Dáil Éireann debate -
Wednesday, 26 Oct 2022

Vol. 1028 No. 4

Saincheisteanna Tráthúla - Topical Issue Debate

Mental Health Services

Deputy Pa Daly

The sample audit for north Kerry child and adolescent mental health services, CAMHS, is due either this week or next week. In my view, the HSE must expand the sample audit to a full review of all files in north Kerry, going back 15 years, as a matter of urgency. As the Minister of State knows, the Maskey report found that significant harm was caused to 46 children in south Kerry and that a further 240 were placed at risk of serious harm. Since that report was published, I have spoken to social workers, parents, patients and former patients. I spoke to a social worker who expressed concern about the supervision of children when there was no consultant psychiatric cover. The social worker told me that requests were made for a review of children who attended CAMHS from 2005 to 2015, when a consultant psychiatrist was eventually appointed. The concerns that she raised at that time were not addressed. The social worker told me that many children were placed on strong psychotropic medication, with poor follow-up. That was not even in Kerry but in another county.

Some parents may even be unaware that their children were under the care of CAMHS because it happened prior to the HSE taking over in 2014. I spoke to the parents of a child in the north Kerry area who is now in his mid-20s. He was a promising sports player but does not leave the house now. He suffered huge weight gain. His life has been destroyed. He was later told by another doctor that there was really not much wrong with him that justified that treatment and overmedication. Parents who were desperate to get help for their children trusted doctors but were let down. Their agony must not be prolonged by any more indecision and delays.

The Minister of State called for a full review but that has not happened. I am repeating the call for a full review. On the heels of the Maskey report, we were told that there are reports that the medical practitioner at the centre of south Kerry CAMHS may have been assigned to north Kerry CAMHS patients. That was reported by RTÉ. The sample audit of the north Kerry CAMHS patients was announced eight months ago. The scope was limited to a sample of 10% of current patients or about 50 cases. That sample audit was not enough then, as we said then and are saying again now. The history of overmedication, no supervision, poor governance and lack of clinical oversight predates the HSE taking over in 2014. I hear that complaints were made by social workers about poor follow-up in the Cork area from 2010 to 2012. I also am concerned that south Kerry families are being let down. They are not receiving therapies that they were promised and some therapies that were received were only online. Despite requests from me to the Minister for Health and the HSE to extend the sample audit to a full review of all north Kerry CAMHS patients over the past 15 years, the HSE has rigidly adhered to the sample audit.

I repeat my call to the Minister of State. The consequences for children, many of whom are now adults, are far too serious for anything other than a full review.

Minister of State at the Department of Health (Deputy Mary Butler)

I thank the Deputy for raising this important issue. I am aware of the issues raised last week in the RTÉ "Drivetime" programme. The health and safety of children in CAMHS should remain the concern of us all. The independent Maskey report of the review of care provided by south Kerry CAMHS made findings regarding significant failings across multiple levels of the system and made 35 recommendations to improve service delivery.

Those recommendations cover a broad range of areas, such as the re-establishment of trust in CAMHS, governance of the service, delivery of clinical services, improved clinical practice and the use of information and communications technology to support the delivery of services. The Government and the HSE are committed to implementing the recommendations as quickly as possible. At the moment 16 of the 35 recommendations are in place.

Deputy Daly said to me that a full review is not under way. Actually, it is, as a full review of all 73 CAMHS teams across the country is under way.

To provide assurance to those who use CAMHS, I requested the HSE to commission national audits in respect of prescribing practice, compliance with the HSE CAMHS operational guidelines and research on service users' and key stakeholders' experiences of CAMHS. Those are three independent audits. Independently chaired by Dr. Colette Halpin, the audit of prescribing practice in CAMHS is undertaken by an expert team, which is administratively supported by the HSE national centre for clinical audit and community operations. Following an initial pilot phase, the full national audit commenced in July. Data analysis has now commenced, with findings to be summarised in a final report prepared by the expert team.

This all came about, as Deputy Daly will know, because of the situation in south Kerry CAMHS. The HSE is conducting three individual audits. Also, and this is important, I requested that the Mental Health Commission, which is independent of both me and the HSE, undertake a review of all 73 CAMHS teams across the country. When both report I will have two parallel reports, which I think will give me great data I never had previously.

