Thursday, 8 February 1996
Dáil Éireann Debate
5. Dr. Moffatt asked the Minister for Health if he will make a statement on the recent allocations in the financial Estimates for his Department regarding the mentally handicapped and the additional allocations of moneys to the various voluntary bodies and health boards for the mentally handicapped in 1996. [2214/96]
Minister of State at the Department of Health (Mr. O'Shea): Additional funding of £10 million has been made available in 1996 for services to persons with a mental handicap. This includes £6 million revenue funding of which £3 million is being provided to meet the 1996 cost of additional services which were put in place in 1995. The remaining £3 million revenue funding provided will facilitate the provision of an additional 66 residential or respite places and 265 day care places as well as home support services this year.
In addition, £4 million capital funding is being provided of which £2 million will be used to support general service developments. The remaining £2 million will be used to develop and improve the  quality of training facilities for persons with a mental handicap under the European Regional Development Fund-assisted programme.
As the Deputy is aware, substantial additional funding has been made available in recent years for the development of services to persons with a mental handicap. Additional funding of £44.58 million was invested in the services in the period 1990-95 which enabled health boards to put in place over 1,000 additional residential places and 2,100 day care places.
I am satisfied this additional annual funding has made a significant impact on the number of persons with a mental handicap awaiting services. However, I am aware that more needs to be done if we are to meet the needs of those awaiting services. The Government is committed under both the health strategy document Shaping a Healthier Future and A Government of Renewal to the continued development of the service as resources become available.
Once this information is available, it is my intention, to initiate a review of the implementation of both policy documents Needs and Abilities and Services to Persons with Autism with a view to preparing an overall medium-term development plan for the services.
Dr. Moffatt: As the Minister of State said, of the total of £10 million, £4 million has been allocated for capital expenditure and, of the remaining £6 million, £3 million has already been spent, leaving £3 million this year for services for the mentally handicapped, which is totally inadequate and hardly in line with the prevailing rate of inflation. Is the Minister making any special case for the mentally handicapped? What was the amount sought for these services from the Minister's Department this year by the voluntary sector and health boards? Does the Minister agree that a sum of  £3 million is totally inadequate in the case of the mentally handicapped who have nobody to voice their needs?
Mr. O'Shea: An extra £10 million is being provided this year to enhance the provision of services for people with a mental handicap. Within the context of the manner of disbursement of those extra moneys, a regional co-ordination committee has been established within each health board area, comprised of the providers of these services, parents' representatives, officials of the relevant health board and so on. Within the guidelines laid down by my Department those committees will submit recommendations to us on how they consider those additional moneys can best be distributed. We must bear in mind that heretofore no proper, in-depth, scientific analysis was undertaken of the number of people in receipt of services or of the number requiring them. The waiting lists have been crude in the sense that they can contain duplicate information. We must make the distinction between current and future need. Indications are that work in bringing the database to a proper scientific conclusion should be completed midway through this year, by which time we will have the Report of the Commission on the Status of People with Disabilities. We will then be armed with scientific analysis of the area and precise information on the number of people who require services.
There are other factors which must be taken on board. For instance, people with a mental handicap are living longer and geriatric people with a mental handicap are far more prevalent than was the case heretofore. We must plan properly and planning is only possible on the best statistical and scientific information. As time passes, interim information will become available and we can plan properly, pursue the area by way of a package and aim for full provision of services for those who need them. A great deal has been achieved through the provision of extra moneys  but we have not been focused enough in the way we have developed services. The most important job to be carried out this year is the conclusion of the policy review and the programme. Armed with those, we can pursue the question of funding in a much more meaningful and effective way.
Dr. Moffatt: The Minister can plan ad nauseam but if he does not invest money in the service, it will be of no use. He knows that there are 1,450 people waiting for residential care. There are about 1,500 people waiting for day-care services and there are already 900 people with a mental handicap in psychiatric hospitals. This is not acceptable. The £3 million in exact funding which the Minister has is in no way adequate for the services needed at present. The number of people with a mental handicap will peak around 2,004 and then decline. I accept the Minister's statement that people with a mental handicap are living longer but, nevertheless, we must get across to the Minister that more funding is needed now. The Government can find £12 million for advisers.
Mr. O'Shea: I repeat that £10 million extra is available this year, not £3 million. On waiting lists and the sector generally, approximately 15,283 people with a mental handicap were in receipt of specialised mental handicapped services at the end of 1995, of whom 7,197 were in residential care. In January 1995, the Department requested information from the health boards on the  numbers awaiting service. The data received indicated that about 1,453 persons were on waiting lists for residential services and 1,526 for day-care services throughout the country. These figures do not take into account the additional 243 residential respite places and 514 day-care places which were provided in 1995.
