Wednesday, 25 January 2017

Health Service: Statements

I thank the Minister for coming to the House today to facilitate this debate. We all know the pressures the health service is under. The Minister is aware of my belief that the problems we see in secondary care will never be rectified until primary care is adequately resourced. To that end, we need to re-invest our efforts in training more young GPs, practice nurses and community health nurses. I know we spoke about the funding of the Institute of Community Health Nursing this morning during a Commencement debate, for which I thank the Minister.

I believe in a solution driven and pragmatic approach. To that end, I urge the Minister to sanction some extra funding for general practice out-of-hours services so that multiple GPs can work during particularly busy periods from mid-December to mid-January to help reduce referrals to accident and emergency departments. It is a simple, practical and solution-driven idea that would alleviate some of the pressures on the secondary care system.

I also ask the Minister to review our district hospital network, particularly district hospitals in rural areas like my own. Senator Conway-Walsh would also be very familiar with the hospital in Belmullet. These hospitals are a good distance from acute hospitals. For example, Belmullet is over 50 miles from one. The community hospital network should not be seen as a relic of a bygone era. I believe community hospitals have a pivotal role to play in a modern health service as they can fulfil multiple roles. For example, they can prevent admissions to acute hospitals because GPs can admit directly to them. They also facilitate discharges from acute hospitals. If somebody has a hip replacement, he or she can be transferred to a community hospital and receive rehabilitation with the help of a community physiotherapist in the community thus freeing up an acute hospital bed. More importantly, district hospitals can play a role that has been underutilised. They can work as an interface between the fair deal scheme and the acute hospital sector. If somebody is an acute hospital patient and applies for the fair deal scheme, they often wait a number of weeks in the acute hospital bed, possibly up to 12 weeks. There is no reason that the patient cannot be transferred to a community hospital for the intervening period before being transferred to the nursing home.That is another role that we should look at.

We also need, as the Minister said, to encourage community based investigations in general practice. My own surgery has an ultrasound scanner, a DEXA scanner for osteoporosis, spirometry for breathing testing and audiometry for hearing, to mention a few, but they are being under-utilised as there is no funding model available for medical card patients. This means that patients are disenfranchised as they have to travel to acute hospitals to have these investigations carried out, when they could be carried out in the community.

I take this opportunity to touch on two further topics. One is alpha-1 antitrypsin deficiency and the other one is narcolepsy. The Minister will be aware that 350 people are diagnosed with alpha-1 antitrypsin deficiency throughout the country. It is the most common genetic lung disorder in Ireland and can lead to severe lung, liver and skin problems. The majority of people with alpha-1 antitrypsin deficiency present with emphysema or chronic obstructive pulmonary disease, COPD. A new groundbreaking drug called Respreeza was shown to slow the progress of emphysema in a recent clinical trial. It was called the rapid study clinical trial, and 21 Irish alpha-1 patients took part. Since the trial ended these patients have been receiving the treatment from CSL Behring on a compassionate use basis. On 26 July last year patients were informed by the company that they would stop providing this treatment on 30 September. On 23 September this was extended until the 31 December 2016. Two further extensions were given, one until the end of January and the next until 28 February. These people are living in limbo, waiting month to month to find out whether they will receive the treatment which is changing the quality of their lives for the better. Unfortunately, on 9 December, the National Council for Pharmacoeconomics, the NCPE, published a decision to recommend against funding Respreeza. Alpha-1 patients are naturally devastated by this decision. They desperately need this issue to be resolved to prevent further distress and anxiety, and I would be grateful if the Minister could consider this.

The Minister will be familiar with the organisation SOUND, the support group for sufferers of unique narcolepsy disorder. It is seeking support to fund a national narcolepsy and related disorders service at St. James’s Hospital. It is envisaged that this unit will complement the existing paediatric service for younger people with narcolepsy. It is something which is urgently needed. Its cost, €1.6 million, is a drop in the ocean in the grand scheme of things within the HSE. The reason that this is particularly time sensitive is that the 80 young people who suffer from narcolepsy as a result of the pandemrix vaccine will soon be adults and will no longer be provided treatment under paediatric services.

