Mental Health Services Provision

Ceisteanna (6)

Robert Troy


6. Deputy Robert Troy asked the Minister for Health his plans to change the Mental Health Act in view of recent comments by a person (details supplied); and if he will make a statement on the matter. [48953/12]

Amharc ar fhreagra

Freagraí ó Béal (10 píosaí cainte) (Ceist ar Health)

We have all been made aware of the tragic circumstances involved in this case and I am certain that I speak for everyone in the Chamber in expressing our sincere sympathies and condolences to the family involved. I have met the person concerned on a number of occasions to discuss the circumstances around the tragic incident and received a written submission from her which calls for greater family involvement and mandatory risk assessment in the treatment of people with mental health difficulties. On the basis that the issues raised may be addressed in the context of a legislative review, I have sent a copy of the submission to the expert group established to review the Mental Health Act 2001 for consideration. The group is continuing its deliberations and is expected to produce its report by March next year. I have also brought the submission to the attention of the Mental Health Commission and to the HSE national clinical lead for mental health.

I thank the Minister for her reply. I do not wish to add to the trauma suffered by the family and its community but valid points have been made regarding the fallout of that tragic day. Mandatory assessment of children should be considered in reviewing the Mental Health Act, as children could be at risk. In this unfortunate case there were very tragic consequences and I urge the Minister of State to take this on board. I welcome the fact that she met the person in question and discussed these very tragic circumstances.

I hope the matter will be taken into account in the review of the Mental Health Act 2001. If it is necessary, I hope there is some way of carrying out a risk assessment of children in this kind of environment. I do not want to comment too much as although the names are public, we should be able to deal with this in a very sensitive way to address the concerns of the woman in question, as well as the many other people who may be faced with a difficulty in the form of children or other people suffering such depression.

I thank Deputy Kelleher for showing such sensitivity. I am never certain if such issues should be discussed in here: people have the right to put down questions but I worry about this topic because it is so sensitive. I have met the person in question on three occasions and been in regular communication with her. One could not help but feel for somebody in such circumstances. It is a case of there but for the grace of God go I. It is an appalling position in which to be.

I have passed everything she said to the expert group and the Mental Health Commission. There are serious difficulties surrounding the matter, and we must be very conscious of patient-doctor confidentiality. I do not know of any doctor, nurse, psychiatrist, psychologist or counsellor who would not intervene if he or she thought for one minute there was a risk to anybody's life. We must believe that and accept it as fact. We should await the findings of the review group.

I will not deal with the details of the case as I do not have that information. I will speak to the broader issue of the Mental Health Act. The interim report of the review group of the Mental Health Act was published last June, emphasising the need for revised mental health legislation to support the objectives of A Vision for Change. Will the Minister of State give an indication of when we will see further mental health legislation in line with that recommendation? The Minister of State famously locked away €35 million in a zip pocket in the back of her jeans, or so she told us one day.

I was not quite so explicit.

That has been mysteriously pilfered by hands unknown; I hope the owner of those hands is not sitting too close.

That would be a brave man.

There was a briefing yesterday in the audiovisual room by Mental Health Reform. Those people indicated they were still hopeful that at least a portion of the €35 million would yet be expended in the current year on the signalled recruitment spoken about. Will the Minister of State give us some hope that this will be realised before 31 December and, as previously promised, that a further €35 million will be presented in 2013 to progress the promise of A Vision for Change?

With regard to the specific case, investigations may be carried out, and in the broader sense - and not this particular case - there may be potential shortcomings. Is there any way we can engage independent adjudication of whether proper procedures are carried out if a shortcoming is noticed in an area like mental health in children? If a complaint is made, the HSE would investigate the matter. There is a Garda Ombudsman and if there is a serious complaint about gardaí, that office would investigate. Could such a process take place, even within the HSE but at arm's length? The process should be independent, verifiable and fair.

How much of the €35 million has been spent on recruitment? We have been led to believe nobody has yet signed a contract. Is it the case that the process is being delayed until January 2013?

I may need more time to answer all the questions but I will try to stay within limits. There is an independent group to monitor mental health, the Mental Health Commission, and it has served us extremely well. It looks not only at acute units but advises on guidelines for treatment. The people directly involved in an incident take no part in producing the reports, which are done by people removed from the incident, and we must accept that process. Equally, we must accept that people involved, either on a professional or other level, can be quite traumatised by incidents like this.

