sure that trainee and qualified psychologists are recognised and accredited. That was deemed urgent in 2018. I raised the issue previously of trainee psychologists and the inequity they face in their training. Trainee clinical psychologists are paid €34,000 per year for their placements and get 60% of their fees paid by the HSE but trainee educational psychologists do not, even though they are working side by side. Educational psychologists pay their higher education fees and work for free on the front line in education settings, in the National Educational Psychological Service, NEPS, and in section 38 organisations.

These people work three years for free on the front line and pay to do so, while their colleagues and peers are supported through that period, as they should be. We gave a commitment to review that. It is vitally important that we do not oversee a system that is so difficult to get through. I speak to people who are absolutely committed to their vocation. In the way that I am committed to this job, they are committed to theirs and they have sacrificed so much. They must step away from a career they have invested in because they cannot afford to do this. A recent petitions by the Psychological Society of Ireland was signed by 2,400 people. I hope I will hear a positive update today.

I thank Senator Currie for giving me the opportunity to update the House on this important matter. I acknowledge the enormous contribution made by psychologists in the healthcare system during the challenging times of the Covid-19 pandemic and before that as well.

In February 2019, the HSE community operations unit convened a project team chaired by Dr. Cathal Morgan to consider the preparation of a workforce plan for psychological services in the HSE, including an examination of the current framework for training psychologists for the health service and the type and skill mix required for the future. The work of the project team has been informed by a thorough stakeholder consultation process. Unfortunately, due to the Covid-19 pandemic, the work of the project team was delayed.

The report of the national psychology project team, titled Establishment of a National Psychology Placement Office and Workforce Planning, was completed in January 2021. In line with its terms of reference, the project team report sets out proposals to establish a national psychology placement function within the HSE. The report outlines considerations for a workforce plan for psychological services in the HSE. A recommendation on the consideration of funding of counselling psychologists along the same lines as clinical psychologists was also included.

Currently, clinical psychologists in training are funded for 60% of course fees and are employed as trainee psychologists for the duration of their training. This is unlike any of the other health and social care professionals. A chapter of the report, titled Psychology Services into the Future, identifies a number of the key drivers that are likely to produce significant changes to the way and extent to which psychological services are delivered. It also notes the implications this will have on workforce planning and the future psychological workforce.

The projected global shortfall of healthcare workers by 2030 means consideration should be given to alternative and flexible approaches to how health services are delivered. The changing role of professions and greater fluidity in skill mix will require a greater alignment of skill sets to work tasks. This is critical in the context of community-based working through different modalities. While new technology is unlikely to impact on the demand for mental health professionals, its effects on service provision can be transformational. The psychological workforce will increasingly work in tiered arrangements and the workforce will require robust governance and supervision structures. Memorandums of agreement and programme boards in higher education institutes will need to align with innovations and change within the healthcare landscape.

While it is a matter for the HSE at operational level to determine the level of recruitment required across staff categories, given the level of workforce expansion required, it is likely that there will be additional posts available for professionally trained psychologists. Implementation of the report's recommendations and the creation of a national psychology placement office must take priority.

I take this opportunity to highlight that there has been a significant reduction of over 19% among under-18s waiting more than 12 months to be seen by primary care psychology staff. This follows an allocation of €4 million I secured last August to address such lists through targeted initiatives, enhanced capacity of mental health need and ease pressure on and reduce waiting lists for specialist mental health services. This will ensure that children and young people will get the support they need when they need it. The second key part was the announcement earlier this month of the establishment of the psychology assistant post on a permanent basis. This also marks a significant achievement in promoting enhanced access to vital primary care psychology supports, which I know was very much welcomed by the sector.

I thank the Minister of State for the update. The report is a year old and now that Covid is, hopefully, coming to an end we need to prioritise this matter. The solutions are there. We need to increase the number of psychologists, address the inequities and support people through the process. The Department should look to the North and what it does in the area of funding because there are examples there that we could use.

