Tá an méid a tharla sna seirbhísí meabhairshláinte i gContae Chiarraí scannalach gan dabht. Ní hamháin gur ligeadh síos na páistí seo ach rinneadh dochar dóibh agus gortaíodh iad. Cuireadh na páistí agus déagóirí seo i mbaol. Tá impleachtaí móra anseo maidir leis an muinín atá ag daoine anois sna seirbhísí meabhairshláinte ar fud an Stáit. Tá géarchéim sna seirbhísí seo agus ní géarchéim ó inniu nó inné í seo. Tá post ann go gcaithfear líonadh agus tá ais-amharc iomlán de dhíth ann anois. Níl sé maith go leor go bhfuil saolta agus sláinte ár bpáistí i mbaol.

The findings of the south Kerry child and adolescent mental health services, CAMHS, review are shocking. They should be troubling for all of us. Anybody following this story will know how distressing the details are and how devastating this must be for those children and their families who were so let down by the State. Not only were they let down by the State, but they were harmed by the State. Forty-six young people suffered significant harm, with a further 200 put at significant risk. This harm ranged from extreme tiredness to high blood pressure, excessive weight gain and the production of breast milk. Hundreds of children were misdiagnosed. They were put on a dangerous combination of medication. They were left to their own devices with a serious lack of follow-ups or checks about their medications. One family told a colleague of mine that they were so concerned about the changes in their child's behaviour and appearance that they challenged the doctor, only for the doctor to threaten to report them to Tusla. That is disgraceful.

Failures in clinical governance and oversight have had real consequences for the health and well-being of these children. Those consequences will last for a long time. There was no consultant psychiatrist to provide clinical oversight. As soon as a locum consultant, Dr. Sharma, was appointed, he saw the problems immediately. He must be credited for the fast, decisive action that he took as a whistleblower. The treatment that he received as a whistleblower needs to be investigated. He claims that he was asked to take time off and reassigned from his clinical role to administrative duties. He resigned because he felt his position was undermined and that needs to be examined.

I welcome that there will be audits of adherence to clinical guidelines and prescription practices. My colleague Deputy Ward and Sinn Féin have called on the Government to do this since March of last year. It has belatedly agreed to do this in the last week. That is not enough. It is only three years since three consultant psychiatrists resigned from CAMHS in Waterford and Wexford because of how poor and unsafe the conditions were due to understaffing. Yesterday, we learned that more than 50 children were inappropriately placed in adult psychiatric units over the last two years. They were units that were unfit and unsafe for young people. It is not just one person or one area. This is a systemic failure for our young people and patients in many areas across the State. It goes back to understaffing and under-resourcing and substantial vacancies in consultant and nursing posts. This is not the story of today or yesterday. One in five consultant psychiatrist posts is either vacant or filled on a temporary basis. Some of these posts have been vacant for years and years.

This issue has plagued our mental health services for the best part of a decade. In that time, the Tánaiste has been Taoiseach, Tánaiste, and Minister for Health, and throughout that time, he has sat at the Cabinet table. There needs to be a step change from the Government, not more apologies. We want action and for the system to be fixed. What will the Tánaiste do to ensure that child and adolescent mental health services are fit for purpose? Will he ensure that the review that has been commissioned will look not only at the guidelines for prescription practices but also at the capacity and gaps in the service?

I thank the Deputy for raising this important issue. Speaking as a public representative but also as a doctor, I am disturbed and worried by what I have read and heard about what happened with psychiatric services for children in Kerry. I extend my sympathies to the children who have been affected and to their families. What it appears has happened is very serious, including misdiagnosis and overdiagnosis of psychiatric conditions, with children being put on medicines inappropriately and those medicines not being monitored appropriately. These are basic failures of medical care that simply cannot be defended. They should not have happened and should have been identified and acted on much sooner than they were. The most important thing that we can do as a State and health service is to make sure we put in place the services and supports that the children and families need so that we can, if at all possible, rectify and remedy the harm that was done. That will range from good quality psychiatric care for the children who need it to other supports for families to help them manage and deal with what has happened.

The Deputy will be aware that the report has been sent to the gardaí, who may have a role in this, and also to the Medical Council. Ultimately, only the Medical Council has the authority to sanction medical practitioners, if that is appropriate. As the Deputy knows as a Member of this Dáil, having been part of many budget debates, the budget for mental health is now more than €1 billion a year. It has increased dramatically in recent years, by 20% or 30% in the last few years alone. Money and resources do not always solve problems on their own. It can be very difficult to fill consultant posts, even when we are willing to offer a contract worth over €200,000 a year, which is the Sláintecare contract.

