Dáil Éireann Debate, Tuesday - 25 June 2013
77. Deputy Seán Crowe asked the Minister for Health the number of the 414 community mental health services posts committed to in the HSE's national service plan for 2012 that have been filled; the number of these positions that have been filled by existing HSE staff members; the action being taken regarding the back-filling of the positions these staff members have vacated; and if he will make a statement on the matter. [30408/13]
Amharc ar fhreagraIn 2012, a special allocation of €35 million was provided for mental health, to be used primarily to further strengthen community mental health teams in adult and children’s mental health services, to advance activities in the area of suicide prevention, to initiate the provision of psychological and counselling services in primary care and to facilitate the transfer of mental health service users from institutional to community-based care in line with A Vision for Change. A total of 414 posts were approved to implement this €35 million package of special measures. As of 31 May 2013, 385 of the 414 posts have been filled, are under offer or are awaiting clearance. The national recruitment service, NRS, of the HSE creates national panels in anticipation of vacancies. On occasion, however, it is difficult to fill some posts for various reasons, including geographical location and international shortages of some grades, notably clinical psychologists. The NRS is currently working to ensure that the remaining posts will be filled as soon as possible, subject to the availability of appropriately qualified candidates. In some cases, alternative arrangements may be necessary for posts that cannot be filled in the normal way.
Candidates for these new posts were asked on application to include details of their current employers. However, at the appointment stage this data may not be current and cannot be validated. Accordingly, it is not possible to indicate the number of the successful candidates who were already employed by the HSE.
It is currently the responsibility of the HSE's regional directors of operations to decide within the context of their current resources whether to fill vacancies that may arise as a result of the appointment of an individual to a mental health development post from 2012. Each director has been asked to consider favourably the back-filling of posts vacated by the appointment of individuals to new mental health development posts to ensure that the objective of enhancing general adult and child and adolescent community mental health teams will be maintained.
The figure changed by just two between April and May.
I based my preparation for today's Question Time on the figures for April of this year. The broad position in April was that 383 of last year's promised 414 staff positions had been filled, were under offer or were awaiting clearance. It appears from the April HSE census that the net increase in the number of staff in the mental health services is much lower, however, and that the actual increase in the number of posts is 188, or just short of 200 fewer posts across the mental health service. Therefore, the figure of 383 is not what it seems to be. As the Minister of State mentioned in her reply, it had increased to 385 by the end of May. I am seeking a clear explanation from her. As a result of the delay in delivering the 414 posts that were promised, very little of the 2012 allocation of €35 million has been spent. Even when these new posts are eventually filled, our mental health services will still be staffed far below the level recommended in A Vision for Change. If posts are being vacated and not backfilled, this is a case of the Government giving with one hand and taking with another. It is not living up to the expectation it created when it promised 414 new additional posts. When will these posts be filled? They are all needed.
No, we have not reached what is recommended in A Vision for Change. I do not think we will reach it for the next two years either. We need to move step by step if we are to make progress in this area. The community mental health teams were badly staffed. We have to make progress and we are making progress. I would like to respond to what was said about the back-filling of posts when people leave and the creation of additional posts. The people we are employing are taking up different posts. For instance, we are employing psychologists, social workers, occupational therapists, nurses, speech and language therapists, child care workers, counsellors and co-ordinators. That is not the average cohort of mental health professionals. These are different types of posts. To a great extent, the people who have left the service worked as nurses, etc. I am being careful in what I am saying. We are developing a different type of service that may not need the volume of posts we had in the past. We may need different types of posts. We are recruiting an additional 50 nurses, 27 speech and language therapists, 35 child care workers, some counsellors, ten co-ordinators, 120 occupational therapists, 78 social workers and 96 psychologists. We are providing all of the pieces that were missing from a well-rounded and properly developed mental health service. This service will be provided in the community rather than in institutions.
The Minister of State played a good game in her reply, with all respect to her.
That is what I am paid for.
I would like to remind the House of what she indicated in her initial reply with regard to the back-filling of posts and what the HSE confirmed in May. She said that responsibility rests with "the regional directors of operations to decide within the context of their current resources [that is it] whether to fill vacancies that may arise as a result of the appointment of an individual to a mental health development post from 2012".
That is right.
It is all being done in the context of the so-called resources available to these directors, and not in the context of the needs of the services themselves or those who present themselves because they need care and attention. The Minister of State can call these posts what she likes and explain them as she pleases - as she has described, some of them are enhanced positions and are welcome in that context - but if we leave vacancies behind as we move people in to fill these posts, there will not be a net additionality and there will be a major problem in relation to backfilling.
As I have already said, it is a case of giving with one hand and taking with the other. There is no other way to look at it. It is not being done.
The Deputy should conclude.
Finally, a further €35 million was ring-fenced for mental health services this year, 2013. How much of that ring-fenced €35 million for mental health in 2013 - the second €35 million - has been spent and what has it been spent on, if at all?
When I say the RDOs will decide what is essential or what post they will need, I make the point that we are delivering a different service and some of the posts may not be essential. For example, if we are moving people out of big, old institutions, then we need to deliver a different type of service.
With regard to the €35 million for this year, we did exactly the same as last year in that we asked the RDOs to send in their business plans and asked them where the gaps are in regard to intellectual disability, old-age psychiatry, psychology services and counselling. Until quite recently only three of the RDOs had submitted their business plans, so we knew where the gaps were in their services and what they needed, but one region had not submitted a plan, so we only got it relatively recently. It has now gone to the recruitment agency that operates on behalf of the Government, and the agency will put a mechanism in place, which should not be that difficult this year as it knows how to do it from last year.
I have also spoken to the national clinical lead in old-age psychiatry and told her what we intended to do. She is quite happy. What amazes me is that, apart from Roscommon, which we have heard about for the last two weeks, I do not hear these complaints from any other part of the country. The people who have this service delivered to them - the service users and the people at the centre - are actually quite optimistic about the new service and how it is going to be delivered.
We must move on to the next question.
May I respond to that?
Very briefly.
We are on the cusp of the second half of this year and the Minister of State is talking about what she has learned from 2012, yet no new positions have been filled for 2013. This is unacceptable. If people have stopped complaining to the Minister of State, she should ask herself why. They are certainly complaining to Deputy Kelleher, myself and others because there is great concern within the mental health services. I am concerned that they may have given up on the Minister of State as well as the colleague on her right.
I always think that when people resort to insults, they have clearly lost the argument.
There is no insult in facing the truth.
We are delivering a new service. It is true that we are on the cusp of the second half of this year but A Vision for Change has been in this House since 2006 and the time limit for it is next year. While I do not dismiss what previous Ministers have done - I have always recognised that - we have done more in the last two years, so, cusp or no cusp, we are making progress.
