-        Mr. Tony Canavan, Chief Officer, CHO Area 2 (Galway, Mayo, Roscommon)

The Cathaoirleach, Cllr. Leyden welcomed Mr. Tony Canavan, Chief Operations Officer, HSE West to the meeting to inform the members regarding the recently published ‘Roscommon Mental Health Services Report’. Mr. Canavan stated that he was pleased to attend the meeting and outlined his area of responsibility which included all health services in the Roscommon, Mayo Galway Area, including mental health services, outside the four main hospitals. He said that he would outline the steps taken to compile the report, give an update on the recommendations in the report and address questions and comments from the members.

·         Work on the report commenced in August 2015, completed in July 2017 and published in September

·         The review team consisted of three members, all outside HSE and this jurisdiction

·         The review is very extensive, interviewed almost sixty staff, visited a number of sites, reviewed outpatient records etc. and invited public submissions from service users.

·         There are twenty-seven recommendations made in the report covering a wide range of issues

·         The report identified gaps in the services, the need for mentoring of senior staff, the restructuring of relationships amongst staff, the development of a media strategy, performance management for all staff. The focus is on primarily on nursing grades and the gaps identified include the development of a strategic plan, engagement with staff and clinical and professional supervision and training re the importance of complaints processes, and a review of day care services

·         The report does not make for good reading

·         There have been three further meetings since the publication in September

·         An Action Plan, based on the recommendations in the report will be completed by the year end. Since the review commenced some recommendations have been acted on to some extent

·         The report is an opportunity to draw a line in the sand and move forward to progress the mental health services.

The Cathaoirleach then outlined extracts from the minutes of the Public Meeting held in Roscommon Town last week that was chaired by Dr. Madeline O’Dalaigh:

·         Need to restore confidence in the Mental Health Sector

·         Concern that three senior staff are still on the implementation team – imperative that people believe in change management

·         Who made the decision to return the €17.6m that was budgeted for Mental Health services in the county and did those who did benefit from this in some way either by promotion of bonuses? This money should be returned with interest.

·         There was a call for an independent review at the meeting

·         When with the Implementation team be up and running?

The members then spoke and raised a number of questions:

·         Disturbing to hear that staff are afraid to speak out.

·         What number of anonymous complaints have been received and are being investigated?

·         Has anyone been held accountable for what is in the report?

·         Concern that some senior managers did not engage in the process.

·         No mention of the patient in the report.

·         A fuller investigation is needed and how will this be done.

·         Concern that there is currently no action plan in place and what will be in the action plan for Roscommon?

·         Are managers/staff being bullied in Roscommon – what is going on? There appears to be staff issues and real hostility – can this be addressed and relationships rebuilt so everyone can work together.

·         Important that this briefing took place today at the invitation of the three members of the HSE forum to put all other council members in the picture.

·         Previously there was a cut from €30 pw to €20 pw for the service users weekly allowance.

·         If the Budget is set for the year, how can money not be spent and it must have an impact on staff i.e. are there adequate staff, are the privacy needs of the patients being looked after?

·         When will the €17.6m be returned to the service?

·         Why the need for a media strategy – if the service is working it is necessary?

·         What stage is the team building at?

·         Problems with the Mental Health Services for years – time now for immediate action

·         When the Council’s three HSE forum reps ask questions, they often do not receive answers – can there be a commitment to get a system that replies are properly given out?

·         All of the staff working in Mental Health services are aware that the service is being run down and everyone is astonished that money was returned.

·         Most service users are vulnerable and unable to talk for themselves.

·         Reservations that staff who may not have cooperated with the review being on the implementation team.

·         Do you accept the report and its findings, how are staff to be protected? Have there been any protected disclosures and were staff rewarded for sending back money

·         St Patricks Mental Health Services in Castlerea.

·         HSE should be concerned about the mental health of their own staff.

·         Accommodation in Cloonbrackna and Galway Road in Roscommon Town – are the users being consulted?

·         Update on S.O.P. to agree circulation of governance meetings to all relevant staff in the organisation

·         How is the Action Plan progressing?

·         These services have complex problems and at present it’s hard to recommend mental health service to any vulnerable person in Roscommon

·         There has to be representatives of front line staff and patient’s representatives on the Implementation Group

·         There is a need for an update in six months time to the members again on progress

·         What is the plan for the Rosalee Unit and Teach de hÍde and Regari College in Roscommon?

 

On the PROPOSAL of Cllr. Leyden

             SECONDED by Cllr. Byrne

It was AGREED that there should be a full independent investigation on how the mental health services were run down and why, there is full accountability for the return of the €17.6m and a time frame for the Action Plan

 

Mr. Canavan replied to the issues raised as follows:

·         With regard to the issue of finance and the figure of €17.6m that was returned during the period 2012-2013 and 2014 it is important to note that the review team stated that the money, had it not been returned, would have been used to move the mental health services further along the road for ‘Vision for Change’. As the budget was managed as one for Galway and Roscommon the €17.6m refers to both counties and the majority of the money would have been in respect of County Galway. There have been additional resources put into Roscommon from 2015 to 2017. All mental health services in the three counties need further investment.

