The Joint Committee on the Future of Mental Health Care - Opening Statement By Mary Walshe Chief Officer Community Health Care Organisation (9) ...
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The Joint Committee on the Future of Mental Health
Care
Meeting 24th January 2018
Opening Statement
By
Mary Walshe
Chief Officer
Community Health Care Organisation (9)
Dublin North City and CountyIntroduction
Good afternoon Chairperson and members of the Committee. Thank you for the invitation
to attend today and I am joined as a witness by Angela Walsh, Head of Service for Mental
Health for my area.
I am the Chief Officer in CHO Dublin North City and County and I am the accountable officer
for the provision of Community Services which includes Primary Care, Social Care Services
for Older Persons and Persons with a Disability and Mental Health Services. As Chief Officer,
I am committed to integration between primary and secondary care. We work closely with
acute hospital services in a co-ordinated way around the assessed needs of the client. This
is done in conjunction with Beaumont and Connolly Hospitals (RCSI Hospital Group), the
Mater Hospital (Ireland East Hospital Group) and the National Children’s Hospital, Temple
Street (Children’s Hospital Group).
Service Area
CHO Dublin North City and County is one of nine Community Healthcare organisations
across the country and is responsible for providing care services to a population of 621,405
within the geographical district of Dublin North City and County. This region is a mixed
urban/rural area and extends from the north city to the boundary of Dublin Fingal (Appendix
1). There are high levels of need within the inner-city due to socio-economic and ethnicity
reasons. Some of the Electoral Divisions in the inner city have over 50% of their population
of people that were born outside Ireland, which can bring its own opportunities and
challenges.
The population of CHO Dublin North City and County has seen an increase from the last
census of approximately 6.9% (39,919) (Appendix 2). According to the 2016 census the
fastest growing constituency in Ireland was Dublin Fingal and four of the top ten electoral
divisions nationwide where there have been significant population increases are in my area.
Dublin City Council area also had a 4.8% increase in population. Population growth has been
a considerable factor in increasing demand for service in recent years and presents a
significant challenge on service planning and delivery in Dublin North City and County.
Governance
As Chief Officer I work closely with the National Director of Community Services (Ms Anne
O’Connor and her team) in implementation of the national priorities. This is managed
through a series of performance meetings with the National Divisions. The governance
structure for the operational management of Mental Health Services in my area lies with the
Head of Service for Mental Health, Angela Walsh, who reports directly to myself. Ms Walsh
chairs the CHO Mental Health Management Committee, which has representatives from all
disciplines to ensure there is a wide range of expertise who can represent the views of
service users, carers and family members (Appendix 3).
1Overview of Services
Mental Health services are provided to the population via Child and Adolescent Mental
Health Service (CAMHS), General Adult Mental Health Service, Mental Health Intellectual
Disability (MHID) Service and Psychiatry of Old Age (POA) Service under the direction of the
Head of Service. I will expand further in relation to these services.
Child and Adolescent Mental Health Service (CAMHS)
Within CHO Dublin North City and County there are 8 Child and Adolescent Mental Health
Teams providing Mental Health Services through assessment and treatment at out-patient
clinics and in the day hospital. These teams are operating as per Vision for Change staffing
levels at an average of 66.5%. The CAMHS In-patient 12 bed unit, St Joseph’s, is operated by
St Vincent’s Hospital, Fairview. The CAMHS Consultants provide 24/7 cover to the in-patient
unit and the National Children’s Hospital, Temple Street Emergency Department.
General Adult Mental Health Service
There are 20 General Adult Mental Health Teams providing mental health services to the
population. Four of the 20 adult teams are fully staffed as per Vision for Change the
remainder are at an average of 65%. General Adult acute in-patient care is provided in four
locations with a total of 125 beds.
Psychiatry of Old Age (POA)
There are 2 Psychiatry of Old Age Teams in CHO Dublin North City and County. These teams
are operating at 53.3% as per Vision for Change. There are 12 acute assessment beds; 6 in
Aishlin Centre, Beaumont and 6 in St Vincent’s Hospital, Fairview.
Day Hospitals (All Services)
There are 8 General Adult, 1 CAMHS and 3 Psychiatry Of Old Age Day Hospitals with service
user led, recovery based hubs within CHO Dublin North City and County.