We must be careful, given the sensitivities involved.

The 414 posts that we managed to get last year will be in place by 10 December of this year. We would have liked to have had them by September, but there were difficulties in vetting the people we were bringing to Ireland, which was necessary due to a lack of expertise in this country.

Part of the €35 million was for the National Counselling Service, NCS, and that has been spent. It is a counselling service available to general practitioners, GPs, in the primary care setting. Another part of the €35 million was for the National Office for Suicide Prevention and the Genio projects, such as those dealing with dementia and people living well in their own communities. Deputy Kelleher is aware of one such project in Kinsale.

The €35 million is being spent on mental health services. I hate the term "going forward", but ensuring those posts are supported will cost approximately €32 million next year. When the teams are put in place on 10 December, it will not just be a matter of bringing people together. Work will be necessary to make them good, cohesive, functional units if we are to provide the type of service that is desired. However, we will provide that mental health service where people want it, be that in their communities or their homes. The savings from closing the beds in large institutions will accrue to us.

We will always need acute units to deal with people experiencing episodes of acute mental distress. Thankfully, we need fewer of them because we are delivering a different service in a different place.

Consultancy Contracts Issues

Written Answers follow Adjournment.

Ceisteanna (7)

Pearse Doherty


7. Deputy Pearse Doherty asked the Minister for Health further to Parliamentary Question No. 225 of 19 September 2012, if he will provide a detailed breakdown, with itemised costs, of the services obtained from Goodbody Stockbrokers for the €333,413 paid by his Department to the company in 2011 and 2012; and if he will make a statement on the matter. [48975/12]

Amharc ar fhreagra

Freagraí ó Béal (9 píosaí cainte) (Ceist ar Health)

In my response to Question No. 226 of 4 October 2012, I outlined how, in 2011 following an EU-wide competitive tendering process, I appointed Goodbody Stockbrokers and Matheson Ormsby Prentice Solicitors, MOPS, as financial and legal advisers to make recommendations on options to address the current imbalance in the private health insurance market. The work undertaken under this contract included the preparation of a report on options for the rebalancing of the private health insurance market and the examination of options for obtaining a more even balance of customers across the market. The request for tenders indicated that matters to be considered included the advantages and disadvantages of ensuring a better spread of risk among health insurers; the structure of the market and how market share and risk were distributed; the position of existing insurers in the market; any possible incentive or barrier to entry into the market by other insurers; any impact of the introduction of a new risk equalisation scheme and revised minimum benefit regulations; and, if recommended in the report as feasible or desirable, how rebalancing might best be achieved.

In accordance with EU public procurement rules, the tender submitted by the Goodbody Stockbrokers-MOPS consortium was chosen as the most economically advantageous proposal arising from the competitive process. The procurement process was conducted in a fair and reasonable manner and each step of the process was overseen by an evaluation committee. The terms of the request for tenders issued for the competitive process required each tendering party to provide a total fixed price inclusive of VAT and all expenses for all the services it proposed to provide. A more detailed breakdown of the costs of the work undertaken by the consortium would consist of commercially sensitive information which I do not consider it appropriate to release.

Many issues affecting the private health insurance market must be addressed in order that it can be stabilised and readied for the transition to a system of universal health insurance, UHI, in the coming years. The consortium has presented a report to me that I am considering in the context of the future structure of the private health insurance market as we prepare for the introduction of UHI.

It is unacceptable that a Department can spend in excess of €250,000 and not give a full account of it to the Houses of the Oireachtas. This was for a report presented to the Minister. I wonder how many pages were in it. If there were 300 pages, it is something else to get €1,000 per page. It is great work if one can get it.

I am of the mind that there is adequate competency within the Departments of Health, Finance and Public Expenditure and Reform to undertake the work allocated to Goodbody Stockbrokers in this instance. I would regard it as almost indicative of a lack of trust in the competence of the Civil Service, the public servants of which are there to carry out that type of work in the ordinary course of events. The blanket excuse of secrecy about commercial sensitivities to hide the full facts of whatever is involved is not acceptable at any time, but particularly in these times when we are discussing quite considerable sums of money. I urge the Minister to set aside this gag, which is what it is, and allow the full facts to be shared and open to full public scrutiny.

