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Office of the Regional Director of Operations
Health Service Executive, Dublin North East,
Swords Business Campus,
Balheary Road,
Swords,
Co. Dublin.
Mr. John Saunders,
Chair,
Independent Monitoring Group,
Department of Health and Children,
Hawkins House,
Dublin 2.
Ph: 01 8131 800
E-mail: rdo.dne@hse.ie
16 th March 2011
Dear Mr Saunders,
I refer to your correspondence dated 3 rd February 2011 and our meeting with the Independent
Monitoring Group on January 25 th 2011 and regret the delay in replying. Please find enclosed a brief
update on the implementation of A Vision for Change in the Dublin North East region. Also enclosed as
requested, is an organisational chart indicating the future positioning of mental health within the new
Integrated Service Area structures (Appendix 2).
In 2010, implementation of A Vision for Change in the Dublin North East region has largely focused on
advancing the provision of more appropriate accommodation for patients requiring acute in-patient
admission. However, considerable reconfiguration of long-stay beds has also taken place.
Cavan/Monaghan Mental Health Services
Pending provision of a purpose built acute in-patient unit through the future disposal of mental health
lands / property, planning for the centralisation of acute in-patient services on the Cavan General
Hospital (CGH) site was progressed in 2010. It is anticipated that the interim acute unit in CGH, which
will bring the provision of acute mental health in-patient services in Cavan/Monaghan in line with the
recommendations of A Vision for Change, will be operational by the beginning of June 2011 with the
transfer of acute services from the institutional setting at St Davnets..
Two continuing care units in St. Davnet’s Hospital merged in 2010 facilitating the closure of ten longstay
beds and providing the remaining residents with more appropriate accommodation.
St. Ita’s Hospital, Portrane
Planning for the new acute in-patient unit in Beaumont Hospital was completed in 2010 and a letter of
acceptance was issued to the preferred contractor. The plans are currently awaiting approval by An
Bord Pleanála in accordance with the Planning and Development (Strategic Infrastructure) Act, 2006.
A refurbishment programme is due to commence shortly in St. Ita’s, which will see the complete
refurbishment of the ‘ABC’ unit. This unit will function as an interim acute admission unit for the North
Dublin area, pending completion of the new acute unit at Beaumont Hospital in 2012. Following transfer
of acute admissions to Beaumont Hospital, the ‘ABC’ unit will become a dedicated continuing care unit
for Mental Health Services for Older People (MHSOP).
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In the interim 25 MHSOP clients are being transferred temporarily to on the units within the newly built
community nursing unit at St Vincent’s Hospital Fairview which represents a significant improvement in
their accommodation.
In accordance with the conditions attached to its registration, Unit 1 Male, Unit 1 Female and Unit 8 in
St. Ita’s will permanently close by March 31 st 2011. Unit 9 closed in December 2010.
In 2010 the St Josephs Intellectual Disability Service (Mental Health approved centre) underwent a
significant reconfiguration which led to the last 60 patients moving from the sub-standard
accommodation in the old red brick building into the Knockaman development comprising 10 six bed
bungalow style residences.
St. Brendan’s Hospital, Grangegorman
The opening of Pine Ward at Connolly Hospital, and the transfer to it of acute services from the
institutional setting at St Brendan’s Hospital, which took place on September 6 th 2010, means that in
line with the recommendations of A Vision for Change, all acute admissions from the North West Dublin
area are now to an acute unit on a general hospital site. The Department of Psychiatry at Connolly
Hospital now has two 22-bed acute units and a five-bed High Dependency Unit. The remaining units on
the Grangegorman site will be replaced by a new purpose built 54-bed facility, which it is anticipated will
be completed in early 2012.
Louth/Meath Mental Health Services
Planning commenced in 2010 for a new acute in-patient unit, which will replace the Admission Units in
St. Brigid’s Hospital, Ardee and Our Lady’s Hospital, Navan in line with the recommendations of A
Vision for Change and the North East Acute Hospital Transformation Programme.
Two continuing care units in St. Brigid’s Hospital merged in 2010 providing more appropriate
accommodation for 20 elderly patients and facilitating the closure of 13 long-stay beds.
Child and Adolescent Mental Health Services
Of the ten allied health professional posts allocated to Dublin North East in 2009, nine have been filled.
Efforts to fill the remaining post continue.
Plans for Phase Two of St. Joseph’s Adolescent Unit in St. Vincent’s Hospital, Fairview, which will
increase the number of beds for 16 & 17 year olds from 6 to 12, were approved in 2010. It is anticipated
that the extended unit, which will incorporate St. Joseph’s Day Hospital, will be completed by the end of
2011.
Community Mental Health Teams
One of the underlying assumptions in A Vision for Change is that the closure of in-patient beds in
traditional psychiatric hospitals would release staff, who could then be redeployed to the community to
work as part of community mental health teams (CMHTs). While every effort is made to enhance
CMHTs, the concomitant reduction in the HSE’s total workforce and the requirement to comply with the
Employment Control Framework pose significant challenges in this regard, given that mental health
services and psychiatric nursing in particular, are especially vulnerable to the impact of early retirement.
Nevertheless, Dublin North East has made a concerted effort to maintain the numbers of psychiatric
nurses.
In 2010, a total of 112 psychiatric nursing posts fell vacant, a substantial number of which were
approved for filling by the DNE Area Employment Monitoring Group given the need to maintain safe
levels of essential frontline clinical services within the limited flexibility available to me under the
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moratorium / employment control framework. Of these, 42 were filled in 2010 and a further 19 have, or
are in the process of agreeing a start date in 2011. A number of remaining posts are with the National
Recruitment Service (NRS). The delay in the recruitment process was a direct result of the need to
redeploy the staff in the NRS to deal with the Early Retirement and Voluntary Redundancy Schemes
announced by the Government towards the end of 2010.