As for the situation in north Kerry, I believe that the random sample audit works. The reason we know it works is that it worked in south Kerry. We did a random sample audit of 50 files. Dr. Maskey identified at that time that significant harm had been done to children and that other children were also affected. As a result of that, a full look-back was done. However, I have to wait for the results of the random sample audit files, whether it is north Kerry, Waterford, Galway or Dublin, to see the results. If then a full look-back is required, I will make sure that happens. I have to go by the procedures Dr. Maskey put in place because I know they work. They worked in south Kerry. Fifty sample files showed there were issues. We will have to await the results of this.

Furthermore, massive supports have been put in place. The HSE continues to engage with families locally, including the Kerry CAMHS family support group, on care and any other issues generally relating to the Maskey report. Those affected can contact the HSE, as the Deputy will know.

Furthermore, and I will come back to the Deputy in my supplementary response, I travelled to Tralee in August and launched the youth advocacy programme, YAP, for all users of CAMHS in south and north Kerry who want to advocate for themselves with the support of their parents. An independent advocacy group is in place to support all service users of CAMHS.

Deputy Pa Daly

I thank the Minister of State for her reply. The only problem is that some of these families have been waiting 15 years since the misdiagnoses and the overprescribing of antipsychotic medication to their children. They are suffering internally in their family units and their children are still suffering as a result of what happened. The random sample, I believe, will lead only to a look-back. At least 25 families have come to my office to ask that they be included in the north Kerry review. Unless there is a huge proportion of people coming into my office, which is highly unlikely, a full review will be necessary. It was announced eight months ago. It was supposed to have been published within six months. That has not happened. It is supposed to be announced this week. That is the latest I have been told. I was told that about a week ago. It is not happening. The families are getting more frustrated and the status of patients who were treated pre-2016 is still up in the air. The south Kerry difficulties dealt with a specific period from 2016 onward, but the Minister of State and I know that the problems were there before the HSE took over the Brothers of Charity Services in 2014, going back 15 or 16 years. Some of those patients are now in their mid-20s and are still suffering, so they are getting increasingly frustrated by what they see as inaction. Their problems will continue. A full look back is inevitable, in my view, because this is continuing and because it is so serious.

I ask the Minister of State to look into this - I know that she has called for it herself already - and to push the HSE into doing what will inevitably have to be done.

Deputy Mary Butler

I am satisfied with the measures now being taken by the HSE in respect of north Kerry CAMHS. When all this happened in February of this year, I moved very quickly to work with the HSE to put in place these three audits and the review through the Mental Health Commission. We cannot lose sight of that. There is a process in place. The process is set out under the terms of the audit being carried out by the HSE. What I requested at that stage across all 73 CAMHS teams was a sample random audit because I knew that it had worked in south Kerry. Fifty files were audited and they showed immediately that there were issues. Then Dr. Maskey performed a full look-back into, if my memory serves me right, about 1,250 files. We should also note that there were 500 files of children who were medicated where no harm was caused to them. It is important to say that.

I have to await the outcomes of these and the other audits on CAMHS nationally that are under way, including the review by the Mental Health Commission. This will help to inform any next steps necessary in respect of CAMHS in Kerry or elsewhere. I want to build back confidence in the CAMHS teams. We have 73 teams in operation at the moment. We will have a 74th team in Wexford very soon. It is important to state, however, that 2% of children who are referred through a GP or a primary care centre may need the support of CAMHS. A huge amount of really good, positive work is being done by multidisciplinary CAMHS teams the length and breadth of the country. It is really important that I try to support those teams to continue to do the really good work they have done, notwithstanding the issues we have. The focus for me, the Department and the HSE is to complete as quickly as possible the various audits now under way along with monitoring take-up of the compensation scheme. This will all help inform the next steps necessary. I will keep this under constant review.

Wastewater Treatment

Deputy Holly Cairns

The latest Environmental Protection Agency, EPA, report on wastewater has highlighted major issues with poorly treated sewage continuing to harm the quality of our rivers, lakes and coastal waters. The damage the report reveals is being done to our waters is incredibly worrying. Some 51% of Ireland's sewage was treated to the European standard set to protect our environment, well below the EU average of 90%. There are areas across the country that failed the EU treatment standards, but half of them are in Cork: Clonakilty and Kinsale, in my constituency, as well as Carrigaline, Cobh, Rathcormack and Mitchelstown. Then there are the 32 areas where raw sewage is just being discharged into rivers and the sea, including Castletownsend, in Cork South-West. Unless they lived in or visited these areas, I think most people would find it unimaginable that in 2022, we are still dumping raw sewage directly into our waters.

