Dail Debate on Patient Safety – 30th June 2010

Deputy Dan Neville

I support the Fine Gael motion on patient safety and, with my colleagues, I call on the Government to establish a dedicated independent patient safety authority which would incorporate HIQA, reassure patients that they have a safe place to go with their complaints, act as an advocate for them and ensure that investigations take place when and where necessary.

Our proposed patient safety authority should take on the functions currently under the remit of the Mental Health Commission. Our purpose in proposing to bring the Mental Health Commission within the remit of the patient safety authority is two-fold. First, many of the functions of the patient safety authority will be similar to those of the Mental Health Commission, which currently registers centres and inspects services for persons with a mental illness. Second, this will further help to integrate services for people with mental illness and those receiving care from other parts of the health service. In other words, it will reduce the isolation of the mental health services and will allow each specialist area of health and social care to support and learn from one another in pursuit of the patient safety agenda.

I now refer to the difficulties and challenges for patient safety within the mental health services. The sixth report on the mental health services for 2009 was published in the last week. The inspector was extremely concerned about the number of people residing in old and unsuitable dilapidated buildings and the fact that vulnerable people reside in these conditions. The report used the word “deplorable” in referring to this. The report was scathing about admitting, for the first time, individuals in acute crisis to such surroundings. The report recommended, as a first step in the closure of these types of buildings, a decrease in new acute admissions and that all such acute admissions should cease in St. Ita’s, St. Brendan’s and St. Senan’s hospitals. However, the Health Service Executive has not said where these individuals in acute crisis being admitted for the first time will go, or how many beds will be taken out of the system by the progressive closure of the three hospitals and others whose closure will be recommended.

It is estimated that approximately 10% of psychiatric nursing staff left the mental health service in 2009. The precipitous decline in numbers associated with delays in recruiting health and social care professionals adversely impacts on the delivery of high quality care and treatment. When cuts are made it is the progressive community services that are culled, thus causing a reversion to the more custodial form of mental health services. We were promoting the idea of developing community mental health services. We are now reversing that development. A Vision for Change strongly recommended fully multidisciplinary mental health services to facilitate patients being treated in the community rather than in mental health institutions. This is now being reversed. There are excessive admissions to approved centres and outpatient clinics are populated by many with minor mental illness. These patients, who should be dealt with at a primary care level are now dealt with in hospital.

We continue to place in inappropriate mental health institutions individuals with intellectual disability, without access to specialist intellectual disability mental health services. The inspector expressed concern at the occupation of scarce child and adolescent mental health service beds by individuals with no diagnosis of mental disorder, often with social problems, who have nowhere else to go. This is inappropriate and potentially damaging to these individuals, as well as depriving others of the needed beds.

The practice of admitting children to adult approved centres continues. Recent HSE child and mental health service audits show that a large percentage of these admissions are 16 and 17 years old, an age group with a traditional pattern of short-term crisis.

I am concerned at the reported 25% increase in suicide in 2009. I asked for a debate on this matter this morning under Standing Order 32, but the Ceann Comhairle ruled that it is not an issue of national importance. A 25% increase in suicide is not of national importance.

Deputy Pat Breen

That is a disgrace.

Deputy Dan Neville

I hope the Minister of State will discuss this issue with me over the coming months