Seanad Éireann - Volume 154 - 11 February, 1998
Adjournment Matters. - St. Ita's Hospital, Dublin.
Dr. Henry Dr. Henry
Dr. Henry: I begin to wonder if the Minister for Health and Children is a little nervous about the issues I table on the Adjournment, but I realise he is very busy. I have not had the pleasure of addressing him yet but I am glad the Minister for Arts, Heritage, Gaeltacht and the Islands is present.
Great concern has been expressed about patients in St. Ita's Hospital, Portrane, by Senators and the public following a radio programme featuring conditions at the hospital. A few weeks after the programme parents and guardians of some of the residents in the hospital received a letter from a doctor who works there asking for permission to include their adult children  or wards in a trial which involved medication and blood tests. While no one questions the integrity of the doctor who wished to carry out the study, some parents and others, such as The Disability Federation of Ireland, were concerned as to the status of such trials within the hospital. I am very glad the Minister for Health and Children visited the hospital and that the Minister for Arts, Heritage, Gaeltacht and the Islands is here to give a report on his visit.
Patients with mental illness or intellectual impairment rely more than most on others ensuring they have the best care. Public representatives, as well as those staff who care for them, have a particular responsibility, with the parents or guardians involved perhaps being unable to exert as much influence as they would like over the physical, psychological and emotional care needed.
The proper supervision of mental hospitals is considered so important that an Inspector of Mental Hospitals was appointed by the State many years ago. He carries out routine inspections, usually visiting all the patients in Ireland at least once every two years. He produces excellent reports but, amazingly, there is always a considerable delay in their publication and they are rarely debated in the Houses of the Oireachtas. The 1995 report is the most recent available.
While I understand the concern of Members of the Oireachtas about St. Ita's, much could be gained by debating the inspector's reports. On page 29 of the 1995 report carried out by Dr. Hanniffy, Assistant Inspector Of Mental Hospitals, it is pointed out that while ward reorganisation has taken place in the hospital, many of the day areas for long stay patients are totally inadequate. There is a more homely atmosphere in the night accommodation, but much more reorganisation of the day areas, especially bathrooms, was required.
These are serious factors in the lives of long stay patients. One quarter of the 328 people who live there were over 75 years and another quarter between 65 and 74 years. There was not even proper bathroom facilities for 150 of the oldest people living on the campus and the Minister will realise the patients and staff are in an impossible position. The corridors and walkways were described as being poorly maintained, but local management pointed out there were insufficient means to meet the maintenance requirements; yet regular meetings between the management and maintenance staff were not held. The inspector recommended that monthly meetings be held to prioritise reforms and that they should be recorded. It seems odd that this did not happen already. I question the involvement of management in the running of the hospital when something as basic as that does not happen.
Another serious criticism in the assistant inspector's report is that only some of the patients in St. Ita's Hospital had personal clothing and toilet requisites. Years ago the Eastern Health  Board, of which I was then a member, stated that the policy of having a pool of clothes from which the patients were dressed would have to stop, and yet that policy continued in St. Ita's Hospital in 1995. Did the Minister investigate this? If one was an elderly person away from home in an institution, just imagine that one could be clothed in whatever came out of a bag that morning. I do not want to go into the details of the sharing of toilet requisites because that is not in the report, but they could be very unhygienic.
The inspector's criticisms were not only on the physical conditions under which patients were kept. A section on seclusion procedures — one of his most serious criticisms in the report — makes one feel that their use and monitoring may be less than adequate. The report states:
Seclusion procedures represent a serious deprivation of patients' rights and all episodes must be properly authorised and monitored. The local seclusion policy should be updated to include excerpts from the Mental Treatment Act, 1945, relating to seclusion and bodily restraint.
I have already said in other debates in this House that it is astonishing that we are working under the Mental Treatment Act, 1945, yet here is the inspector saying that a policy in one of our hospitals should be updated to include excerpts from that Act. That extract from the report continues:
The policy should define seclusion and policy guidelines and procedures should be clearly stated. The medical and nursing staff should record seclusion in patients' case files, giving clear reasons as to why seclusion was used. The record should also include evaluation of the effects of each episode of seclusion and should be included in the medical and nursing notes.
It is astonishing to read that even if the report dates from 1995. There would appear to be a lack of management interest in the hospital if the above recommendations on such a serious issue have not been instituted. Did the Minister for Health and Children investigate this? He must have read the 1995 report when he visited the hospital.
Regarding the proposed trial and the concerns it raised, while the service in St. Ita's Hospital is accredited by the Royal College of Psychiatrists and the Irish College of General Practitioners, one would have to ask what are the procedures in place regarding drug trials, which may, indeed, be very worthwhile, which are to be carried out in the hospital. It is essential to dispel the perception that people behind walls are ever used in trials which are not specifically for their benefit.