There are approximately 1,600 patients with narcolepsy in Ireland. SOUND represents the people who developed the disorder as a result of the swine flu pandemrix vaccine. There are currently 80 plus members, and the funding amount of €1.6 million will provide staff, including a neurologist, a neurophysicist, a respiratory consultant, clinical nurse manager, dietitian, laboratory nurse and four lab technicians. The recognition of the association between the pandemrix vaccine and narcolepsy disorder has exposed the lack of proper treatment pathways for patients. A 2012 Government report recognised the link between the vaccine and the disorder, and it was withdrawn from clinics. Sufferers have to live with a range of debilitating symptoms, including hallucinations, cataplexy, increased risk of accidents and obesity, to name just a few. It is an incurable, life-long illness which impacts on all areas of their daily life. This is a unique problem. As a result of a public health programme there are over 80 young people who will never know what a normal life is. There needs to be a commitment from the Government to ring-fence funding so that life-long supports will be put in place for sufferers. There must be a seamless transition from paediatric treatment to the treatment of adult sufferers, and there must be a commitment for a multi-disciplinary centre of excellence.


Wednesday, 25 January 2017

Order of Business

Last week, I formally submitted proposed legislation, namely, a declaration of independence day Bill. It would formally recognise the crucial and historic events that were the meeting of the First Dáil and the declaration of independence, made on 21 January 1919, and ensure the designation of 21 January as our declaration of independence day. Given that its 98th anniversary has just passed, it is timely and important that this legislation be in place well in advance of the 100th anniversary in two years’ time.

Last year’s successful year-long 1916 centenary commemorations saw more than 3,500 events in Ireland and 1,200 abroad. These have introduced a new generation of Irish people to the events of 1916 and their impact on our nation. I have always been struck by how the meeting of the First Dáil and the declaration of independence on 21 January 1919 have not been commemorated to the level they should. On the 90th anniversary in 2009, a fantastic commemoration in the Mansion House was led by the former Taoiseach, Mr. Brian Cowen.

To ensure that 21 January is officially recognised as our declaration of independence day, I have drafted legislation and will seek Senators’ support in seeing it through the various Stages. There is no plan to designate a public holiday, but if we passed the legislation, it would allow schools, public bodies and community groups an opportunity to commemorate an important day in an appropriate way.

In proposing the Bill, I am conscious of the need to adopt the correct approach so as to ensure that 21 January 1919, a truly historic day for Ireland, is given the recognition that it deserves. I intend to hold a formal briefing in Leinster House for Members on the proposed legislation and I hope they will be in a position to attend.


Wednesday, 25 January 2017

Commencement Matters

Community Nursing

I thank the Minister for attending the House today to address my concerns regarding the Institute of Community Health Nursing. One thing we can be sure of is that all of us wish to be healthy, live long and have a family with few medical concerns but at one stage or another everyone here will use our health service, in some cases in an emergency and in others for longer term care. Therefore, we must develop, protect and care for our health services, something at which we are failing miserably. Despite the economies that have been forced upon us, we can be proud of the nurses and doctors who serve us so well. Their loyalty to us and their care should be mirrored by ours for them. The foundation of effective and economic care lies outside the walls of the high-tech hospitals and in the communities. Countless international studies from bodies such as the World Health Organization show that the highest quality and most equitable systems are based on the primary health care model, that is, the care we receive where we live.

My bias is not based on my profession as a GP in rural Ireland but on fact. Family doctors and public health and community nurses have a pivotal role to play. Every day they are serving young mothers and their babies – our future citizens – and caring for the elderly who cannot be as independent as they once were. They are a resource of which we can be proud and which we should nurture because they are our eyes in those communities. For years have been involved in the early detection of vulnerability and in identifying problems such as neglect, child and elder abuse, post-natal depression and the risk of suicide. Community health nurses are generalists. The community is their client and their caseloads include people of every age group across the whole health-illness spectrum, including mothers and babies, schoolchildren and older people as well as those with intellectual, mental and physical disabilities. They also provide care and support for those in need of palliative care as well as their families. They work from local health centres or primary care centres and provide a range of services free of charge to people, including child health visits and school visits, visits and care for older people and care on discharge from hospital. They provide home and clinical care to adults who have a nursing need and hold a medical card. They co-ordinate respite support for carers and assess the need for special equipment. These people knock on 10,000 doors every day, delivering services discreetly and effectively in a timely fashion.