Let there be no mistake about it. The reply that I received to the original question showed that the Department paid more than €967,000 to private consultancy firms in 2011. The figure up to September of this year had already reached €897,000. What will it be by the end of the year? We are heading towards the €1 million figure. These are major sums of money at a time when people are suffering because of other decisions the Minister is taking.

The Government is undertaking the most extensive reform of the health service since the foundation of the State, particularly in the context of new hospital groups, the small hospital framework and the methodology with which we remunerate hospitals and give them their budgets, that is, moving from a block budget where everything stops once the money is gone. That system further encourages the retention of people in beds when their acute phase of treatment is over. It does not incentivise hospitals to move them on. We want to change it to a money follows the patient system. Even within the insurance market, current arrangements see public and private hospitals charge per day. I want that changed to a money follows the patient system in terms of paying per procedure. Those hospitals that admit patients on the day of their procedures, look after them efficiently and reduce readmissions and the average length of stay will all benefit.

The company in question won the tender, but I insisted that the Department renegotiate the price downwards. That was done. The information is invaluable to us in planning a complete sea change in terms of moving towards UHI. We all acknowledge and accept that, while there is vast experience in the Department and the HSE, we do not have the full range of expertise that we always need. For example, there is a lack of suitably trained individuals within the HSE in the context of financial reporting. This matter was highlighted by Mr. Mark Ogden in his report and confirmed by PA Consulting Group. The latter has made certain recommendations. I hope those reports will be released shortly in order that it can be seen that we have taken action to correct what has been a glaring deficit since the HSE's inception.

I find the Minister's response incredible. In the same breath he discussed reform and stated that, when the money was gone, everything would stop. That is not good enough. It is not a case of closing down. People have needs. None of us can forecast or plan absolutely for whatever life's cards will deal. The money follows the patient notion is a fallacy. Patients are chasing ever-reducing services and ever more difficult access to same. That is the reality.

The Minister's reply was absolutely unacceptable. Ostensibly this is one of the major so-called reforms the Minister is planning in terms of universal health insurance but the detail is not being shared. Public moneys are being offered to these private consultancy groups but the figures are not reducing. It is time to say that the competency is within the service to carry out this work at no additional cost. That is what we should be reliant on in the first place.

What can I say to the Deputy? He is forever saying that things are outrageous, scandalous and unacceptable and that this and that are a fantasy. I have to put it to him that his own health policies are utterly phantasmagorical because they do not amount to anything other than aspiration-----

The Minister has never bothered to read them.

I did not interrupt the Deputy and I would appreciate it if he would show me the same courtesy.

The bottom line is that money following the patient was implemented last year on a limited and phased basis in our orthopaedic system and it saved us €6 million. That money will be considerably improved on and enhanced as we spread that out across the system.

I am absolutely sure the money spent on consultancies is considerably less since I came into office than heretofore. Without being overly political, a previous Minister spent many millions of euro on consultancies and reports, many of which sat on a shelf thereafter. The reports I have commissioned are being put to good use and are being acted on. As I said earlier, we hope to produce some of them in the next couple of weeks and the Deputy will see the benefit and the actions they have led to.

It is not true that patients have to chase ever-reducing resources. We are improving efficiency in our health service and, as I said earlier, making sure we do not just focus on inputs all the time, which seems to be the Deputy's focus, but rather on outcomes for patients. The Deputy might not like to hear it, as he was the very man who shroud-waved to the best of his ability last January and February as we came to the retirement of 6,000 people from the service - not only did we maintain a safe service, but we improved it.

We have reduced the number of people who must wait a year or longer for an inpatient treatment by 85%, the number who must wait nine months or longer by 91% and the number who must wait three months or longer by 18%. The Deputy can shake his head all he likes but the reality-----

The reality is very different.

-----is the reality. As an elderly lady said to me many years ago, the truth is not fragile, it will not break.

Real progress is being made. The Deputy chooses to join with others and talk of nothing but doom and gloom and say nothing will change except in some wonderful aspirational fantasy land Sinn Féin will create in health without regard to where the money will come from or to how we will reduce the cost of delivering the service in this country. We are improving things for patients. I would be the first person to say we need to do more and that there is much more to be done. I continue to commit myself to that.

I would like to take this opportunity to thank the men and women who work in our health service for the fantastic job they have done, despite a diminishing budget and despite having fewer people.

Written Answers follow Adjournment.
The Dáil adjourned at 5.45 p.m. until 10.30 a.m. on Friday, 9 November 2012.