The HSE report into the harm caused to south Kerry children in need of psychiatric help will come as no surprise to those families who require to deal with CAMHS. The Child and Adolescent Mental Health Services is an understaffed, under-resourced, underfunded branch of the health service, where governance and accountability are, by common consent, of a low order.
In the Kerry case, it took a whistleblower to raise the red flag over the treatment of up to 1,300 children who had been prescribed damaging medication, over a four-year period, by an unsupervised junior doctor. (Botox, it transpired, was one of the treatments prescribed for a patient with ADHD.)
The Taoiseach acknowledged, by way of comment, that what happened was a failure of governance and accountability in the health services. Equally vacuous was the response of the head of the HSE, Paul Reid, who said of the scandal that it was ‘deeply regrettable, beyond comprehension, and wrong’. Both statements were a little like telling us that Monday follows Sunday, as if the remedying of these faults in the system was the business of somebody else.
(This is somewhat akin to the practice of government TDs and senators ‘calling for’ improvements to this, that and the other by way of weekly media statements. On who, you might ask, are they calling for these much needed measures? Or are they unaware that it is they themselves who are in charge of the bus, and they themselves who can decide what or what not to do?)
The CAMHS service has been slammed by the country’s GPs as ‘a collusion of anonymity where nobody takes responsibility for the child or the family’. The Irish Hospital Consultants have accused the Taoiseach of promising ‘another meaningless audit into CAMHS without offering any action to solve what are widely known problems’.
The Sláintecare health strategy was unveiled to a fanfare of trumpets four years ago as the final, definitive solution to the delivery of an adequate, accessible health service. Reform was in the air; leadership and governance would deliver the health service we needed. Six new regional health areas would be set up to deliver high quality, local services. (Those with long memories drew a deep breath, recalling the setting up of eight regional health boards in 1970, their expansion to eleven in 1999, before the scrapping of the lot to set up the HSE.)
A Sláintecare Implementation Group was set up to drive the reforms and make sure the targets were met. Last September, the two senior people on the group – Laura Magahy and Dr Tom Keane – resigned in frustration at the foot dragging higher up the civil service tree.
Neither was replaced. Since their departure, the implementation body has met once. Control of the operation has been brought in-house, where the country’s highest-paid mandarin, Robert Watt, together with Paul Reid, will take charge.
In the second quarter of last year, the HSE hired 25 senior managers to its ranks; it hired five extra medical and dental staff. In six years, the number of HSE administrative staff has more than doubled; but the complement of medical staff has grown by 40 percent.
Even those who once believed that Sláintecare was the answer are having second thoughts. But Sláintecare has an inbuilt defensive shield to protect it from attack. Its progenitor was a 14-member committee of TDs drawn from every party in the Dáil. No matter how bad things get, they are unlikely to cut a rod to beat themselves with.