These people are supported by the Institute of Community Health Nursing, a small yet vibrant body whose funding is far from adequate. In fact, it is abysmal. The organisation seeks the development of the profession in order to research what is done so it may be done better and to be an advocate for those who often cannot make their own voices heard. The ICHN is severely struggling to keep services running with the limited number of public health nurses available.We are all aware our population is ageing, and the Government and HSE are using this as justification and reasoning when explaining our crippled accident and emergency department crisis. The chronic ailments afflicting these people can and should be addressed by public health nurses in the comfort of their own homes, which afford them security and dignity. The waiting lists for older people to receive day-care services and for families to receive respite care when they need a break is a continual frustration and a bottleneck in the system.

The key word, and indeed a solution, is integration in our health system, with social services, hospitals, general practitioners and public health and community nurses working together, preferably through partnership arrangements, for the betterment of the health of our country. The problems we see in secondary care will never be rectified until primary and community care is adequately resourced.

Fianna Fáil will support this Bill, which makes necessary changes in several areas. I welcome the amendment of the Nursing Homes Support Scheme Act 2009, which underpins the fair deal scheme, to exclude ex gratiapayments to patients of the Lourdes Hospital redress scheme, the Lourdes Hospital payment scheme, the symphysiotomy payment scheme and schemes for individuals disabled by thalidomide, as well as the Magdalen laundry redress scheme that was catered for in a previous Act in 2009.

Separately I acknowledge the importance of including several over-the-counter medications under the general medical service, GMS, scheme for people with medical and long-term illness cards. It includes nicotine replacement therapy and emergency contraception. Unfortunately, however, prescription charges are not covered in this legislation and as we are all aware, prescription charges have increased in recent years from 50 cent per item to €2.50 per item. I believe this sole action discriminates against elderly patients who have many core mobility issues and are on multiple drugs but not of their own free will. I have always advocated a flat prescription fee or, ideally, no prescription fee should be put in place because in that way people who are vulnerable will not be jeopardised. This charge diminishes the quality of life of elderly citizens. As for the nicotine replacement therapy, it is worth remembering that there are almost 31,000 hospital admissions per year for cigarette-related illnesses in this country at a cost of €5,400 per admission. This equates to a staggering €164 million per year. To put this in perspective, the Minister afforded €40 million to the winter initiative.


Wednesday, 1 February 2017

Health (Miscellaneous Provisions) Bill 2016: Second Stage

Fianna Fáil fully supports the introduction of legislation to allow the Minister to make regulations to add certain elements to tobacco packaging and we published our legislation on this issue in 2012. Cigarette companies use marketing techniques to deliberately target young people. The Marlboro brand, identified by its iconic red chevron, is worth $21 billion, which is truly staggering.

In September 2015 the Seanad passed a Second Stage reading of a Private Member’s Bill, the Longer Healthy Living Bill, introduced by the Independent Senator, Professor John Crown. The Bill was supported through Second Stage by Senators from Fianna Fáil, Sinn Féin, Labour, Fine Gael and the Independent benches. The then Minister for Health, Deputy Varadkar, did not oppose it and highlighted a few suggestions including minor technical changes to improve it. During that debate the Minister stated “In terms of recruitment, there is an international shortage of consultants, doctors and nurses.” I have been examining the retirement of key personnel in the health service. It has now reached the point where significant changes are required. There are too many times when critical professionals within the health services are forced to retire due to their age and for no other reason. Our current health system is embattled by staff shortages, shortage of senior consultants, not enough general practitioners and a dearth of highly qualified specialist nursing staff. As Professor Crown said during the debate “Are we so flush with trained, experienced staff that we can afford to offload them involuntarily?” Since being elected to the Seanad I have engaged widely on this topic and while it does not address conditions, pay or otherwise, it is an evidence-based solution to an ever increasing problem.It is my intention to submit extensive amendments on Committee Stage which will be designed to allow health professionals to postpone their retirement with the mutual agreement of their respective employers in the HSE, organisations funded directly by it, the Department of Health and all other major health service providers. To ensure the amendments would be workable, I have reviewed and taken cognisance of the issues identified by then Minister for Health, Deputy Leo Varadkar, during that debate. I am seeking to incorporate them into the amendments I will be tabling on Committee Stage.