·         The report in its entirety has been accepted by the HSE.

·         The review was carried out because of the care provided to individual patients, and so the report is grounded in patient care.

·         There has been progress in relation to involving service users as they are now represented on the implementation team.

·         The Implementation group was set up at the end of August and consist of senior management chaired by Mr. Canavan. No staff were initially included but will be including frontline staff following the next meeting. There will be independent oversight of the workings of the group and agreement of the Action Plan.

·         There will be accountability for senior management.

·         The HSE (Mr. Canavan) met with Oireachtas members and will meet again in the New Year

·         Staff will be consulted regarding the plan. Rebuilding human relationships is complex

·         There is need to look at the realignment of the services as they currently exist and this will include the input of all staff. Increasing services is not just about money and money can be spent better.

·         There is currently no plan, but it is being developed with staff and users and there has been considerable progress and is expected to be ready by early 2018

·         Progress on other aspects include:

o   Establishment of a forum for engagement of unions of all the services in the three counties with their first meeting this week.

o   A provider has been engaged who will work with individual teams – team building

o   Providing structures and policies

o   All senior managers to be available on the ground in their different areas of responsibility

 

Further questions/concerns/issues were raised by the members:

·         Grave concern that, at this moment in time, there is no plan for Roscommon Mental Health Services

·         There needs to be one to one contact between staff and patients – not emails

·         How many members of staff, if any made protected disclosures?

·         What are the number of anonymous complaints?

·         Is there a person approved to look after day-care centres in the West?

·         What training has been undertaken by senior staff? Have the senior staff have the right qualifications? Did the Director of Mental Health Services meet with the staff since the report issued?

·         The minutes of HSE governance meetings should be circulated

·         Acknowledge the good services that are in the county should the public require them.

·         Can Mr. Canavan return in June 2018 to give the members a progress report?

·         Will the €10 p.w. cut from the service users be restored – this cut did not take place in Galway or Mayo.

·         What is the timescale for the implementation of the twenty-seven recommendations?

·         Has the breakdown of the €17.6m been analysed?

 

Mr. Canavan replied as follows:

·         Working relationships are the most difficult challenge and least certain of success

·         A reply to the issue of the €10 cut for service users will be given at the HSE forum meeting and it will be reviewed in New Year

·         No information on protected disclosures as they a made to a specific nominated person only – robust legislative requirements in place to protect the person making disclosure.

·         Not aware of how many anonymous complaints are being dealt with but only receive a small number compared to those that are signed and they are dealt with.

·         No one currently assigned to oversee Provision of Day Care services but this will continue to be worked on with the members and reviewed as it is also a political issue. There are better models of day care delivery that can be realigned in Roscommon

·         HSE previously starved of budget for training but the resources will be found to undertake training in Roscommon as it is an immediate issue.

·         SOP for Minutes – there is a clear procedure as to who is at meetings, their purpose etc. There should be a clear process about how decisions are communicated throughout the organisation to staff who should be kept informed.

·         A lot of good practice taking place that should be encouraged and highlighted, and if not it will fall away.

·         Request to return to plenary meeting will be given positive consideration although there is no direct line of governance to Roscommon Co Co, the place for discussion of issues is at the Regional Health Forum.  However the issue being discussed today warrants attendance of Mr. Canavan and he has no objection to returning in six months time.

·          About half of the 27 recommendations are started and difficult to say when they will be completed but some will take more than a year at least.  There a ‘A Vision for mange’ which is the National Strategy but no specific plan for Roscommon – there needs to be a more specific detailed plan for the area that has shorter timeframes for actions within the overall strategy.

 

The Cathaoirleach asked Mr. Canavan to forward breakdown regarding the €17.6m that was previously discussed and the detail of the extra expenditure from 2015 to 2017 to the Meetings Administrator and he agreed to do so.

She welcomed his commitment to return to a meeting mid 2018 but sought further clarification on who returned the money.  Mr. Canavan stated that there was no analysis on the breakdown of the money but it would have been 75% Galway and 25% Roscommon. He did not think that it would have been a decision made by any one person and no bonus or promotion resulted from this action.

After some discussion it was agreed that Mr. Canavan be invited to attend a Meeting in June next year for an update on progress and in the meantime any issues should be communicated to the three members of the Regional Health forum

On the PROPOSAL of Cllr. Leyden

              SECONDED by Cllr. Fitzmaurice           

 It was  AGREED that Members of the HSE forum give feedback to members at least every second month between now and June.

The Chief Executive thanked Mr. Canavan to attending and for the honest views and facts presented to the members and emphasised the importance of everyone involved in the report and is liking forward to receiving updates.

Cllr. Ward reminded members that any questions they wish to be addresses at the HSE forum should be sent to him or his two colleagues on the committee.