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 Header Item Written Answers Nos. 1 - 20
 Header Item Departmental Management Structures
 Header Item Mental Health Services Provision
 Header Item Mental Health Services Provision
 Header Item Ambulance Service
 Header Item Ministerial Responsibilities
 Header Item Hospital Staff Data
 Header Item Mental Health Policy
 Header Item Mental Health Policy

Thursday, 2 June 2016

Dáil Éireann Debate
Vol. 911 No. 3

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Written Answers Nos. 1 - 20

  The following are questions tabled by Members for written response and the ministerial replies as received on the day from the Departments [unrevised].

  Questions Nos. 1 to 12, inclusive, answered orally.

Departmental Management Structures

 13. Deputy Louise O'Reilly Information on Louise O'Reilly Zoom on Louise O'Reilly asked the Minister for Health Information on Simon Harris Zoom on Simon Harris why policy issues in respect of abortions as well as oversight of the Protection of Life during Pregnancy Act are subsumed into the tobacco and alcohol control unit of his Department; and if he will make a statement on the matter.  [13693/16]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris The Public Service Management Act, 1997, gives Secretaries General the power to assign responsibility for the performance of functions to officers of a department. Work is assigned by the Secretary General in my Department to areas where the skills and expertise reside in order to have the work completed as effectively and efficiently as possible. Responsibility for abortion policy is under the remit of the Chief Medical Officer who has overall responsibility for the area.

The Protection of Life During Pregnancy Act 2013 was enacted on 30th July 2013 and commenced on 1st January 2014. The development of the Act reflected the very considerable input of a number of staff in the Chief Medical Officer's division. This means that very considerable knowledge and expertise on abortion and related matters resides within this area of the Department. The senior officers involved also have other responsibilities and this extends to the regulation of tobacco and alcohol.

The Act regulates access to lawful termination of pregnancy in accordance with the X case and the judgment of the European Court of Human Rights in the A, B and C v Ireland case. Its purpose is to confer procedural rights on a woman who believes she may have a life-threatening condition, so that she can have certainty as to whether she requires a termination.

As evidenced by the significant programme of work undertaken, my Department continues to actively engage with policy issues in this area, under the direction of the Government and the Oireachtas. The Government has made a commitment in the Programme for a Partnership Government to establish a Citizen's Assembly to make recommendations to the Dáil on the Eighth Amendment of the Constitution.

Mental Health Services Provision

 14. Deputy Aengus Ó Snodaigh Information on Aengus Ó Snodaigh Zoom on Aengus Ó Snodaigh asked the Minister for Health Information on Simon Harris Zoom on Simon Harris his plans to end the scandal of adolescents being placed in acute adult mental health settings due to a lack of suitable inpatient spaces for young persons; when he will phase out this practice; and if he will make a statement on the matter. [13714/16]

Minister of State at the Department of Health (Deputy Helen McEntee): Information on Helen McEntee Zoom on Helen McEntee The HSE aims for the placement of children in age appropriate mental health settings as much as possible. A 95% target of appropriate placement in Child and Adolescent Mental Health Units is indicated in the National Service Plan 2016. This allows for some operational flexibility surrounding emergency placements in Adult Units. Examples of factors that influence such admissions include the availability of a bed in, or the distance to, the nearest Child and Adolescent Mental Health Unit, the wishes of the young person involved, or the need for an urgent clinical assessment. While it remains challenging for the HSE to meet this ambitious target, significant progress has been made; there were 95 admissions to adult units in 2015 compared to 247 such admissions in 2008. It is a priority for the HSE to keep such admissions to a minimum, and this is kept under constant review.

The admission of a child or adolescent to an Acute Adult Inpatient Unit is only made following a clinical assessment of the needs of the individual at community level, and in consultation with the HSE Mental Health Directorate. The Mental Health Commission is also informed of any admission of a child into an adult unit.

There are currently 66 operational Child and Adolescent Mental Health beds across the country. This includes extra 8 beds recently opened in the new Linn Dara Unit in Dublin, and further beds for those under 18 are scheduled to open in the system. In the context of expanding child bed capacity, the HSE is endeavouring at present to address staff recruitment or retention difficulties in certain facilities, such as the Eist Linn unit in Cork. As these staffing issues are resolved, the potential exists for an overall national capacity of 76 operational Child and Adolescent Mental Health beds in the system.