This is symptomatic of underinvestment in water infrastructure. There are many issues Irish Water needs to address but the Minister cannot pass the buck. Issues with wastewater treatment are one of the major matters I deal with in my office, from the lack of a proper support system in Shannon Vale to malodours from wastewater treatment plants in Kinsale, Castletownbere and Belgooly. Each time I bring this up here or ask a parliamentary question, I am told it is the responsibility of Irish Water, allowing the Minister to wash his hands of the matter. That is not good enough because, ultimately, the Minister for Housing, Local Government and Heritage has responsibility for water quality.

This hypocrisy was most clear earlier in the year, when the Minister, Deputy Darragh O'Brien, visited Shannon Vale to see the impact of the lack of proper infrastructure. A formerly beautiful park in the centre of the village is now a dangerous and polluted area due to the inadequate wastewater system.

I tried to ask a parliamentary question following the Minister's visit but it was disallowed because he apparently has no responsibility for Irish Water. The Minister was implying to the community that he could do something about the issue while apparently having no role in resolving it afterwards.

Irish Water has an operational function but the issues raised in the EPA report relate to capital investment, which is definitely the Government's responsibility. It clearly states that based on current investment levels, it will take at least two decades to get all treatment facilities up to standards. The EPA has found that it will take a multibilllion euro investment and, based on current investment levels, at least two decades to get all treatment systems up to standard. That is simply unacceptable.

Some areas in Ireland are looking at the release of wastewater below health and environmental standards well into the 2040s. There is a clear need for accelerated investment. Each year, the EPA produces these reports and there is slow progress but this is shockingly slow. New plants such as Castletownbere have come online but they have their own problems. I have to once again point out the importance of investment in public services such as education, disability services, healthcare and now, water services, rather than giving tax cuts to wealthier people. Every year, the Government chooses not to invest in water infrastructure and it is another year that our waters are polluted.

This report only deals with wastewater. It does not mention the areas in Cork South-West and throughout the country where drinking water facilities are at capacity. Will the Minister of State provide the necessary funding to help communities such as Kinsale, Clonakilty and Castletownbere?

Minister of State at the Department of Housing, Local Government and Heritage (Deputy Malcolm Noonan)

I thank the Deputy for raising this important issue on the EPA's urban wastewater treatment in 2021 report. Having a well-functioning and resilient wastewater treatment infrastructure that will protect our environment is an issue of national importance and I appreciate the Deputy's concern in this matter.

Since 1 January 2014, Irish Water has had statutory responsibility for all aspects of water services planning, delivery and operation at national, regional and local levels. Irish Water's primary function is to provide clean, safe drinking water to customers and to treat and return wastewater safely to the environment. In turn, the EPA holds Irish Water to account for its environmental performance. The EPA is responsible for monitoring and enforcing compliance with the necessary quality standards for the collection and treatment of wastewater discharges.

As part of budget 2023, we secured funding of more than €1.65 billion to support water services, with €1.56 billion of this allocated to Irish Water. This overall investment will deliver significant improvements in our public water and wastewater infrastructure. In 2021, Irish Water invested €367 million in wastewater, which is the highest annual level to date.

Many serious challenges remain which will take significant investment, as the Deputy pointed out. The EPA has identified in this report the priority areas where Irish Water must target its available resources to deliver improvements where they are most needed and will bring the greatest environmental benefits. Irish Water is also working to ensure that new capacity is made available for housing and commercial development.

Irish Water's investment will deliver significant improvements in our public water and wastewater services, support improved water supplies throughout Ireland, including rural Ireland, and support a range of programmes to deliver improved water quality in our rivers, lakes and marine area. It is key to addressing Ireland's shortcomings in water and wastewater infrastructure, including compliance with the urban wastewater treatment directive.

