12 November, 2002
Dr. Henry: I thank the Minister of State for attending the House. I also thank the Cathaoirleach for allowing me to raise this matter. The Leader of the House has had to endure me bringing up this topic several times on the Order of Business.
Ms O'Rourke: It is good that the Senator is raising it now.
Dr. Henry: This is a serious issue, not just for the 12 postgraduates involved, but also for the country at large, given the serious shortage of clinical psychologists. The Northern Area Health Board of the Eastern Regional Health Authority established a doctoral programme in clinical psychology in Trinity College. The organisation came into play in January when various graduates were interviewed and selected. On 1 July they were informed they had places. Many of them gave up jobs to take up these college places, and the staff were put in place. One person was recruited from Queens University, Belfast, to come to Trinity College by which the staff were employed. In mid-September, with the course due to commence at the beginning of October, Trinity College was informed by the Northern Area Health Board that it had no funds to meet the salaries and fees of the new intake of students on the course. Over two months ago the board was seeking a meeting with the Department of Health and Children to try to secure the necessary funding.
Trinity College has the staff in place to offer the course, but students can only be enrolled if they are contracted employees of the Northern Area Health Board. Thus, in the light of the financial delays notified by the board, unfortunately, the course did not begin in October. Professor Robertson told the students that as soon as he had further information from the board, he would write to let them know when the course would start. I have been writing to the health authority and the relevant health board to find out when it will start.
This is a serious issue for the 12 students involved, but it is also a very serious one for all of us. This is because the number of clinical psychologists employed by health boards to deal with the most serious problems is down 50%. It is not as if psychologists were add-on extras - they are badly needed. Efforts are being made to recruit clinical psychologists abroad, but even with this intake we will not have a sufficient supply until 2005.
It is not just a problem for the health boards because the courts are in serious difficulty without them also. In fact, there are no clinical psychologists to assist children, which is putting family courts at a serious disadvantage. There are no clinical psychologists for the prisons either. I was rather amused to read an excellent report by the Department of Justice, Equality and Law Reform in 1999, when it assessed the IQ of 10% of the prison population. The report found that 28% of prisoners had an IQ below 70, which is quite astonishing and totally out of line with the position in any other country in Europe. One wonders, therefore, what good prison terms are doing for prisoners.
I was fascinated by one of the report's recommendations that all prisoners under 21 years should be assessed by a clinical psychologist. One Department, therefore, is recommending something that cannot possibly be done because another Department is removing money from the system.
Another problem arises because in some psychiatric hospitals, unless one has a sufficient number of clinical psychologists, one cannot apply for accreditation for the training of young psychiatrists. Therefore, we could end up magnifying the problems we already have in recruiting junior staff for psychiatric institutions outside the major centres because we do not have psychologists for accreditation to take place.
The Minister of State will be only too well aware that accreditation for training is one of the buzzwords with non-consultant hospital staff. It is a serious problem because the Royal College of Physicians, the Royal College of Surgeons, the Royal College of Anaesthetists and the Royal College of Psychiatrists are all advising people not to take posts that do not have accreditation. The Medical Council is also saying it will not subscribe to temporary registration of these posts if there is inadequate training. If there are no clinical psychologists there, it is described as inadequate training.
I applaud the Northern Area Health Board for trying to get a grip on the problem by training some clinical psychologists. I do not know whether they got the approval of the Department of Health and Children to fund the training of these 12 people, but really this is a case of biting off our nose to spite our face. We need to get money rapidly so that perhaps the course might get going at Christmas because they will hardly get much done now. It is ridiculous to pay staff to run a course because we have to fulfil their contracts while we have no students on the course.
Mr. Callely: I want to outline the background to this issue of the funding of the postgraduate course in clinical psychology in Trinity College Dublin. In 1995, the Department of Health and Children agreed that there should be a review of psychological services in the health service. For a number of reasons it was not until the second half of 1999 that the group commenced detailed work on its agenda. Given the considerable length of time that had elapsed between agreement in principle to establish the joint review group and the actual commencement of its work, and the evidence of growing pressures on the provision of psychological services, the joint review group decided that actions urgently required to address specific issues falling within its remit should not be delayed by the need to complete all of the group's work and prepare a final report.
As far as workforce planning was concerned, it was clear to the group that, on the supply side, the key factor was the inadequate number of postgraduate training places in clinical psychology. The joint review group therefore estimated, on a preliminary basis, that the health services would have a requirement for at least 50 new professionally qualified clinical psychologists per annum - about 30 training places over the level of provision at that time - in order to bring about an improved balance between the supply of and the demand for qualified staff.
The Department of Health and Children responded swiftly to the requirement for the provision of extra training places. In September 2000, the Department invited bids from all health agencies, including voluntary bodies, to provide additional trainee clinical psychologist posts in association with any of the recognised postgraduate training providers. Since the other existing training providers were not in a position at that time to provide the places within the required timeframe and given the urgency of providing the additional training places, all the increased training places were allocated to the Psychological Society of Ireland's postgraduate diploma course for a period of three years, commencing in the autumn of 2001.
Funding was allocated by the Department in November 2001 to the successful health agencies for the creation of 30 trainee clinical psychologist posts and also for the payment of course fees. The effect of this new funding has been to bring about a rapid increase in the numbers enrolled on the Psychology Society of Ireland's professional diploma in clinical psychology.
The Department is, therefore, currently supporting the provision of 30 additional postgraduate training places in psychology at the annual cost in excess of €1 million. There is no question of this funding, which is playing a key role in meeting the human resource needs of the psychology services, being withdrawn at this time.
Although a large number of agencies applied to avail of the increased places in autumn 2001, expressions of interest were not received from the area health boards in the ERHA region. In August 2002, the Northern Area Health Board applied for additional funding to be made available to support the provision of six extra places on the TCD doctoral programme.
The notes provided to me make reference to 2000 and then go on to state that in 2002 the Northern Area Health Board made provision for funding. The Senator may recall that prior to the creation of the ERHA, there was the Eastern Health Board which was abolished in 2000 and the Northern Area Health Board would not have been in a position to apply for funding at that time. It is something at which I must ask my Department officials to have a closer look. The management team and the officials of the Northern Area Health Board are doing a Trojan job in the infancy of their work in the creation of the new area health board, the NAHB.
As the substantial funding allocated by my Department, currently supporting the extra thirty PSI training places, has been distributed to those agencies that participated in the bidding process two years ago in 2000, this request is currently being examined in the context of the 2003 funding position made by the NAHB.
I understand that strenuous efforts are also being made to address the particular issues arising for the current TCD programme by the Northern Area Health Board and the other area boards, along with the Eastern Regional Health Authority and the other interested parties. It is hoped that these discussions will facilitate the commencement of the course at an early date. The Department remains committed to working on an ongoing basis with health agencies, educational providers and the education authorities to ensure adequate provision of training places, consistent with the human resource requirements of the health services.
Dr. Henry: I thank the Minister of State for pointing out that the Northern Area Health Board would not have been in a position to apply for funds in 2000. I agree with him that they work very hard and are a very progressive board. I hope he will reach into his long pocket and get something to give them so that they can get this course under way.