I am satisfied that the HSE is making progress in relation to the issues raised by the Deputy, while taking account of the wishes of each young person, their parents or guardians, and the complexities of each case. This includes factors such as geographic location, the expected length of stay, which is usually very short-term, and the age of the young persons involved, which is usually in the 16-18 year age bracket. The HSE also makes special arrangements, where such placements occur, to ensure specific supports and protections for those involved under age 18.

The Department will continue to closely monitor this issue, in conjunction with the HSE, to ensure that the various new initiatives contribute to improving CAMHS services across all regions. While it is not possible to attach specific timeframes to eliminating this practice completely every effort will be made to achieve further progress on this issue.

Mental Health Services Provision

 15. Deputy Michael Moynihan Information on Michael Moynihan Zoom on Michael Moynihan asked the Minister for Health Information on Simon Harris Zoom on Simon Harris the plans he has in place to extend crisis intervention teams and counselling in primary care services for persons with mental health difficulties; and if he will make a statement on the matter. [13837/16]

Minister of State at the Department of Health (Deputy Helen McEntee): Information on Helen McEntee Zoom on Helen McEntee The current development of Crisis Houses, and Crisis Intervention Teams, form part of a spectrum of service supports for individuals with a mental illness presenting in crisis. One of the objectives of the HSE Mental Health Division has been to improve the response of mental health services for individuals in such circumstances. This includes accommodation and treatment for an individual in the most appropriate setting, relevant to their presenting need.

The new Programme for Government commits to further enhancing 24/7 service support and liaison teams in primary and emergency care, building on the commitment in the HSE National Service Plan 2016 for this area, including the development and staffing of crisis houses and the crisis response generally, and enhanced 24/7 access to specialist services where a psychiatric assessment considers this necessary.

Counselling is provided across the health service by both the HSE and the voluntary sector, including in primary care, but also within social care and mental health services. Counselling can be provided by a range of trained health professionals operating in primary care or more specialist services to meet clinical needs.

The Counselling in Primary Care service is a national service expanded in recent years to increase the access to counselling and psychotherapy and to supplement existing services provided at primary care level. Since 2012, €7.5 million has been provided to develop this service. The service provides short term counselling for adults with non-complex psychological problems aged 18 years and over who hold a valid medical card.

Counselling and psychotherapy are provided within specialist community mental health teams when service users are clinically assessed as requiring this intervention. Counselling is also provided by a range of voluntary organisations across the health service. The HSE’s National Office for Suicide Prevention also funds voluntary organisations such as Pieta House and Console to provide support across a range of needs.

The HSE National Service Plan 2016 identifies priorities for allocation of new development funding this year including the continued development of early intervention and counselling services. This includes funding for the development of counselling services in primary care for young people, in collaboration with the mental health services, and funding for the provision of new Jigsaw mental health services for young people in Cork, Dublin City centre and Limerick. The Department of Health is currently examining proposals from the HSE relating to the development of these specific initiatives for enhanced services, as well as proposals for the ongoing development of a range of existing and new specialist mental health services. It is expected that a decision on the release of the development funding for 2016 will be made shortly.

Ambulance Service

 16. Deputy Robert Troy Information on Robert Troy Zoom on Robert Troy asked the Minister for Health Information on Simon Harris Zoom on Simon Harris the action he will take following the national ambulance service capacity review; and if he will make a statement on the matter. [13782/16]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris Last month at my request, the HSE published the National Ambulance Service Capacity Review together with an action plan for implementation which incorporates the recommendations of both the Capacity Review and the 2014 HIQA Report on the National Ambulance Service.

The Capacity Review makes it clear that we need a very significant programme of investment in our ambulance services. In that context, a phased investment in a multi annual programme involving manpower, vehicles and technology is required. Additional funding of €7.2m has been provided for the National Ambulance Service in 2016 which includes €2m for new developments. The Deputy will also be aware that the Programme for Government commits to additional annual investment in terms of ambulance personnel and vehicles.