Under our current system, someone could become an assistant psychologist and be paid but trainee psychologists must pay for their degree or doctorate and work for free. We need to adopt an holistic approach to this and address the shortage of posts. A placement office is essential because we must co-ordinate. I think there is a cliff-edge date where someone who has not worked in all three areas will not get the same qualifications. We need to sit down with representatives of the Psychological Society of Ireland and we need a timeline for implementation. We also need clear direction on who is responsible. We need to know whether the Minister of State, the Minister for Health or the Minister for Education are responsible for this. I would appreciate if the Minister of State could clarify the matter because different people have sent emails back and forth seeking clarity.

I have met representatives of the Psychological Society of Ireland.

Sláintecare reform supports the implementation of Sharing the Vision 2020-2030 under the enhancing community care workstream. The need to build a more accountable and transparent health service is a focus of Sláintecare. It is also a key objective of the new Sharing the Vision policy in the context of mental health service delivery.

There has been an unprecedented investment in recruitment across the health service, including for health and social care professionals, in response to the Covid-19 pandemic. This has included an increase in capacity of primary care psychology services recently through the introduction of two initiatives, as previously mooted. When I took up my post a year and a half ago I was concerned that approximately 10,000 under-18s were waiting for psychology supports. I learned that 5,000 of them had waited in excess of 12 months. Last September, I secured €4 million and we ran a programme for four months under which each community healthcare organisation, CHO, had to see what it could do. Some hired locums, some provided for overtime and others outsourced. We managed to have 19% of those on the waiting list seen, which is a good proportion. However, 81% remain on lists. I will roll over the initiative again for the next four months. The Minister has spoken about a targeted approach to waiting lists and we have made a submission on a long-term approach.

Earlier this month, there was a second announcement on the permanent establishment of a psychology assistant grade. The establishment of these positions on a permanent basis marks a significant achievement in promoting enhanced access to vital primary care psychology supports. I look forward to the scheme being implemented as it will make a significant change. I thank the Senator for her interest.

Gift Vouchers

I welcome the Minister of State at the Department of Justice, Deputy James Browne, to the House to discuss the need to introduce mechanisms to prevent the depreciation in the value of vouchers due to maintenance fees.

I thank the Minister of State for coming to the House to discuss this important issue.

In 2018, I voted for the legislation - Senator Ned O'Sullivan was here at the time - covering gift vouchers and expiry dates. People were delighted because some people were losing out on the value of vouchers on the basis that they were only valid for one year and there was no means of extending the validity period. Sometimes companies did not honour vouchers. An example would be where someone named Mary had her second name written on the voucher. The legislation changed all of that, which was very good.

At that time, another issue was raised with regard to gift vouchers. I refer to the company One4all and its application of maintenance fees. Where a person does not use a voucher within one year, thereafter One4all applies a maintenance fee of €1.45 per month. I have been contacted by people who live in a small town where there is only one shop that accepts One4all vouchers. These are elderly people who could not use their voucher during the pandemic as they were not going out and somebody else was doing the shopping for them. To use the voucher in other ways, they would have had to go to the city or to another town. They recently discovered that the value of the voucher has depreciated and they have lost quite a bit of money. If someone has a €50 voucher, it falls down behind a heater or whatever and he or she finds it four years later, it will be of no value. This is not acceptable.

Ireland was the first country to regulate in regard to the expiration timeframe for vouchers, which was extended to five years. At that time, the Minister, Deputy Humphreys, wrote to the European Commission, which gave a commitment to review this matter and to consider how the problem could be overcome. I have heard since that some shopping centres and delivery companies are applying a maintenance fee in respect of vouchers not redeemed within a required amount of time. Employers give employees gift vouchers as a means of thanking them or for another particular reason. People should be entitled to the full value of the voucher.

I thank Senator Maria Byrne for raising this important issue. According to the Consumer Protection (Gift Vouchers) Act 2019, the term "gift voucher" means any voucher, coupon, document or instrument, including in electronic form, that is intended to be used as a substitute for money in the payment in whole or in part for goods or services, or otherwise exchanged for goods or services. This legislation, which provides requirements in relation to gift voucher contracts, was brought into Irish law in December 2019 by the then Department of Enterprise, Trade or Employment. Many vouchers or gift cards purchased and used today now meet the definition of "electronic money" and are subject to regulation under the European Communities (Electronic Money) Regulations 2011, as amended, commonly referred to as the EMR.