Some 93% of Ireland's public wastewater plants are compliant with the urban wastewater treatment directive. The vast majority - 90% - of the total wastewater load that is not yet in compliance with the directive requirements comes from one treatment area, namely, the Ringsend wastewater treatment plant which serves Dublin and the surrounding area. Irish Water is investing more than €500 million in the staged upgrading of Ringsend wastewater treatment plant, which will deliver the capacity to treat the wastewater for a population equivalent of 2.4 million people, while achieving the standards of the urban wastewater treatment directive, by 2025. Irish Water also has plans in place to address any outstanding issues at the remaining non-compliant plants. Some 40% of the 90% of sewage about which the Deputy spoke comes from Ringsend, which will be brought up to standard by 2025.

Since 2014, Irish Water has eliminated 60%, by volume, of all raw sewage discharges through targeted investment in new sewage infrastructure and is on target to eliminate nearly all of the remainder by 2025. This work represents investment in 21 areas where there was no sewage treatment before.

Urban wastewater pressures are impacting on 208 water bodies. This equates to 4% of water bodies, nationally, where urban wastewater improvement measures are required to achieve water framework directive objectives. Works are complete to address urban wastewater pressures on 12 water bodies and projects are progressing in 61 further water bodies. Another 63 water bodies have assessments under way and for the remaining 72 water bodies, assessments will be initiated in a rolling programme to be completed by 2029.

Collection networks will also need to be improved and adapted to a changing climate. However, these projects are complex, especially in cities, and will therefore take considerably longer to address. The number of areas on the EPA's priority action list has been reduced by one third since 2017. Irish Water has a plan to complete works at all plants on the list by 2030. We have a river basin management plan with public consultation that has to be ambitious. With regard to the pressures that we are seeing on receiving bodies of water, the issue of urban wastewater is reducing and agriculture has taken over as the most significant factor. Significant improvements are being made but I absolutely accept the Deputy's points that are still outstanding.

Deputy Holly Cairns

Unfortunately, that is the exact stock answer I have come to expect. This is a pressing health and environmental issue. Raw sewage and poorly treated wastewater impact on local ecology and has public health implications. Wastewater in Kinsale and Clonakilty, two of Ireland's major tourist destinations, has failed to meet EU treatment standards and raw sewage is being discharged into picturesque Castletownsend.

These areas need Government investment, rather than the Minister of State passing the buck to Irish Water. The Government needs to provide the investment and then meet with Irish Water management to ensure that the projects are prioritised. The EPA report clearly warns that, at current rates, we are still decades away from resolving this issue. The problem is even more nuanced as the new plant in Castletownbere, similar to ones in Kinsale and Belgooly, regularly have malodours coming from it. Castletownbere is being held as an example of success in this report and by Irish Water in the media afterwards, when it is awful for locals. This gives an example of where we are at.

Related to this are the exorbitant connection costs. At-standard cost for a single household is almost €2,300. It is even more depending on the length of the connection and SMEs can pay multiples of that. It is just nonsensical to spend millions on a treatment plant and then have families be unable to afford to connect to it. That comes down to funding and not Irish Water.

The least we should be able to expect from the State is a safe and dependable water system that can guarantee safe drinking water and a healthy environment. That should be a Government priority and not an issue to just pass on to Irish Water. Communities throughout Cork South-West and the country need investment. It is up to the Government to provide that.

Deputy Malcolm Noonan

I agree wholeheartedly with the Deputy. It is certainly not the case that we are talking about decades. We cannot take decades. It has to be resolved. Irish Water has plans in place for the 32 areas that were assigned in the EPA report. Those plans will be brought forward. The Government has brought in record investment over the past number of years. We are front-loading that investment. It is critically important we do so from a human health perspective, a biodiversity perspective and with regard to development of these small urban settlements.

If there are specific issues, which I know the Deputy has brought to the attention of the Minister, we will certainly work with Irish Water on them. The Minister has been deeply committed to ensuring that we achieve these targets and to holding Irish Water to account to ensure it will meet those targets. We accept there has been historic underinvestment by successive Governments but that investment is being addressed. The structural issues around Irish Water and the establishment are being addressed. I have a hand in the river basin management plans. We have to make sure that we get these water bodies up to a good standard. It is critically important, from all of these perspectives, that we address the issue.