It should be noted that many of the key recommendations of both reviews are already being addressed as part of a significant programme of reform and modernisation of the National Ambulance Service which has been underway in recent years. This programme has now achieved many of its key targets including the establishment of the National Emergency Operations Centre, and the creation of an integrated deployment platform which allows the ambulance service to operate as a national fleet, rather than in regional divisions; continued delivery of improved technology to improve response times; and expansion of the Community First Responder scheme.

My Department engages on an ongoing basis with the National Ambulance Service in relation to service requirements and performance and will continue to do so to ensure that the action plan is implemented.

Ministerial Responsibilities

 17. Deputy Jan O'Sullivan Information on Jan O'Sullivan Zoom on Jan O'Sullivan asked the Minister for Health Information on Simon Harris Zoom on Simon Harris the responsibilities and reserved functions of each of the Ministers of State who are attached to his Department; why no Minister of State has special responsibility for the roll-out of an enhanced primary care service; and which Minister will have responsibility for delivering this critical policy. [13733/16]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris Finian McGrath TD has been appointed as Minister of State for Disabilities at my Department, with responsibility for all legislation, policy and funding relating to the provision of specialist health and personal social services to persons with a disability. Catherine Byrne TD has been appointed as Minister of State with responsibility for Communities and the National Drugs Strategy which expires at end 2016 and in respect of which a new and important strategy for the future is being developed. Helen McEntee TD has been appointed as Minister of State for Mental Health and Older People, with responsibility for all legislation, policy and funding relating to the provision of mental health services for adults as well as children and adolescents, including the new strategy on suicide prevention. Minister McEntee will also be responsible for all services for older people, including the Nursing Homes Support Scheme. Marcella Corcoran Kennedy TD has been appointed as Minister of State for Health Promotion with responsibility for driving the health and well-being agenda which was already given a priority status under the last Government and requires to be pro-actively rolled out across the entire population for the benefit of the nation's health.

The Programme for a Partnership Government places particular emphasis on enhancement of the capacity of primary care and improving the integration between primary care and other services, in particular the acute hospital system. In my view the achievement of a decisive shift of focus to primary care, with the maximum proportion of people’s healthcare needs being met in the community, is best ensured by political responsibility for this agenda resting with me as Minister for Health.

Hospital Staff Data

 18. Deputy Thomas Pringle Information on Thomas Pringle Zoom on Thomas Pringle asked the Minister for Health Information on Simon Harris Zoom on Simon Harris the number of training positions, positions that have been filled and vacancies currently available, by hospital, in tabular form; the number of qualified training consultants available in Letterkenny General Hospital, County Donegal; how he will address the low take-up of training positions in hospitals outside County Dublin; and if he will make a statement on the matter. [13684/16]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris The HSE has responsibility under the Health Acts for the training of NCHDs. It has advised that details relating to training positions are contained in its most recent report 'Annual Assessment of NCHD Posts'.  This report outlines all of the training positions by specialties and can be found within the Staff and Career section of its website.  Detailed information regarding trainees by hospital site is maintained by the individual training bodies.

  The HSE has confirmed that for the training year 2015 to 2016 only 29 posts at First Year Basic Specialist Training level remained unfilled by trainees and the majority of these posts were in General Internal Medicine. However, these posts have been filled by doctors who are not on training programmes and are not vacant.

  Only permanent appointed consultants who are registered on the Specialist Register of the Irish Medical Council are eligible to be trainers. Of 58 whole time equivalent consultants employed in Letterkenny General Hospital, 40 are permanently appointed and are, therefore, eligible to oversee training of NCHDs.

  The HSE has confirmed that the low take up of training positions outside of Dublin is a priority and is being addressed. Geographical distribution of trainees is a standing item on the bi-annual meeting between each training body and the HSE and forms part of the annual service level agreement between each training body and the HSE. All training programmes now include mandatory rotations outside of the Dublin area, and almost all have mandatory rotations to model three hospitals.

  There is a global shortage of doctors and intense competition amongst those in training to access the best training opportunities available. However, I am satisfied that the HSE recognises the need to support the distribution of training posts across the system as far as practicable and has introduced measures to ensure that the training model supports hospitals outside of Dublin to the greatest extent possible.