Specialist Services
In addition to the above there are sub-specialist services including 4 Rehabilitation
Psychiatry Teams and 3 Liaison Psychiatry Teams (Beaumont, Connolly and Mater Hospitals)
and one Homeless Community Mental Health Team.
Mental Health Intellectual Disability Service (MHID)
Mental Health Intellectual Disability Service is provided by the HSE (St. Joseph’s Intellectual
Disability Service) and in partnership with two Section 38 agencies, providing assessment
and treatment to clients attending their services. St. Joseph’s Intellectual Disability Service
2includes an Approved Centre under the Mental Health Act, 2001 and community residential
and outreach services. It is important to note St Joseph’s Intellectual Disability Service is
funded through National Social Care.
Further detail in relation to bed capacity is included in Appendix 4.
Staffing
The overall staffing for CHO Dublin North City and County Mental Health Service is 1,232
whole time equivalent (WTE) as at November 2017 (Appendix 5). The single biggest
challenge for mental health services in terms of recruitment is Mental Health Nursing. Since
2013 there has been an average of 35 – 45 WTE on-going vacancies that remain unfilled
(excluding maternity and sick leave) in mental health nursing, across all services. A vacancy
is defined as an approved post that is currently unfilled through any measure.
Finance
The overall budget for CHO Dublin North City and County Mental Health Services in 2017
was €114.458m which includes an allocation of €14.233m to St Vincent’s Hospital, Fairview
(Section 38 Service Provider). The allocation in 2018 is an increase of €2.694m (2.35%).
Further detail in relation to Mental Health Budget is provided in Appendix 6.
CHO Dublin North City and County received Programme for Government (PFG) funding of
€2.053m since 2013 for the recruitment of posts under Vision for Change and new
developments in line with the HSE Clinical Programmes for mental health. (Breakdown of
these posts is included in Appendix 7). These additional posts have been welcomed in
enhancing service delivery with a focus on recovery.
Challenges & Opportunities
Child and Adolescent Mental Health Service (CAMHS)
As I alluded to earlier the population growth within my area has resulted in an on-going
increase in referral rates to CAMHS, which brings a significant challenge in terms of our
ability to meet timelines in relation to this demand on the service. In response to this a
robust Quality Improvement Plan commenced in CAMHS in 2017 to focus on children who
were on the “greater than 12 months waiting list”. This initiative resulted in these children
being offered appointments and therefore significantly reducing this waiting list. A
continued focus will remain on CAMHS in 2018, specifically progressing to those children on
the “6 to 9 month waiting list” to further reduce same.
3Capital Development
Having appropriate infrastructure to support the effective delivery of service is paramount
and a detailed capital plan has been devised to meet the growing demand on services over
the next five years in my area. A significant number of our mental health teams are co-
located or due to re-locate to Primary Care Centres which leads to a better interface with
G.P.’s and our colleagues in Primary Care.
Service Reform Fund
In 2017, CHO Dublin North City and County was awarded €230,000 via the Service Reform
Fund. These funds will be utilised to assist service users to maximise their recovery and
support them in seeking employment. This fund will also support service users to articulate
their views and fully participate in Mental Health Management Teams.
Connecting For Life
The Connecting for Life Steering Group is well established and chaired by myself. The
Connecting for Life Implementation Plan for CHO Dublin North City and County is in final
draft stage and is due to be formally launched in Quarter 1 2018. There are 2 Resource
Officers for Suicide Prevention who provide information, support and co-ordinate initiatives
in relation to suicide prevention in the community. There has been a reduction of 50% in
the number of suicides between 2006 and 2015.
Conclusion
CHO Dublin North City and County is committed to providing a high quality, standardised,
cohesive patient focused service that best meets the needs of the population we serve. We
support integrated health services that meet the diverse health and social needs of the
community and treat each person according to their needs. We work with all stakeholders
in our area, both statutory and non-statutory, to achieve high quality health and social care
services to ensure our service users are supported to recover from their mental health
illness and are treated with dignity and respect.
A key focus for our area is positive engagement with service users, families and carers, who
can assist us in planning and developing services into the future.
