Four patients cost HSE €3m in travel

The lack of a forensic learning disability service in Ireland has meant that the HSE spent over €3 million (€3,076,915) at UK facilities between 2005 and 2007 for the treatment of just four Irish people with learning disabilities who offend, IMT can exclusively reveal.
Part of this amount, or €22,889, was spent by the Executive on travel expenses for family members who visited patients in UK facilities during this time. Irish patients were treated by three service providers in the UK. These were: Northgate Hospital, Morpeth, Northumberland; Care Principles, which has a number of centres across England; and St Luke’s Hospital in Essex.

All of these specialise in the treatment and rehabilitation of adults with learning disabilities, personality disorders or autistic spectrum disorders, including those with a forensic background.According to the information received under Freedom of Information requests, between 2005 and 2007, HSE Dublin North East spent STG£801,592 (approximately €917,476) for the treatment of two patients at the Tweed Unit of Northgate Hospital, €1.7 million was spent by the HSE South for the care of one patient at Care Principles; and the HSE West spent €398,807 for one patient at St Luke’s Hospital in Essex.
The HSE South spent a further €20,389 on visits by family members to the single patient treated abroad – €10,947 in 2005, €6,430 in 2006 and €3,012 in 2007. The HSE Dublin North East spent €2,500 on family visits in 2005.
Commenting on the figures, Dr Peter Leonard, Senior Registrar in Forensic Psychiatry at the Central Mental Hospital in Dundrum, said he was surprised that the amount spent was not higher.
According to a position paper published last year called ‘Persons with a learning disability who offend: forgiven but forgotten?’ (by the Irish College of Psychiatrists), 10 people were placed abroad at the end of 2005.
Dr Leonard said that on the basis of this research and anecdotal evidence, there were sufficient numbers of patients being treated abroad to justify a service in Ireland.

“Notwithstanding initial capital costs, a forensic learning disability service could be provided in Ireland on the basis of equivalent revenue costs. It’s utterly unacceptable that very vulnerable Irish citizens should be transferred overseas for a service that could and should be provided in Ireland.
“Such a long-term approach also dislocates people from their home place, natural support network and their family. Purchasing such services abroad leads to lack of continuity of care when the service users return to Ireland to a situation where there’s no appropriate service to follow them up. Lack of investment in a local service makes seamless transition for patients virtually impossible.”

Dr Leonard added that there is also a vast population of people with a learning disability with forensic needs in Ireland who are currently being managed in services that do not meet their needs.
“Our survey indicated that there are over 100 people in Ireland who are urgently in need of a forensic learning disability service. Such a service would provide support and assessment for local services and assist them in managing those who not require a secure environment. Such support is also currently being purchased at some expense from the private sector in the UK.”
“There’s a significant population of persons in Ireland who urgently require a forensic learning disability service. Whatever the numbers placed abroad, there’s a clear need for a national service as a matter of urgency in order to ensure equity of access to appropriate healthcare for an extremely vulnerable group in society,” Dr Leonard concluded.
The Faculty of Learning Disability Psychiatry of the College of Psychiatry of Ireland is currently conducting a national survey of mental-health service providers to determine the number of people with a learning disability who are placed in services abroad, due a range of specific needs that cannot be met in Ireland – including forensic and autism-related needs.