I am aware of the issues around Clonakilty and other parts of west Cork that have to be addressed and which may have come under increasing pressure, especially during the tourism season in the summer months. Capacity has to be built in and future-proofed. We will continue to work with Irish Water on that. The EPA report is very useful in highlighting where the challenges. We are confident that Irish Water has the capacity and the ability to address the challenges, especially for these smaller settlements, which are equally as important as the Ringsend plant or those in any of the larger urban settlements.

Domestic Violence

Deputy Brian Stanley

I want to raise the issue of the need for a domestic violence centre in County Laois. I raised this issue on 19 January on the floor of the Dáil and raised it again on 30 March. I have raised it at the Committee of Public Accounts a number of times and have also raised it in a series of parliamentary questions. I am raising it again this morning because it is really important that we get a domestic violence refuge in the county.

The third national strategy on domestic violence issues was launched recently and I welcome that. In that strategy, 12 locations in the country which do not have domestic violence refuges, including, nine counties, are identified as priorities. Laois is one of the counties identified, as is Offaly. The midlands is without one of these centres as there is no refuge in either Laois or Offaly. Domestic abuse services in Laois and Offaly are both doing great work but are under pressure. The pandemic brought its own problems but there was a 38% increase in demand last year. We were coming out of the pandemic at that stage but unfortunately, domestic violence is an increasing problem. It is a cultural, educational and societal problem. In the Laois centre, there was a 38% increase year on year in the number of clients supported, with 505 people receiving actual support. People working in the service tell me that the cases are becoming more complex and the annual reports of domestic violence services show that clearly. The services can only do so much without a safe refuge for people, sometimes men but mainly women and children, who are trying to escape domestic violence.

There is little or no emergency accommodation available in the county. Laois County Council is really firefighting at the moment in terms of the provision of homeless accommodation. Unfortunately, the fact that people are fleeing Putin's illegal war in Ukraine is bringing its own pressures. Accommodation that might have been available in the social housing system or by way of HAP tenancies is becoming more difficult to source and there are waiting lists for emergency accommodation. Typically, people are being sent out of the county to access services, which means taking them away from local schools, doctors and other services and away from family supports.

The Laois Domestic Abuse Service has a four-year strategic plan and it was confirmed to me again yesterday that a refuge is the number one priority for the staff and the board. I ask the Minister of State to confirm that capital funding has been announced for a refuge in Laois and that money will not be a barrier. Can he assure me that if the jigsaw can be put together in terms of identifying a suitable site and so on, the money will be forthcoming? A strategy group is in place locally and is working on this. Tusla is working with that group, along with a number of other stakeholders. It is really important that money does not become the barrier to getting a refuge in place. People are at their most vulnerable when they are escaping domestic violence. Often women and children go back into abusive situations because they have no other option. They need a refuge space to feel safe, get their head together, access support services and to plan a way forward. That may involve obtaining barring orders and so on but they need that space.

Minister of State at the Department of Justice (Deputy James Browne)

I thank Deputy Stanley for raising the very important matter of domestic violence refuge accommodation in County Laois. It is the intention of the Minister for Justice that every person who needs a refuge space will have access to one. The Minister fully acknowledges the need for a significant increase in the provision of refuge spaces and she is committed to achieving this to ensure that victims have a safe place when they need it. In June, the Minister, Deputy McEntee, brought to Government the third national strategy to combat domestic, sexual and gender-based violence, Zero Tolerance.

The strategy has a particular focus on prevention and on ensuring victims are better supported. As part of this, it contains actions for nationwide delivery of refuge accommodation. As a start, the strategy commits to doubling the number of refuge places. This will be the fastest ever expansion of refuge spaces. We will also work to deliver additional safe house and step-down accommodation. We have identified 12 locations nationwide where the delivery of additional family refuge spaces would have the most impact, if prioritised. These priority areas, as the Deputy is aware, include Portlaoise, where eight family places are suggested as a potential refuge size requirement.

The Minister is informed by Tusla, the Child and Family Agency, that a group involving local stakeholders, including the Laois Domestic Abuse Service, has been established to take forward plans to develop the proposed refuge and associated support services. Planning is not yet at the stage to identify the specific amount of either capital or revenue funding required. Furthermore, planning is not sufficiently advanced to identify the specific timelines for completion of the refuge, but Tusla and the Department of Housing, Local Government and Heritage will be working with local stakeholders to support and ensure the process progresses as fast as possible.

