Politicians have condemned the governance structure overseeing Kerry’s mental health services as “exceptionally confusing”.
Michael Fitzgerald, the chief officer for Cork Kerry Community Healthcare Organisation, admitted patients suffered as a result of the complex hierarchy system.
Representatives of the HSE appeared before the Oireachtas Health Committee on Wednesday to discuss the failings in the South Kerry Child and Adolescent Mental Health Services (Camhs).
The HSE reiterated its apology after the Maskey review of the care of more than 1,300 children found that 46 suffered significant harm.
The report, published in January, found that hundreds of children received “risky” treatment by a doctor working in the service.
I think the answers I'm getting are just so puzzling
Concerns raised about the doctor, who is not named in the report, sparked a review of services.
Social Democrats co-leader Roisin Shortall asked for details of the governance structure during 2016/21 in South Kerry.
Mr Fitzgerald spent several minutes attempting to explain the chain of command to the committee.
He pointed to a number of roles including the head of mental health services, the director of services, the chief officer, consultants and the Camhs governance group.
Dr Maura Young, executive clinical director for Kerry mental health services, admitted the structure is “complex”.
However, Ms Shortall and other TDs said they were “confused” and there was an impression that “everybody is responsible but no one is responsible”.
“I think the answers I’m getting are just so puzzling,” Ms Shortall added.
“I don’t know who is in charge of anything, and I feel like there’s all this different line management. Is it clinical? Is it administrative? Who does the buck stop with ultimately? And that is the question.
“I’d asked Ms (Anne) O’Connor if she would actually send us a diagram of the governance structure in South Kerry.
While we have good cover in place at the moment, from a consulting perspective, we would obviously like to have an ongoing permanent consultant in place.
“It’s exceptionally confusing and I can well understand how issues arise.
“I am totally confused. I don’t know who is responsible for anything, and you referred to about 20 different people, all kinds of different disciplines, clinical people, administrative people.
“It seems that nobody is in charge.”
Green Party TD Neasa Hourigan said she was “completely confused” by the structure, while Fine Gael TD Bernard Durkan said he was “thoroughly confused”.
Mr Fitzgerald agreed that the governance structure did not work and patients suffered as a result.
He added that officials are still trying to recruit a permanent consultant for South Kerry.
“Dr (Sean) Maskey also points out that we have a lot of work to do to create the conditions where we would attract a consultant in South Kerry, and it may not be that easy,” Mr Fitzgerald added.
“While we have good cover in place at the moment, from a consulting perspective, we would obviously like to have an ongoing permanent consultant in place.
“The governance arrangement needs to be reviewed so that we have an ongoing oversight right across Cork and Kerry and we build out structures accordingly.”
The committee was told that the whistleblower who reported the concerns about the doctor emailed the clinical director of Camhs and Dr Young.
Dr Young said they contacted quality and patient safety advisory chiefs and convened within two days.
She said that as there was no consultant in place providing oversight, it “all fell apart”.
Dr Young added: “When the concerns were highlighted to us by the local consultant at that time, he said, ‘look, I’m coming across abnormal prescribing patterns and I’m not happy with some of the diagnoses that’s being made’.
“What we needed to do was take a 10% random sample to see were the issues isolated or were they widespread across the whole caseload.
“At that time there was just over 500 cases opens, so we took a 10% sample, which is about 55.”
Anne O’Connor, HSE chief operations officer, said a nationwide review of services will take place.
“In order to provide assurance to families who need our services, the HSE’s National Oversight Group will be commissioning an independently chaired review of medication practice across all Camhs teams,” she added.
“The National Oversight Group will also commission an audit of compliance with operational guidelines, as well as a qualitative study of how those who use, work in and refer to Camhs experience those services.
“Information from the planned national audits will guide our continued efforts to enhance youth mental health services.”
She said an audit will begin with patients who attended with attention deficit hyperactivity disorder (ADHD).