Officials in the Department of Finance will consider the issue of reducing balance fees as part of future discussions on the electronic money directive.

I thank the Minister of State. I welcome that the Department will consider the issue of reducing balance fees. These companies are regulated by the Central Bank. I understand that they cannot defy what is set in European law, but many people are not aware that the value of their vouchers is being reduced as the information in this regard is in tiny print at the bottom of the voucher. One would need a magnifying glass to read it. Many people are not aware that this has happened until such time as they present their card or voucher and are told that the value of it is less than they expected. That is embarrassing.

I welcome that this matter will be considered by the European Commission. We need to keep the pressure on for proper regulation in this area. As I said, when people give a gift card they expect that the recipient will get the full value of it. I know the companies involved are not breaking the law, but the recipient is not receiving the full value. People are not aware of that. In the meantime, we may need to run an awareness campaign.

I again thank Senator Byrne for raising this important issue. We all know people who have been affected in terms of reducing balance fees. It is often only when a person presents a gift card given to him or her by a loved one that he or she realises the value has been reduced to a low amount or, in some cases, zero. It is incumbent that people purchasing vouchers are informed of the application of these fees. On behalf of the Minister for Finance, this issue will be raised with the European Commission in the context of the laws that are being put in place. It is important this is done. Not every voucher scheme applies such fees. In the meantime, I encourage people, when purchasing, to choose a voucher to which no fees are applied. In some cases, these fees are disproportionate, in my view.

I thank the Senator for the opportunity to speak to the House on this issue. This is an important matter for consumers. As stated, there is legislation in place in Ireland that ensures that these consumers are protected. Firms that are providing gift cards or vouchers under electronic money regulations must comply with their regulatory obligations. In this case, they must ensure consumers are informed of any fees or charges applicable to the vouchers they are purchasing and-or using. As correctly point out by Senator Maria Byrne, in some cases this information is in very small print. Companies have a duty to ensure the information they are providing is accessible and readable, as I understand the law on the matter. In addition, developments are under way at EU and domestic level to enhance the existing electronic money framework in order to align it with more stringent legislation such as the revised payment services directive.

Legislative Measures

It is 22 years since an independent working group published a very detailed report and findings on the coronial system in Ireland. That working group called for radical reform and major reconfiguration of the coronial system and stated that a clear strategy for change was essential. In April 2021, the Irish Council for Civil Liberties, ICCL, published research that showed that no significant reform had occurred in either policy or practice.

In fact, its research showed that bereaved families were, and still are, consistently failed by the State. One of the clear failings in inquests is the manner in which the jury is selected. Reform of this process was outlined in the ICCL's recommendations. Jurors in inquests are often used repeatedly, are known to the bereaved families and are selected by An Garda Síochána, even in cases where the Garda is party to the inquest itself. The fact that the inquest system has not been reformed at all in the 20 years since the independent working group made its findings is shameful and means that bereaved families continue to be failed by a system that is just not human rights compliant.

On Friday, 25 September 2019, the Attorney General granted the families of those who lost their loved ones in the Stardust fire a new inquest. He rightly found that a new inquest was not only warranted for the families who had been so badly let down by the original inquest, and the damaging inquiry reports that followed that inquest, but he also found that it was in the wider public interest that a new inquest be held. As soon as that decision was taken by the Attorney General, the legal team representing the families, other elected representatives from various parties and I repeatedly sought and got assurances from the Minister for Justice that the inquest would not only be adequately funded by the State but that it would be human rights compliant. What has happened to the families to date has been anything but human rights compliant. Legal aid was denied the families earlier last year. They were asked to submit deeply invasive information about their financial circumstances and some of them were refused legal aid. This is despite the fact that they have waited 40 years for justice. Recommendation 22 in the ICCL's report had already flagged this issue.

In recent days, the matter of jury selection at inquests has once again come to the fore. Under no circumstances should the Garda Síochána be selecting the jury for the Stardust inquest. It is a party to this inquest. The ICCL's recommendations 44 and 45 state very clearly that jury selection should be randomly made from the electoral register and that in high-profile cases lawyers should be able to challenge the make-up of that jury.

