Funding community psychiatric services
O’Hanlon and Leonard question whether community services can be properly funded as care moves out of institutions. Desmond argues existing spending can be redirected by closing beds and hospitals, while critics warn of inadequate community provision; the Chair defers remaining questions.
The main thrust of the report is to transfer much of the service out of the institutions into the community and I should like to ask the Minister if he intends to allocate special funding to the health boards in order that they may build up their community services in psychiatry?
Comment on this
I do not think any special funding is required. We are currently spending a sum of £160 million per year on psychiatric hospital services. Plenty of money is available and that money can be redirected and we should now be thinking not just of selectively closing down psychiatric hospitals. If we were really prepared to grasp the nettle we would close them all down, and, of course, Deputies can use that is any political frame work they want to in the local elections.
Comment on this
What the Minister is saying is a fallacy if one looks at the experience in the US and in Italy where they did what the Minister is suggesting. They did not fund the community services properly and now they are left with patients who left the psychiatric hospitals and are living rough, so to speak, in not having any suitable service available to them. Indeed, recently the House of Commons committee on the social services reported in an exactly similar way.
Comment on this
Let me point out with respect to the Deputy that the psychiatric services in the Republic of Ireland are light years ahead of what the UK have, thanks to successive Ministers and the change that has occurred, particularly in the past ten years. Therefore, when we open up the hostels, the workshops, the day care centres and the out-patient services the only way to fund them is to close permanently the beds from which those patients will come. We have £160 million to do this work and if we keep all the psychiatric hospitals open with about 40 per cent occupancy in them we will never be able to do it. Therefore I urge that the local communities and the health boards face up to the implications of that new strategy.
Comment on this
Will the Minister agree that to provide this community service will take a great deal of funding from funds which the health boards are not getting at present before he can start to talk about the institutionalising of these patients?
Comment on this
No. Let me put the strategy before the Deputy. On behalf of 11,500 patients with 6,500 nursing staff and several thousand more ancilliary staff we are spending £160 million a year. We could comfortably take about a third of those patients out of the residential institutions they are in, put them out into the community and take about £40 million of the £160 million and use it outside the hospitals, but there is no way that we can keep all our psychiatric hospitals open with a 40 per cent bed occupancy with no staff being taken out into the community. My ambition is that we open up residential hostels, residential outpatient services, residential treatment workshops and do all that can be done. We are now working on this to great effect with no increase in costs, but the concomitant of it is that as we do it we close our beds for ever. That is my ambition.