Chairperson, this concludes my opening statement and I have included some information in
the appendices. My colleague and I are happy to assist with any questions or clarifications
you may wish to raise.
Thank you.
4Appendix 1
Community Healthcare Organisation Dublin North
City & County Area Map
5Appendix 2
Census 2016 CHO Dublin North City and County
Demographics as per Health Atlas Finder – Area Profile
Table 1: Top 10 Electoral Divisions nationwide ordered by population increase, 2011-2016
Population Population Actual Percentage
Position Electoral Division County change
2011 2016 change
Blanchardstown-
1
Blakestown Fingal 36,057 38,924 2,867 8.0
5 The Ward Fingal 8,241 10,470 2,229 27.0
9 Balbriggan Rural Fingal 15,140 16,479 1,339 8.8
Blanchardstown-
10
Abbotstown Fingal 4,870 6,204 1,334 27.4
Four of the top ten electoral divisions nationwide where there have been significant population
increases are in Fingal. The Dublin City Council area also had a 4.8% increase in population in this time
period.
Table 2: CHO DNCC Population profile by age group ascending
Age Group Number of People
0-4 43,668
5-19 116,778
20-64 389,189
65-74 40,613
75+ 31,148
In CHO DNCC 25.8% of the population (160,446 people) are aged 19 years or under while 11.5%
(71,761 people) of the population are over 65 years of age.
Table 3: CHO DNCC Population profile by nationality
Nationality Number of People
Irish 495,909
UK 8,266
Polish 18,250
Lithuanian 5,624
Elsewhere in the EU 37,141
Elsewhere in the World 29,449
Not Stated 26,766
In CHO DNCC 20.2% of the population (125,496 people) were born overseas.
6Table 4: CHO DNCC Population profile by deprivation level – HP Index
Deprivation Level HP Level Number of People
Extremely Affluent 15,778
Very Affluent 58,411
Affluent 132,489
Marginally Above Average 167,177
Marginally Below Average 130,254
Disadvantaged 74,013
Very Disadvantaged 32,395
Extremely Disadvantaged 10,887
In CHO DNCC 60.1% of the population (373,855 people) were reported as above average on the
deprivation level HP index with 39.9% (247,549 people) reported as below average.
7Appendix 3
CHO Dublin North City and County Governance Structure
Ms Mary Walshe Chief Officer
Dublin North City & County
General Head of Head of Health Head of Social Head of Business Management
Manager Primary Care & Wellbeing Care Mental Health
Communications
Rosaleen Harlin Des O’Flynn Denise Curran Mairead Lyons Angela Walsh Head of Finance
Michael O’Keefe
Head of Human
Resources
Mellany
McLoone
General General Manager General Manager General
Manager Social Inclusion - Disability Services Manager
Primary Care Addiction Service Older Persons
Sheila Marshall Services
Michelle Forde Donal Cassidy
Paula Keating
8CHO Dublin North City and County Mental Health Services Governance Structure
Head Of Service
Mental Health
Business
Manager HOS
MH Office
Principal Occupational Speech & Mental Health
Adult Services Executive Clinical Area Directors Social Work Director of Suicide Resource
Psychology Therapy Language Engagement Project Manager
Managers Directors of Nursing Managers Counselling Officers
Managers Managers Therapy Manager Lead
Directors of
Clinical Directors Occupational SLTs and Counsellors
CAMHS Manager Nursing/Assistant Psychologists Social Workers
/Psychiatrists Therapists, Dieticians
Director, Nurses
9Appendix 4
CHO Dublin North City and County
Bed Capacity