The other issue with jurors in inquests is the fact that their income is not protected by law. Is the State seriously going to ask jurors to sit for at least a year on the most significant and largest inquest in the history of the State without any income protection whatsoever? Will the Minister of State give a commitment that the Juries Act will be applied to the coronial inquests? While radical reform is still needed, surely that very small but highly significant reform could be applied in time so that it takes effect for the Stardust inquest.

I thank Senator Boylan for raising this very specific question on amending the Juries Act to allow for inquest jurors to be paid while they serve. I understand that the Senator is raising this point in the context of the Stardust inquests. The Stardust fire was a national tragedy that has left a particular legacy of pain for many families and communities. I again offer my deepest sympathy and condolences to the families of the 48 young people killed in that fire over 40 years ago.

As the Senator may be aware, there is no requirement for an inquest to have a jury. That decision is a matter for the independent coroner. Furthermore, there is no current statutory authority to prescribe fees or expenses to jurors for service at inquests when summoned to do so by a coroner. Most inquests are completed within a short period. The provisions of the Juries Act 1976 expressly do not apply to coroner inquests. Thus, the expenses provisions in section 29 of that Act do not apply. The Minister for Justice has received a letter from the legal firm representing many of the Stardust victims' families last week concerning matters to do with the inquest. My Department is currently considering this letter and the Minister is committed to ensuring that the new inquests into the Stardust deaths, and the families involved, are provided with all relevant supports.

With all due respect, and this is not directed personally at the Minister of State, the families have had enough of sympathy from Ministers. They have had enough of the tea and sympathy from Ministers for Justice. What they want is a human rights compliant inquest. While the Minister of State said that the provisions of the Juries Act expressly do not apply to coroners' inquests, section 31 of the Act could be amended specifically to allow for it to apply to the Stardust inquest. That was the case with legal aid as a regulation was changed to be specific to the Stardust inquest. To even suggest that there would be no jury for the largest and most significant inquest in the history of the State, to say to the families that they have to go into a system akin to the Special Criminal Court and not have their case, their facts or their findings heard by a jury of their peers, is an insult. I do not mean any disrespect to the Minister of State, who has come here to take this matter, but the families have had enough of this treatment by the State.

I again thank the Senator for raising this very important matter. The conduct of inquests is entirely a matter for the senior Dublin coroner, Dr. Myra Cullinane, and her independence in the context of such matters is set out in the Coroners Acts. Nine pre-inquest hearings have been completed to date. The ninth took place last week, on 19 January. My Department is committed to ensuring that the new inquests into the Stardust deaths, as well as the families involved, are provided with all relevant supports. To this end, Government funding of up to €8 million has been allocated for the new inquest, including for legal aid for the families. My Department and the Government are committed to ensuring that a new venue is in place as soon as possible, in order to permit the inquest to be continued by the Dublin coroner. As stated previously, Department officials are considering the matters raised in the recent correspondence from the legal representatives of the families to the Minister and a response will issue from her in due course.

Water Quality

I thank the Minister of State for taking this matter. He will be familiar with the fact that last summer there were two very serious E.coli outbreaks, one in Ballymore Eustace, which provides much of the water supplies of Kildare and Dublin, and the other in my home town of Gorey. There were 52 confirmed illnesses, and potentially more, as a result of those outbreaks and the difficulties that happened at the time. There has been an examination by the Environmental Protection Authority, EPA, of what happened. My understanding is that Wexford County Council's report on the matter has been finalised but has not yet been published because it must first go to a number of the parties that were identified. I hope it will be published in the very near future because it is important for the people for Gorey and everyone else that there is transparency in this process. There must be an understanding of what happened, accountability and, more, importantly, assurances that the events that happened will not happen again, either in Gorey or anywhere else. I am glad that a lot more precautionary boil water notices are being put in place. It is not very pleasant for people to be subject to such notices but I think they would rather receive notices than risk drinking water that is far from good quality.