Mental Health Policy

 19. Deputy Pat Buckley Information on Pat Buckley Zoom on Pat Buckley asked the Minister for Health Information on Simon Harris Zoom on Simon Harris the form and terms of reference for the review panel on A Vision for Change; the progress of same; if the review will provide recommendations; and if and when it will publish a report.  [13729/16]

Minister of State at the Department of Health (Deputy Helen McEntee): Information on Helen McEntee Zoom on Helen McEntee In January 2006, the Government adopted the Report of the Expert Group on Mental Health Policy 'A Vision for Change' as the basis for the future development of mental health services in Ireland. It advocated:

  - A holistic view of mental illness and an integrated multidisciplinary approach to addressing the biological, psychological and social factors that contribute to mental health problems.

  - A move away from traditional institutional-based care to a patient-centred, flexible and community based mental health service.

  - A person-centred treatment approach which addresses each of these elements through an integrated care plan, reflecting best practice, evolved and agreed with both service users and their carers.

  - The aiming of interventions at maximising recovery from mental illness, building on the resources within service users and within their immediate social networks, to allow them to achieve meaningful integration and participation in community life.

  - The organisation, nationally, of mental health services in catchment areas for populations of between 250,000 and 400,000, with specialist expertise provided by community mental health teams

  – expanded multidisciplinary teams of clinicians who work together to service the needs of service users across the lifespan.

  'A Vision for Change'  has guided national mental health policy for the past 10 years and its term comes to an end this year. The Department is currently finalising a request for tender for a review and analysis of international evidence and best practice in the development of mental health services, including a review of current delivery of services in Ireland. This review will provide evidence to determine the policy direction for a revision of 'A Vision for Change'.   The review will also have regard to both human rights and health and well-being objectives. At that stage, the exact timeframe for completion of the revised policy direction will be determined by the planned analysis outlined above.

Mental Health Policy

 20. Deputy Michael Moynihan Information on Michael Moynihan Zoom on Michael Moynihan asked the Minister for Health Information on Simon Harris Zoom on Simon Harris the key priorities in mental health under the new programme for Government and why there is no funding commitment on mental health as there was in the 2011 to 2016 programme for Government; and if he will make a statement on the matter. [13832/16]

Minister of State at the Department of Health (Deputy Helen McEntee): Information on Helen McEntee Zoom on Helen McEntee The Programme for Partnership Government confirms this Government’s commitment to further develop and improve our mental health services in line with existing policy as set out in A Vision for Change. We recognise the importance of fully implementing this long-standing policy in a manner which recognises both geographic accessibility and which will allow primary care teams in particular to provide or access a much greater range of care. However, as A Vision for Changeis 10 years old this year the Government is also committed to conducting an evidence-based expert review of progress in its implementation and in the improvement of mental health services. The review will take account of international best practice and will inform the next steps in the development of our mental health policy, having regard to both human rights and health and wellbeing objectives.

The Programme for Partnership Government gives a clear commitment to increasing the mental health budget annually so that we can build capacity in existing services and develop new services. For example, we aim to extend counselling services in primary care to people on low income and .extend support for organisations that offer free counselling and psychological services. In addition, we will work to ensure that every Emergency Department has Clinical Nurse Specialists in psychiatry on their team, with greater linkages to primary care.

The Programme for Government recognises the need to further promote awareness and prevention strategies in our education system. We acknowledge that a more thorough understanding of students’ own emotional wellbeing is also required. That is why a National Taskforce on Youth Mental Health will be established to consider how best to introduce and teach resilience and coping mechanisms to children and young people, and also how to access support services voluntarily at a young age. Accessible and informal mental health services can play a vital role in connecting with young people. We plan to extend services such as Jigsaw, which offers free access and a more informal environment to young people who wish to engage with our mental health services.

The Government is committed to the implementation of the national suicide strategy Connecting for Life - a national plan for the whole of Government and the whole of society to work together. The importance of this strategy cannot be underestimated, and I plan to ask the relevant Oireachtas Committee to monitor and oversee its implementation.

Some €115m in additional funding was added to the mental health budget in the HSE National Service Plans over the period 2012 to 2016. I am confident that, as the economy continues to grow, the priority this Government attaches to mental health will see further development of services through additional funding and effective use of existing resources.


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