Table 1: General Adult Acute In-patient Beds CHO Dublin North City and County
General Adult In Patient Acute Units Number of Beds
Mater St Aloysius Ward 10
Department Of Psychiatry Connolly Hospital 47 (including 5 High HDU)
Ashlin Unit, Beaumont Hospital 38
St Vincent’s Fairview 30
Total 125
Table 2: Psychiatry of Old Age Acute In-patient Beds CHO Dublin North City and County
Psychiatry of Old Age In Patient Acute Units Number of Beds
Ashlin Unit, Beaumont Hospital 6
St Vincent’s Fairview 6
Total 12
Table 3: Continuing Care Beds CHO Dublin North City and County
(Continuing Care/Rehabilitation/Psychiatric Number of Beds
Intensive Care Unit)
Psychiatry of Old Age Sycamore Unit Connolly Hospital 25
Psychiatry of Old Age O’Casey, Fairview C.N.U. 25
Phoenix Care Centre 54 (including 24 PICU)
St Mary’s St Vincent’s 10
Private Providers 46
Total 160
Table 3: Medium and High Support Hostels CHO Dublin North City and County
Residential Services Number of Beds
High 24 hour nursing 132
Medium >24HR nursing 126
Total 258
10Appendix 5
CHO Dublin North City and County
HSE Personnel Census November 2017
Table 1: CHO DNCC Mental Health WTE Breakdown Nov 2017 versus Nov 2016*
Nov 2017 (Nov 2016 figure: 1,215) WTE Nov WTE change % change WTE WTE
2017 since Nov 16 since Nov change Change
16 since Dec since Oct 17
16
Overall 1,232 +16 +1.4% +7 +2
Consultants 45 -3 -0.1% -2 +1
NCHDs 79 +0 +0.0% +3 -1
-1 -1.0% -1
Medical/Dental 124 -3 -2.4% +0 +0
Nurse Manager 138 -10 -0.1% -9 +1
Nurse Specialist 59 +15 +0.4% +17 +2
Staff Nurse 353 -3 0.0% -15 +7
Public Health Nurse 1 0 +0.0% 0
Nursing Student 3 -4 -0.6% -0 -6
Nursing (Other) 14 +2 +0.2% +2 -0
Nursing 568 +0 +0.0% -5 +4
Therapists (OT, Physio, SLT) 53 +6 +0.1% +4 -2
Health Professionals (other) 120 +5 -0.0% +4 +3
Health & Social Care Professionals 174 +11 +6.7% +8 +1
Management (VIII+) 2 0 0.0% 0
Clerical & Supervisory (III to VII) 121 +11 +0.1% +10 -1
Management/Admin 123 +11 +9.7% +10 -1
General Support 130 -3 -2.3% -8 -2
Patient & Client Care 113 +1 +0.6% +2 -1
*WTE = Whole Time EquivalenT
Table 2: CHO DNCC Mental Health WTE Breakdown 2013 – 2017*
Nov 2017 (Nov 2016 figure: WTE WTE WTE WTE WTE WTE WTE
1,215) Nov change change change Change change change
2017 since Oct since Dec since Year 1 since since
13 14 Dec 15 Dec 16 Oct 17
Overall 1,232 +83 +46 -0 +16 +7 +2
Consultants 45 +9 +2 -4 -3 -2 +1
NCHDs 79 +14 +18 +9 +0 +3 -1
Nurse Manager 138 +1 -10 -16 -10 -9 +1
Nurse Specialist 59 +49 +43 +27 +15 +17 +2
Staff Nurse 353 -53 -45 -28 -3 -15 +7
Public Health Nurse 1 +1 +1 +1
Nursing Student 3 -3 -1 -4 -4 -0 -6
Nursing (Other) 14 +2 +4 +3 +2 +2 -0
Therapists (OT, Physio, SLT) 53 +14 +4 -1 +6 +4 -2
Health Professionals (other) 120 +40 +23 +11 +5 +4 +3
Management (VIII+) 2 +1 +0
Clerical & Supervisory (III to VII) 121 +36 +30 +13 +11 +10 -1
Care 113 -3 -6 -0 +1 +2 -1
Support 130 -23 -15 -11 -3 -8 -2
*WTE = Whole Time Equivalent
11Appendix 6
CHO Dublin North City and County
Finance
Table 1: Mental Health Financial Position - CHO Dublin North City and County
2015 2016 2017 2018
€'000 €'000 €'000 €'000
Pay 79.654 81.575 87.843
Non Pay 30.245 29.454 30.125
Gross Expenditure 109.899 111.029 117.968
Income (4.139) (4.010) (4.288)
Net Expenditure 105.760 107.019 113.680
Budget 105.861 106.912 114.458 117.152
Variance - 101 107 - 778
Table 2: CHO DNCC Mental Health Services Expenditure - Breakdown by Service Area 2015 - 2017