At the time of the outbreaks, the Minister for Housing, Local Government and Heritage, Deputy Darragh O'Brien, acted swiftly and ordered full inquiries. I was very happy with that. As part of that, he insisted on an audit of all the water treatment plants around the country, including the one in Gorey. The audit identified the changes that were necessary at Creagh. A commitment was given that there would quickly be an audit of the 20 largest water treatment plants in the country and that that would then be extended outwards because, of course, we have several hundred other treatment plants. One of the basic things any individual expects is that if they turn on their tap, they will have access to a good, reliable and clean water supply. I ask for an update on the audit of the 20 largest plants and where we stand regarding the audit of all the other plants.

A clear indication was given to local authority and Irish Water staff that there would be refresher courses on this. I appreciate that the Minister of State cannot give an absolute guarantee that what happened before will never happen again. At the same time it is important for people in Gorey and others who have been affected that it be indicated clearly that everything is being done to ensure that lessons were learned from the events of last summer and that any discrepancies that have been picked up in Gorey and nationwide, are addressed.

I thank the Senator for bringing this matter forward as a Commencement matter. I addressed it previously, and the Minister, Deputy Darragh O'Brien, also has addressed it previously. It is an unfortunate incident and unacceptable, that must be said. In regard to an update, the Minister, Deputy Darragh O'Brien, met the managing director of Irish Water, as well as the chief executives of both Dublin City Council and Wexford County Council on 8 September 2021 to discuss the incidents at Ballymore Eustace and Gorey water treatment plants and held a follow-up meeting on 13 October 2021. In those meetings the Minister requested Irish Water to undertake immediately a number of improvements, including audits of the water treatment plants throughout the country. In November 2021, Irish Water provided an update to the Minister. While initially prioritising the largest 20 treatment plants, the list was expanded to the top 25 water treatment plants to cover the largest for both population served and output volume. With the addition of the Gorey plant this resulted in the top 26 water treatment plants being assessed. These plants serve approximately 65% of Irish Water's customer base.

To conclude, Irish Water, local authorities and their staff have responded to the serious incidents at Gorey and Ballymore Eustace by putting in place a range of measures to provide greater assurance around the management of our water treatment plants including 24-7 monitoring of plants that serve the majority of the population. It will be important to continue to monitor the effectiveness of these measures as Irish Water continues along its evolution to become a fully integrated company with full control over its own staffing resources. It is important, as the Senator said, that we learn lessons from these incidents. There were serious public health breaches that we must ensure will never happen again. In regard to the point the Senator made in regard to Wexford County Council's report, I agree that should be published for transparency purposes. All the outputs of the investigations into what happened should be publicly available for elected Members, the wider public, Irish Water and the local authorities to learn from the lessons of the mistakes on these two unfortunate incidents.

I thank the Minister of State. I welcome his stance and that of the Minister, Deputy Darragh O'Brien. We were proactive in addressing this issue and we have seen progress from Irish Water as a result of the audit of those 26 water treatment plants. When will it be extended to all of the other water treatment plants, many of which serve smaller communities? I note that 35% of the population still has not experienced this audit. It is important for us to be able to guarantee to everybody in this country that they have access to a good, clean, reliable water supply. I appreciate that the Department will continue to monitor this and the lessons are learned. I welcome the Minister of State's commitment to full transparency about the events that happened last summer.

The point is well made about the further 35% of smaller water treatment plants that serve Irish Water customers. I will take that point back. It is important that there be a full audit of all water treatment plants because there is the potential for further incidents. There is potential for that in those smaller plants. Since the formation of this Government, one thing we have done is put in place record capital funding for Irish Water to be able to meet its water service delivery programme and to ensure as it is a basic human right that when people turn on their taps they have access to clean, potable water. From that point of view it is critically important that as a Government, we work with Irish Water to ensure it is delivering on that and once it moves into being a fully integrated company with full control of its own staffing, that will be an important aspect of that work. There is no doubt but there are lessons to be learned in this regard. It is important that there is transparency. All reporting of the incidents and what led to those incidents should be made available to Senators, elected Members, local authorities and to the public generally. I hope we will move on from this and learn our lessons and ensure that we have clean drinking water for everybody in this country.

Sitting suspended at 11.16 a.m. and resumed at 11.30 a.m.