The Deputy's own party has been involved in running the health services in Northern Ireland for over 20 years. He will be aware of the difficulties that arise with recruiting specialist staff, not just in this jurisdiction, but also in Northern Ireland and indeed globally.

My thoughts are with the families and children affected by this. To learn of the systemic failings in their care is devastating. I can only imagine how distressing and upsetting it is for the families involved. An integral part of this process was open disclosure in action. Open disclosure has happened on this occasion in a way that is perhaps better than in the past. One of the first things that was done was to provide 240 young people identified as having had deficits in their care, and their families, with meetings. The HSE apologised to each individual at these meetings, and also in writing, for any harm caused. It is clear from the review that there were significant failings in the care provided to children and young people at multiple levels of the system. There were also failings of clinical oversight.

The report has made findings in regard to these and there are recommendations to improve services. The HSE has considered the report locally and nationally and has accepted all of its recommendations. Work is under way to implement it. That will be monitored by the Government. Among the recommendations identified are an assessment of reconfiguration of the service and a full nationwide audit of compliance with CAMHS operational guidelines by all CAMHS teams to make sure that similar problems are not happening in other parts of the country, which I know people will be concerned about. As Deputy Doherty mentioned, a prescribing audit will be conducted for each of the 72 CAMHS teams nationally. There are 72 CAMHS teams across the country and there will be a prescribing audit in each case to see if similar issues might have arisen in other parts of the country. We do not believe that is the case but we want to assure ourselves that it is not the case.

As I mentioned, this is not the story of one location, one doctor, one problem or one scandal. This has been going on for years now. The Tánaiste could be forgiven if he was just coming into office and he had an approach or a view on how to fix this but he has been in government for ten years. He has been at the Cabinet table as Minister for Health, Taoiseach and Tánaiste. He could have given the same script, speech or response three years ago when a psychiatrist resigned from the south east because it was unsafe and unsound in terms of CAMHS. We have issues with capacity and that is why children are being put into adult services. Children are being put into adult beds which are not fit for purpose. This has been condemned by the Ombudsman for Children but there is no action.

There is an issue in terms of the contract but the Government created a two-tier contract. Pay cuts were made that have not been reversed. Will the review include an examination of capacity issues? There are capacity issues in the south east, in the north west and right across the State. There are 3,065 children on CAMHS waiting lists. More than 800 of those children have been waiting for six months and over 300 of them have been waiting for a year. These are children with mental health problems that are not being supported by the State. Will there be any step change from Government in how we treat young people with mental health problems?

I am a little disappointed that the Deputy has chosen to try to make this issue, which is very sensitive, into a party political one and to try to personalise it politically. I would remind him that while he may pretend to claim otherwise, Sinn Féin is very much an establishment party. In the past 20 years, his party has been in government on this island as long as my party has been. His party has co-chaired a government that is in charge of health services in Northern Ireland which consistently perform inferiorly to our health services here in terms of patient outcomes. If Deputy Doherty is holding me responsible for any clinical failures in the past ten or 20 years here in this State, then surely his party is responsible for the failures that have occurred at a clinical level north of the Border. Sinn Féin cannot have one standard for us but no standards for itself.

In relation to capacity issues, it is accepted that we have capacity constraints, not just in our mental health services but in our health services generally. Huge investment has gone into our health services in the last couple of years. The Deputy may not be aware of this but we have 40% more doctors in the health service in Ireland now than we had ten years ago, including 40% more consultants. We have more nurses and midwives than ever before, at 40,000, with more per head and more per bed than almost any country in the world.

The Government is failing these children and has been for a decade.

Deputy Alan Kelly, please.

I, along with many others, had one of those moments this morning when everything just stopped as I listened to the radio and heard Maurice O'Connell talking about his son Jason. It was heartbreaking to listen to. The raw honesty meant it was something that one just had to listen to. He spoke of how his son lost his personality and lost his smile. It was one of those moments when one had to not just stop and listen, but also digest. Collectively, we all have to digest what has happened here. Imagine being in the room when Jason's father and sister were told this news and Jason's first response was to ask if it meant he was going to die. We have to deal with this issue.

What really shook me when Maurice O'Connell was telling his story was that there was an implication in the report that this was not catastrophic. Sure, Jason did not lose a leg or an arm but I am sure the Tánaiste will agree that this is catastrophic for these children. We all have to accept that. To say the community in south Kerry is shocked, appalled and worried is an understatement. I know a little bit about that, as the Tánaiste is well aware, because I have a lot of extended family down there. Deputy Griffin, who is behind the Tánaiste, knows that as well. I have spoken to many people down there. In fact, I raised this issue in here a significant period of time ago. I am travelling down there later. There is deep shock at what has happened and concern as to whether people can trust the service.