On hearing of the trials, I immediately contacted the EHB to ask if there was an ethics committee at the hospital and if the trial had been submitted to that committee, whatever about the board of management. I was assured there was  such a committee — it is not mentioned in the report of the Inspector of Mental Hospitals although there is mention of other committees such as fire committees — but the trial was not submitted to it. The trial, I was told later, not by the EHB but by another source, had been submitted to the ethics committee of the Irish College of General Practitioners. It is unusual that a doctor, who understands the importance of ethical considerations, did not send the protocol to the ethics committee at the hospital if this committee was functioning as it should. How frequent are the meetings of the ethics committee? When did it meet last? What trials did it look at? What protocols were evaluated? What trials have been carried out in St. Ita's Hospital to date?
The statement from the EHB on the trial under discussion stated that it was to be carried out on patients with a “learning disability”. Was the trial, therefore, to be carried out on those who live in St. Joseph's mental handicap facility, which is on the site? Those in St. Ita's Hospital are hospitalised under different old medical illness categories. Some are even hospitalised under the heading “Person of unsound mind”. I doubt if that category is used anywhere else in the western world.
We are in a sorry state regarding our treatment of those in mental institutions in this country. The Inspector of Mental Hospitals goes to a great deal of effort to produce reports, but I sometimes believe we think that once a report is made we have done something, although that is not the case. I got two copies of the 1995 report of the Inspector of Mental Hospitals from the Library and neither appeared to have been opened. They were in pristine condition. We are working under mental health legislation which is nearly 50 years old, while the changes in attitudes to mental health and the improvement in mental treatment in the last few decades has been dramatic. The concern about St. Ita's Hospital should spread to the whole service. I hope the Minister for Arts, Heritage, Gaeltacht and the Islands will ask the Minister for Health and Children to actively promote the interests of those who have no hope of doing so themselves.
Minister for Arts, Heritage, Gaeltacht and the Islands (Miss de Valera) Minister for Arts, Heritage, Gaeltacht and the Islands (Miss de Valera)
Minister for Arts, Heritage, Gaeltacht and the Islands (Miss de Valera): The Minister for Health and Children, Deputy Cowen, regrets that he cannot be in the House this evening and he has asked me to relay his report on his visit to St. Ita's Hospital. I know he will take special interest in what the Senator has had to say on the matter.
As the Senator will be aware, St. Ita's Hospital is administered by the Eastern Health Board. The board's current development plan in relation to the hospital campus provides for the closure of old wards in the main hospital block in line with a reduction in patient numbers in the psychiatric service and mental handicap service provided at St. Ita's Hospital. This will be facilitated by the provision of purpose built residential facilities in  the community and on the hospital campus for residents with a mental handicap, and the transfer of long-term older psychiatric patients from the main hospital block to more modern accommodation on the hospital campus as vacancies arise.
The “Assessment of Need for Services for Persons with a Mental Handicap, 1997-2001”, which was published in 1997, highlighted the need for a sustained capital programme to provide additional and enhanced services. The capacity of existing facilities to absorb the additional places in the coming years and to provide the specialist services for clients with disturbed behaviour is now limited. A programme of building is essential to deliver the volume and quality of services required.
The Senator may be aware that the Minister for Health and Children recently announced the establishment of a £30 million capital programme for services to persons with a mental handicap to run in tandem with the service developments identified in the “Assessment of Need for Services for Persons with a Mental Handicap, 1997-2001” over a four year period. The sum of £5.25 million is being provided in 1998 to begin the implementation of this programme.
One of the main elements of that programme is the provision of new residential and day care facilities for persons with a mental handicap who are currently accommodated in psychiatric hospitals and other inappropriate settings, and the refurbishment of existing facilities which will continue to be used in the medium to long-term.
Details of the capital programme are now being worked out with the health boards and voluntary agencies. The programme will include the Eastern Health Board's development plan for its services to persons with a mental handicap in St. Ita's Hospital. The board's development plan includes the provision of new facilities both on and off the St. Ita's Hospital campus and the refurbishment of some of the existing facilities. It is understood that the board has already applied for planning permission for the first of the purpose built residential and day complexes planned for the services.
I confirm that the Minister for Health and Children recently paid a visit to St. Ita's Hospital to view the facilities and services provided. The Minister has also met the chief executive officer of the Eastern Health Board to discuss the measures required to implement the remaining elements of the board's plan for the overall development of the hospital campus.
I assure the Senator that the Minister for Health and Children, his Department and the board are fully committed to the implementation of the overall development programme for the hospital.
Dr. Henry Dr. Henry
Dr. Henry: I thank the Minister for the message she was given. I do not believe in shooting the messenger, but I could hardly be more disappointed.  I hope she will bring the serious issues I addressed to the Minister's attention because this is simply a platitude.
Miss de Valera Miss de Valera
Miss de Valera: I will do that on the Senator's behalf.
Seanad Éireann 154 Adjournment Matters. St. Ita's Hospital, Dublin.