The report into the south Kerry child and adolescent mental health service, CAMHS, is truly shocking. It is very distressing for all of the families concerned. These parents did the right thing and went to south Kerry CAMHS to get professional help for their children. Some waited up to two years to access that service. Instead of helping their children, the service actually harmed them. The treatment of 227 children by a junior doctor, who is not named in the report although he has been named in the media, was deemed risky. Some 46 children suffered significant harm, including lethargy, distress, raised blood pressure, significant weight gain and even the production of breast milk. The trauma these children and their families endured is unimaginable. While this junior doctor's prescribing practices and the inappropriate use of combinations of drugs, including antipsychotic drugs, were clearly appalling, the damage caused to children would not have been as long-lasting or extensive if he had been properly supervised. Of course, he was not. The report details a service that was entirely chaotic. Concerns were raised about this doctor in 2018 but these concerns were not followed up on. In fact, the doctor was recommended for other jobs in 2020. There has been no full-time consultant child and adolescent psychiatrist in south Kerry CAMHS since 2016. There is still no full-time consultant.

This report details endemic problems with south Kerry CAMHS, but media reports today suggest that a review is also to be undertaken in north Kerry CAMHS. I am sure that many families accessing CAMHS across the country now have questions they wish to be answered. It should be noted that there are nearly 3,000 children on CAMHS waiting lists. Most of these have been waiting for an appointment for more than three months.

What is going to be done to ensure accountability for what happened in south Kerry CAMHS? Is anyone other than the junior doctor in question going to lose his or her job or even be formally reprimanded? When will a full-time consultant child and adolescent psychiatrist be appointed to south Kerry CAMHS? Is the Government going to authorise a wider inquiry into CAMHS around the country to ensure the care of children is receiving appropriate supervision and resourcing in order to restore public confidence?

I thank the Deputy for raising this profoundly serious issue. I have read the executive summary of the report - the preliminary section of it. It is shocking and very serious. What happened is unacceptable. It represents a damning indictment of the service. The first principle of medicine is to do no harm. Children were harmed by a complete failure of clinical performance and oversight and by the entire management of the service. As the Deputy has outlined, the treatment of 227 children was deemed risky by the report, which does not pull any punches to be fair to the consultant, Dr. Seán Maskey, who came over from the UK. The report says that 46 children were harmed significantly. It goes through what is meant by harm. Some children gained a lot of weight. Some were sleepy during the day, had raised blood pressure or produced breast milk. These were the results of overprescribing and a lack of oversight.

It demands a fundamental review, not just of south Kerry but of the overall situation pertaining to child and adolescent mental health. To be frank, it is not a resources issue. The resources are there to make appointments. It seems there have been ongoing difficulties over the years in recruiting senior clinicians in psychiatry to these posts in certain parts of the country and especially in CAMHS. Following the publication of the report, the HSE has apologised and communicated with all the parents involved. My understanding is that there has been an extensive look-back over 1,300 files. I outlined the outcome in that regard. It is important to say that it is not the parents’ fault, because many are feeling guilty. I watched one parent last evening on the "Six One News" say that she was taking on some of the guilt herself regarding what had happened. It is not the parents’ fault, though, because they will go by what is indicated or advised by the treating clinician.

Following the publication of the report, there will be a full audit nationwide of compliance with CAMHS operational guidelines by all CAMHS teams. In addition, a prescribing audit will be conducted in each of the 72 CAMHS teams. It will include a random selection of files proportional to the medical caseload from a continuous six-month predefined period in 2021. I have been in discussions with the Minister of State with special responsibility for mental health, Deputy Butler, in the last 24 hours with a view to seeing what more needs to be done. I have an open mind concerning how we pursue this issue further.

Some of the 35 recommendations included in the report raise fundamental questions about whether the service is actually hopelessly deficient. The whistleblower here, Dr. Ankur Sharma, was a locum consultant psychiatrist appointed in 2020. He has now resigned from the HSE because he said he received no support and was sidelined after he blew the whistle. Again, serious questions are being raised in our State agencies about the treatment of whistleblowers. This of course raises very serious questions for senior management within the HSE and about the culture there. I welcome the Taoiseach’s commitment to a wider inquiry. I ask him to confirm that this wider inquiry will also include an examination of the treatment of the whistleblower in this case. It is important that this happens and that we change that kind of culture, which is too often about silencing whistleblowers rather than encouraging whistleblowing in State agencies.

I am open to discussions with the Deputy and others regarding the best way forward here. I have a sense that over the last ten to 15 years there has been investment in child and adult mental health and that certain services developed in certain areas. From just observing, it seems to have never reached the optimum levels that we would all have understood would be the case when we started down this road of creating genuine child and adolescent mental health services. It must also be said that there are many good practises across the country and many good practitioners and psychiatrists who are angry and annoyed with what has transpired here.

The Deputy is correct, however, in saying this is not just about one NCHD. There is a systemic collapse here in respect of overall clinical governance and overall management of the service. Any review must look end-to-end at it. Questions were raised, including the fundamental decision to have an NCHD in charge of a community area and so on. People may have made a call at the time, but even that must be interrogated in respect of best practice in future. There is a broader issue around the recruitment of qualified personnel within the mental health arena generally. We must face up to that now. This is no longer just about percentages of funding, etc. It is a matter of getting high-quality services in place and that has proved challenging in some areas.

What about the whistleblower?

Yes, that aspect will be pursued. That is what I mean by "end-to-end".