While the figures reflect the more precise information becoming available to the boards, the bottom line is that we need to be absolutely certain of the accuracy of those waiting lists. We need to know if there is duplication and whether people in receipt of services are getting the appropriate services. Some of the innovations of the 1990s, such as respite care and home support, have opened up new avenues. To examine waiting lists in the crude terms of residential and day care places is to miss areas where creativity can be applied to give a more fulfilling lifestyle to the people about whom we are talking.
The figure is £10 million extra this year. Our determination to continue the work that has provided an extra 1,000 residential places and 2,100 day-care places will continue. We are approaching it in a much more scientific and professional way. We must look at the extent to which the money provided is doing the best by the clients we all seek to serve.
Mr. D. Wallace: I welcome the Minister's remarks about the scientific information he requires and the statistics on those awaiting facilities. An area of crucial importance is where people with a mental handicap who were in residential care are sent home to elderly parents when they become adults. It is a problem and a traumatic time for people. I have been made aware of cases where this is happening and it is unacceptable. I accept that there is an additional allocation of £10 million this year and huge strides have been made in this area but people feel let down.
The Minister said he needs information but he has already given us information. Can additional funding be found for groups such as the Cope  Foundation in Cork, and others, who do tremendous work? If they had more money, they could provide additional spaces. It is an urgent problem. While awaiting the information there is a crucial need for assistance and these people, particularly elderly parents, feel left out. I make a strong plea to the Minister to examine this to ascertain what assistance can be given to those people.
Mr. O'Shea: Deputy Wallace mentioned some specific examples of people who were in residential care and we would be happy to examine them. More money is needed in every area of health. Both the Minister and I are committed to maximising the resources in this area. The Deputy need have no doubt that will continue during the lifetime of this Government.
Mr. B. O'Keeffe: An extra £3 million is being provided in capital spending. I heard of a case yesterday where a 22 year old person with a mental handicap was sent home to a parent who is a manic depressive to be looked after on a 24 hour basis. We spend our time putting together four and five year plans for the mentally handicapped. The difficulty is they are compiled by service providers, parents and voluntary groups on the basis of what can be attained realistically in four or five years. Unfortunately, the level of funding——
Mr. B. O'Keeffe: ——in this sector is totally inadequate. Parents are trying to look after mentally handicapped people in their own homes because they cannot get residential places. I appeal to the Minister to make additional funding available because this is a major problem for these parents.
Mr. O'Shea: If the Deputy gives me details of the case he mentioned I will be happy to pursue it. The Minister and I are fully committed to the development  of services for people with a mental handicap. Our method of providing a service this year is the best one in terms of getting full value from the money available in the interests of the people we all want to help.
Mr. Flood: Is it true that the information for which the Minister is trawling the country already exists in his Department? Each health board will have that information, that exercise has already been gone through and the position has not changed over the last few years to any appreciable extent. I suggest this is a delaying tactic. My second question relates to the Minister's statement that persons with a mental handicap are living longer. Is it not the case that the Minister is presiding over a section of a department which has failed to keep pace with the fact that elderly carers of people with mental handicap who were in a position for the past 30 or 40 years to care for such people are dying? Consequently, those mentally handicapped persons need residential care which is not available because over the past two or three years we have not kept pace with the provision of additional residential accommodation as in the early 1990s.
Mr. O'Shea: In compiling the database we must be sure we are comparing like with like as between one health board and another. In the latter part of 1995 the health research board, which is finalising the processing of the data in the database, has employed a researcher to complete that work. An independent clinical audit will have to be carried out on a random group to ensure the information is accurate. This job is not easily done. Even if figures are received from one health board it does not mean its terms of assessment of people are compared with another health board. I accept patients are living longer and that from time to time emergencies arise. We have tried to keep a check on the system to provide for emergencies but, depending on the client, it can be  difficult and money is not always the answer in the short-term. We are seeking to identify all the difficulties and adopt a comprehensive approach to the development of a medium term programme which we can pursue in the context of meeting the total service requirement for this group.
Dr. Moffatt: The Minister omitted to mention the total number of applications received and the allocation sought for the voluntary bodies and the different health boards for the current year. Will the Minister examine the position in Lisnagry where 21 mentally handicapped patients are denied access to education, because of a Government embargo?
Mr. O'Shea: My initial response is the most appropriate. Where extra moneys are involved they are allocated to the health boards. We give certain guidelines and the regional co-ordinating committees respond to them and come back with their priorities. One of our guidelines is that those who are in most need of service should be provided with it.
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