HSE accused of using ‘vagueness’ to obscure budget spend specifics

Interim document identifies ‘urgent need’ for remedies in primary care and funding

Senator Joan Freeman said the HSE failed to give the Oireachtas Committee on the Future of Mental Health Care specifics on spending, and presided over an ineffective recruitment process. File photograph: Cyril Byrne

Senator Joan Freeman said the HSE failed to give the Oireachtas Committee on the Future of Mental Health Care specifics on spending, and presided over an ineffective recruitment process. File photograph: Cyril Byrne

 

The HSE has been accused of using “smoke screens and vagueness” to obscure how it spends its budget.

Senator Joan Freeman, chair of the Oireachtas Committee on the Future of Mental Health Care, said the agency failed to give it specifics on spending and presided over an ineffective recruitment process.

The committee, which published its second interim report on Thursday, also rebuked the Department of Health for running a parallel assessment of mental health policy and refusing to engage.

Its criticism of the HSE in particular was central to the launch the report, aimed at securing a cross-party consensus on mental health services.

“We remain dissatisfied with the level of specifics we received from them on the subject,” Ms Freeman said in an accompanying statement.

“The committee felt that the HSE did not drill down enough into the spending figures to show us exactly where money is being spent on the front line and this frustrated committee members.”

She said smoke screens and vagueness had been used to make this more difficult to ascertain.

Huge issue

The committee believes that despite HSE claims that recruitment and retention of staff was a “huge issue” due to more attractive conditions in other countries, there was “a poor process of recruitment that would impede recruiting professionals because of the ineffectiveness and inefficacy of the recruitment procedure”.

The 75-page report also contained a section specifically addressing its difficulties with the Department of Health.

Shortly after the committee’s establishment last July, it learned about an “oversight group” in the department tasked with reviewing and proposing an update to the existing Vision for Change mental health policy.

“In order to avoid duplication, the joint committee sought, on a number of occasions, to engage with this group so as to ensure complementary, rather than divergent, efforts,” the report stated.

“However, securing meaningful engagement proved difficult and continues to prove difficult. This apparent lack of co-operation was a cause of concern.”

Its commentary points to a troubled relationship with the country’s central health bureaucracies ahead of meeting its final report deadline in October.

The most startling service area in which the gaps in provision are felt is in child and adolescent mental health services

As it is, the interim document identifies “glaring inadequacies” in the service, and the “urgent need” for remedies in primary care, recruitment and funding.

Among its key recommendations are the development of a “realistic plan and timeframe” for 24-hour crisis intervention teams; addressing capacity in primary care services; and reducing the “over-reliance” on medication in place of counselling.

Burden

It wants to establish an efficient IT infrastructure across the health service and “urgently and realistically” assess whether pay is sufficient to attract and retain clinical staff. It also suggests providing subsidised accommodation for staff to “alleviate the cost-of-living burden”.

People from minority groups still experience major mental health inequalities, it says, declaring a crisis in the Travelling community in particular.

Travellers experience a six times higher suicide rate, accounting for approximately 11 per cent of all Traveller deaths, it says.

“LGBTI young people have three times the level of self-harm, experience three times the level of attempted suicide and are four times more likely to experience severe or extremely severe stress, anxiety and depression.”

The 2018 budget for mental health services is €917.8 million, 6.3 per cent of total health spending, and below the level recommended.

The report said mental health services should shift in focus to primary care, although it identified significant gaps in provision and the continued use of emergency departments as access points.

“The most startling service area in which the gaps in provision are felt is in child and adolescent mental health services,” it said.

In a statement, the HSE said “it has provided significant detail on expenditure and budgets across the nine community health organisations and nationally within the financial structures and systems available, and has at all times endeavoured to facilitate the committee and to provide transparent evidence to the best of our ability”.

It added: “Medical staff, including psychiatrists and other mental health clinicians, can avail of international work opportunities where terms and conditions are most attractive to their circumstances.

“Of all posts advertised in the last two years, half have been filled due to lack of applicants or lack of appropriate qualifications for posts which require more specialist qualifications eg CAMHs, MHID, or because candidates refuse the post or withdraw from the recruitment process.”