A number of Primary Health Care Centres, funded through Public Private Partnerships (PPPs) and
incorporating accommodation for Mental Health CMHTs, were planned for 2010. However, for a variety
of reasons, in a number of cases directly linked to the recession and the reduced supply of investment
funding, only one of these centres (Trim, Co. Meath) opened as planned. New replacement premises
were also provided for the CMHT in Navan, Co. Meath, where a Day Hospital is currently in
development.
Mental Health Expenditure
The 2011 allocation for mental health services nationally is €708m of which €144.58m (DNE receives
20.4% of the national mental health budget) has been allocated to Dublin North East, which represents
approximately 7.3% of the 2011 funding allocation for the Dublin North East region.
Organisational Structures
A diagrammatic representation of the HSE’s organisational structure nationally can be found in
Appendix 1. Appendix 2 outlines the proposed regional organisational structure following the
establishment of Integrated Service Areas (ISAs), of which there will be four in Dublin North East as
follows:
ISA 1: Cavan/Monaghan
ISA 2: Louth/Meath
ISA 3: North Dublin (incorporating part of North West Dublin)
ISA 4: Dublin North City (incorporating the remainder of North West Dublin)
Analysis of the changes necessary to realign existing mental health service boundaries with ISA and
Primary Care Network boundaries is already well advanced.
Challenges
In addition to the lack of additional investment envisaged in A Vision for Change, some of the key
implementation challenges are the current recruitment moratorium; the scarcity of healthcare
professionals with particular specialist skills e.g. CAMHS, MHID, Forensic, Eating Disorder; IR
difficulties related to service reconfiguration; and difficulties arising from the simultaneous pursuit of a
number of national policies, all of which seek to draw from the same finite pool of allied health
professionals.
Even with the increase in the number of training places for allied health professionals, it can, on
occasion, be difficult to fill specific posts, particularly in specialist services. For example, one particular
senior clinical psychology post in Dublin North East has been advertised on several occasions but
remains unfilled. The post was offered to, and accepted by, two different candidates who subsequently
declined it when another more suitable post became available.
There are concerns that, arising from the provisions of the Planning and Development (Strategic
Infrastructure) Act, 2006 a number of major mental health capital projects may be delayed. Also, the
current economic environment is impacting on investment in Public Private Partnerships and is also
likely to adversely affect the planned sale of mental health lands / property.
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Learning
While the pace of change can often be frustratingly slow, closing traditional psychiatric hospitals
requires careful planning to ensure adequate involvement of all relevant stakeholders, both internal and
external. It is important to acknowledge that the closure of in-patient beds does not necessarily yield
significant savings for re-investment in community-based services, which are often more expensive to
operate, particularly on a 24/7 basis. Providing alternative accommodation for residents of traditional
psychiatric hospitals is not synonymous with discharging them from the service; consequently, there
are often additional costs to the mental health service. Finally, to facilitate this type of major change,
there needs to be some level of additional funding to reward innovation and support some degree of
parallel service provision between the old and the new, so as to ensure patient safety during the
transition phase.
Conclusion
Despite all of the above challenges I believe the update above demonstrates that very significant
progress has been and is being made in 2010 and 2011 by the mental health teams in DNE,
particularly as regards the movement away from very poor quality institutional inpatient settings.
A major objective for DNE in our 2011 Regional Service Plan is to set out a 3 to 5 year DNE VFC
Workforce Reconfiguration Plan to identify what progress we can aspire to in terms of changing the
disciplines, care settings and locations of our staff to support VISION, while recognising that we don’t
have sufficient resource to fully meet the objectives of VFC.
I trust that this update is of assistance and will meet with the Monitoring Group’s requirements.
Yours sincerely,
_______________________________
Stephen Mulvany
Regional Director of Operations
Dublin North East
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Appendix 1: HSE Organisational Chart - National Structures
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Appendix 2: HSE Organisational Chart – Proposed Regional Structures
V2.1 – 22/10/2010 - NPMO
ISA Management Team
RDO
ISA Manager
Mental Health Services Hospital Services Primary & Community Services
2
Business Management
Executive
Clinical Director
Mental Health
1
Director of
Nursing
( Primary, Acute &
Continuing Care)
Executive Clinical
Director
Acute &
Continuing Care
Group
Operations
Manager Acute &
Continuing Care
Operations
Manager Primary, &
Community Care
Group
Exec Clinical
Director Primary
Care
Finance
Manager
HR
Manager
Mental Health Services
will be delivered for a
catchment area led by an
ECD. The ECD will have a
Nurse Manager and
Business Manager.
Further work is needed on
proposed roles for key
Allied Health Professionals
in Mental Health
Hospital Services
In a Hospital Group with a
large Tertiary Centre
(Model 4 Hospital) services
will be delivered through
Clinical Directorates e.g.
Women and Children’s
Directorate.
Primary & Community
Services
The Operations Manager
Primary & Continuing Care
Group will be responsible
for the delivery of Primary
Care Services through
PCTs (5-10,000). Health &
Social Care Networks (30-
50,000) and for an
Integrated Service area
(120,000)
Business Management
Embedded Finance & HR
resources will be
consolidated to provide
support the ISA
1 . Nursing roles to be determined
2.
The Q&CCD are developing the model for Quality & Risk at local level
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