The real issue, in the context of the audit that will be carried out, is that people who have the resources can go outside the public system and pay for second opinions but the majority of people cannot. In my experience, CAMHS has been very much impenetrable and lacking in scrutiny. There are some very good people in the service but there are silos in operation. This is not due to just one rogue operator but to systemic failure over many years for which we are all guilty, every one of us. We are going to have to deal with this in a certain way. The Tánaiste talked about the audit but we need to go further than that.

Thank you, Deputy. Your time is up.

I want to ask the Tánaiste these questions. Will the audit that is being carried out be a Scally-type review? What is the Government going to do to deal with the massive issues relating to resources and resource gaps around the country? Finally, what process will the Government put in place to deal with the issue of compensation for these families?

I did not have a chance to listen to that interview this morning but a number of people have mentioned it to me already so I will make a point of doing so later today. It is important to hear the voices of patients and parents. It is the best way to understand the impact this has had on them.

Let me not mince my words in any way. I am a politician and a medical doctor. I have come across, as have all of us in this House, a number of examples of failings in care and failures in our health service to provide the standard of care that we would expect for ourselves and our families. This is very much at the more severe end, in my view. What happened here is hard to accept. It is hard to accept that it happened in our country, and that there were huge failures of this nature involving children, in particular. Maybe it should not, but it makes it feel worse that children who were supposed to be helped were harmed. There was overdiagnosis and there were incorrect diagnoses. Children were put on the wrong medicines and left on them for too long, and those medicines were not properly monitored. That just should not happen and it should have been detected and identified much earlier.

It is very disturbing that we find ourselves talking about this and more particularly, that those families are experiencing what they are experiencing at the moment. I do not think any of us can begin to contemplate how they must feel and how worried they must be. The most important thing that we must try to do is to put this right. That means making sure the families and children affected receive the services and supports they need. The HSE needs to be forthcoming and generous in that regard. There will not be any financial barrier from the Government when it comes to providing them with the services and supports they need. We have done that in previous instances, like with CervicalCheck, for example, where packages of support were put in place for families and patients and that needs to be done now.

In terms of the detail of the review and how that is going to work, the Cabinet has not yet had a chance to discuss this. We will discuss it on Tuesday and I know the Minister of State will provide more information on how that is going to operate as soon as she has it. I am sure it is absolutely the case that it will be necessary to provide financial compensation to many of the families affected by this. These are clear failings in care. This was care that was clearly not up to basic professional standards.

I have absolutely no doubt that families will bring cases forward, they will be assessed and compensation payments will need to be made. The Deputy knows from his experiences, as I do from mine, that this is a lot more complicated than it seems because every case is individual. We will need to find a mechanism to do that and we have had some initial discussions on how that can best be done and in a sensitive way.

It cannot just be an audit to see if there are more rogue operators. The audit has to be based on the issue of resources around the country and the fact that CAMHS operates in silos. Most of all, the checks and balances are not there from a clinical point of view. According to the report, "The service has not implemented many of the recommendations of the CAMHS Standard Operating Procedure 2015 or the subsequent CAMHS Operational Guideline 2019." Why? Who is accountable for the fact that this was actually pointed out? It was 2015 and 2019. Why did somebody not ask what was going on there?

In our day-to-day working lives as Deputies, we can see that it is not possible to get to the bottom of required information at critical times. These services were operating as silos. There was no clinical governance. No consultant psychiatrist was appointed since 2016. Did nobody shout "what the hell is going on here?"

Thank you Deputy, time is up.

Will the Tánaiste confirm that any audit will deal with the broader issue - not just how operations happened but the lack of checks and balances and the lack of resources across the system geographically?

The Minister will provide more details on the audit in early course. It is intended that it will be nationwide. It will be an audit of compliance with CAMHS operational guidelines by all CAMHS teams to ensure the other 71 teams have been prescribing appropriately. This will include a random selection of files proportional to the medical caseload from a continuous six-month predefined time period in 2021. Additional clinical resources have been made available to the team in Kerry including an additional doctor. However, the HSE has not been successful in filling the consultant psychiatrist post and recruitment efforts continue. In the meantime, a consultant psychiatrist post from another team attends on site two days per week and provides support through the rest of the week. That is only an interim solution. The Government is willing to offer a Sláintecare contract to consultants with an annual salary of more than €200,000 if they commit to public practice and public practice only. We are working very hard to get agreement from the doctors' representatives to put that in place so that we can offer that contract and perhaps fill posts such as this.