2015 2016 2017 2018
€'000 €'000 €'000 €'000
Adult Not Available 76.818 80.276
CAMHS Not Available 7.772 9.967
POA Not Available 8.192 9.204
St Vincent’s Hospital Fairview 13.489 14.237 14.233
Grand Total 105.760 107.019 113.680 N/A
12Appendix 7
CHO Dublin North City and County
Mental Health Development Posts 2013 – 2017
Table 1: Mental Health Development Posts CHO Dublin North City and County- 2013
Year Total Posts Grade Of Post Posts Grade of Post Reason Not
WTE Filled Unfilled Recruited
2013 38 37 CAMHS 1 Clinical Nurse Post offered and
1.5 Consultant Psychiatrist Specialist awaiting candidate
1 Clinical Nurse Specialist acceptance
General Adult
1 Consultant Psychiatrist
22 Clinical Nurse Specialist
1.5 Staff Nurse
1 Psychologist (Basic)
1 Occupational Therapist
(Basic)
Psychiatry Old Age
3 Clinical Nurse Specialist
1 Psychologist (Basic)
1 Occupational Therapist
(Basic)
MHID
2 Clinical Nurse Specialist
Self-Harm
2 Clinical Nurse Specialist
13Table 2: Mental Health Development Posts CHO Dublin North City and & County- 2014
Year Total Posts Grade Of Post Posts Grade of Reason Not Recruited
WTE Filled Unfilled Post
2014 26 26 CAMHS All filled
1 Consultant
1 Senior Clinical Psychologist
1 Asst Director of Nursing
General Adult
1 Senior Psychologist
1 Senior Occupational
Therapist
1 Grade IV
7 Grade III
2 Social Worker
Psychiatry Old Age
1 Consultant Psychiatrist
1 Clinical Nurse Specialist
Dietetics
2 Dieticians (DNC)
Homeless
1 Psychologist
MHID
1 Psychologist
1 Senior OT
2 Psychologist x 2
(Daughters of Charity)
2 Clinical Nurse Specialist x 2
(St Michael’s House)
14Table 3: Mental Health Development Posts CHO Dublin North City and & County- 2015
Year Total Posts Grade Of Post Posts Grade of Reason Not Recruited
WTE Filled Unfilled Post
2015 28 24 CAMHS 4 1 Clinical Recruitment Underway
1 Senior Dietician Nurse
1 Occupational Therapist Specialist
1 Senior Psychologist Will be filled by Qtr 2,
1 Social Worker 1 Grade III 2018
1 NCHD
2 Clinical Nurse Specialist Post advertised through
1 Grade V 1 Grade VII National campaign –
Traveller Awaiting notification of
General Adult Mental Health successful applicant
1 Clinical Nurse Specialist
1 Advance Nurse
Practitioner Post offered and
2 Grade IV 1 Senior awaiting candidate
1 Occupational Therapist Dietician acceptance
1 Consultant Psychiatrist (CAMHS)
3 Clerical Officer
2 Social Worker
Psychiatry Old Age
1 Basic OT
1 Grade III
1 Consultant Psychiatrist
Self Harm
1 Clinical Nurse Specialist
Physical Health
1 Dietician
National Posts
1 Grade VII Traveller Health
MHID
3 Social Workers
15Table 4: Mental Health Development Posts CHO Dublin North City and & County- 2016
Year Total Posts Grade Of Post Posts Grade of Reason Not Recruited
WTE Filled Unfilled Post
2016 4 3 Liaison Psychiatry 1 1 Grade III Post offered and
2 Family Therapy awaiting candidate
acceptance
Mental Health Engagement
Lead
1 Grade VII
1 Grade III
Table 5: Mental Health Development Posts CHO Dublin North City and & County- 2017
Year Total Posts Grade Of Post Posts Grade of Reason Not Recruited
WTE Filled Unfilled Post
2017 15 15 3 Clinical Nurse Specialist 15 On receipt of Primary
(7/7) Notification –
2 Senior Social Workers recruitment to
(7/7) commence
2 Senior OTs (7/7)
1 Social Worker
2 Basic OT
1 NCHD
1 Clinical Nurse Specialist
2 Grade IV
1 Psychologist Basic
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