As the Deputy can appreciate, due to the variations in sites, resources available and specific local features, the costs for each of the planned refuge developments will be considered on a case-by-case basis. Decisions on funding will be supported into the future by work being progressed nationally to develop principles for refuge design. Tusla will continue to engage with stakeholders to support the refuge development process in County Laois. The Minister informs me that in 2022, the Laois Domestic Abuse Service was allocated €281,440, with €79,000 in additional funding to strengthen its capacity for the provision of supports to women and to further develop services to children impacted by domestic violence and abuse. Additional resources such as project management support and other supports for capacity building will be available to the Laois Domestic Abuse Service and other organisations taking forward refuge developments in the 12 priority locations, as outlined in the third national strategy.

Deputy Brian Stanley

I welcome the Minister of State's reply. The point I want to make strongly is that typically, women and children fleeing domestic violence would be sent to emergency accommodation or refuges but the supply of emergency accommodation, which is typically in the private rental or bed-and-breakfast sector, is drying up. In many cases it is also not suitable for women and children fleeing domestic violence situations.

I welcome the fact that the strategy has a particular focus on prevention and on ensuring that victims are better supported. The delivery of refuge accommodation is central to that. While I welcome that element of the Minister of State's reply, I am a bit concerned by his statement that the "costs for each of the planned refuge developments will be considered on a case-by-case basis". That is fair enough but I ask him to restate the overall figure and to confirm that it is still available. As I recall, funding in excess of €300 million was announced for the strategy and I ask for confirmation that the money is there to provide these much-needed centres in each of the areas that do not have one, including County Laois. Offaly is putting forward a different solution and that is fine. The domestic violence service there is doing good work but the geographic situation in that county is different.

A number of site options are being considered in Laois and I do not believe finding a site will be a problem. There is great local commitment to the development of a refuge from the local authority, An Garda Síochána, Tusla and various other stakeholders. Ms Marna Carroll, the service director of Laois Domestic Abuse Service, and her staff have done Trojan work and I commend them on all of their efforts, particularly over the last couple of years through the pandemic. It has not been easy for them. All public representatives in the area have had occasion to refer people to the service, sometimes too often. It is really important that we do this, that we give women and children support at that vulnerable point in their lives. I am sure the Minister of State will agree with me on that. I ask him to confirm that the pounds, shillings and pence are available and that money will not be a barrier when a suitable site is located. We must move these projects on quickly. We do not want them to take forever and a day. I am sure the Minister of State will agree that these projects must be up and running quickly. We do not want any delays.

Deputy James Browne

Again, I thank Deputy Stanley for raising the very important matter of the domestic violence refuge accommodation that is necessary in County Laois. I have heard the Deputy's concerns clearly and will relay them to the Minister for Justice, Deputy McEntee.

I heard very clearly and understand the very strong commitment in County Laois to deliver this necessary accommodation to support women and children who find themselves in the horrific situation of domestic violence or abuse. I do not have the global figure to hand, but I will get it for the Deputy. I assure him that funding is in place to support the establishment and building of necessary refuge accommodation over the coming years.

As previously mentioned, the central element of the new strategy is that everyone who needs a refuge space should be able to access once. When someone is faced with the difficult choice to leave an abusive situation, the Minister wants them to know exactly where they can turn to for help. Over the lifetime of this strategy, we will see the fastest ever expansion of refuge spaces. The Minister believes that we will be putting in place the correct structures to deliver additional refuge accommodation now, including the development of a new strategy, and that it will accelerate the number of additional spaces that can be opened each year. Work undertaken in implementing the strategy has already prepared the way for this, including a significant increase in funding as part of budget 2023. An interdepartmental group is developing and progressing agreed processes and approaches to ensure that we will have the highest standard of refuge accommodation delivered in the most efficient way. The Minister knows that there is much to do, but, along with our Government colleagues, we are determined to do whatever is necessary.

Again, I will read the Deputy’s concerns to the Minister. In my county we have the Wexford Women’s Refuge and Wexford Rape Crisis, both of which do fantastic and absolutely wonderful work. I know how important it is for Laois to have its own accommodation. I will relay that to the Minister.

Cuireadh an Dáil ar fionraí ar 9.51 a.m. agus cuireadh tús leis arís ar 10 a.m.

Sitting suspended at 9.51 a.m. and resumed at 10 a.m.