Wednesday, 1 February 2017

Order of Business

This morning, the Minister of State at the Department of Justice and Equality, Deputy Stanton, was present for a Commencement debate, which I initiated, regarding bodies under the Department’s remit and their investments in the tobacco industry. In response to a parliamentary question submitted by Deputy Jack Chambers, the Tánaiste confirmed that the common investment fund holds a small proportion of tobacco-related stocks as part of a dividend reinvestment scheme that affords charities the choice of receiving investment income in cash by reinvesting it in the fund. She also confirmed that the Courts Service invests in a small proportion of tobacco stocks on a passive basis. In light of the decision made by the Ireland Strategic Investment Fund, ISIF, shortly before Christmas to exit from its legacy tobacco investments, it is imperative that we have a full divestment of all taxpayer moneys from tobacco companies. It frustrates me somewhat to have to bring such a Commencement debate before this House. It is worth remembering that tobacco use in Ireland is a leading cause of preventable deaths, with approximately 6,000 deaths each year from the direct effects of tobacco. As well as the human and personal tragedies of each death, tobacco is the cause of an enormous drain on our health system. The direct cost, an estimated €500 million per year, does not include lost productivity from ill-health and other huge drains on our public services. There are approximately 31,000 admissions each year that are directly related to tobacco illnesses. Each admission costs €5,400, which equates to a staggering €164 million per year. The ISIF decision came as a result of pressure from within this House and from my party colleagues in Dáil Éireann. It is a welcome decision and one which is entirely in line with the tobacco-free Ireland plan, which was launched by Senator Reilly when he was Minister for Health. While I acknowledge the small nature of these investments, I also acknowledge the monumental efforts made by Members of this Parliament in combating the negative effects of tobacco use in this country. It beggar’s belief that we would have a Government Department with financial interests in any major tobacco corporation. I intend to continue to pursue this issue and to bring a motion of resolution before the Seanad seeking a full divestment and the implementation of guidelines to ensure no further investment in tobacco by a Government Department or any body under its remit.


Wednesday, 1 February 2017

Commencement Matters

Tobacco Investments 

I thank the Minister of State, Deputy Stanton, for coming to the House to discuss the investment of taxpayers’ money in the tobacco industry by two publicly funded organisations under the remit of the Department of Justice and Equality, namely the Charities Regulatory Authority and the Courts Service.In response to a parliamentary question submitted by Deputy Jack Chambers, the Minister confirmed that the common investment fund, CIF, holds a small proportion of tobacco-related stocks as part of a dividend reinvestment scheme that affords charities the choice of receiving dividend income in cash or reinvesting it back into the fund. According to the Minister’s response, the Courts Service also invests in a small proportion of tobacco stocks on a passive basis.

Following the recent commercial decision by the Ireland Strategic Investment Fund, ISIF, to exit from its legacy tobacco investments, it is now, more than ever, untenable for a Department or Government agency to have investments in this industry. The Minister for Finance, Deputy Noonan, the Minister for Health, Deputy Harris and the Minister of State at the Department of Health, Deputy Corcoran Kennedy, have each acknowledged and shared my concerns regarding the investment of taxpayer’s funds in the tobacco industry. It must not be forgotten that the companies in which the Department of Justice and Equality has investments are the same companies that threatened to sue the former Minister for Health and current Fine Gael Senator James Reilly and his successor, Deputy Leo Varadkar, for doing their job with regard to cigarette packaging and advertising.

In response to Deputy Jack Chambers, the Minister acknowledged that no guidelines are in place in her Department regarding such investments. The Minister further acknowledged that she was not aware of all of the investments made by organisations that are in receipt of grant funding from her Department. There must be a commitment to divest from such investments and guidelines must be put in place to ensure that no future investments in tobacco stocks are made. These guidelines should be Department-wide and prohibit any investment in tobacco companies.


Tuesday, 7 February 2017

Health (Miscellaneous Provisions) Bill 2016: Committee and Remaining Stages

I wish to discuss my amendments. I am disappointed that they were not ruled out of order. They were designed to address the situation of mandatory retirement for critical health professionals in the public health system.These are senior decision makers in our system, who are forced to retire for no reason other than their age. As Professor Crown stated during the 2015 debate, we are not so flush with trained experienced staff that we can afford to offload them voluntarily.

The Longer Healthy Living Bill 2015 received cross-party support. The Oireachtas Joint Committee on Justice, Defence and Equality examined in detail the broader issue of mandatory retirement in the context of the Employment Equality (Abolition of Mandatory Retirement Age) Bill tabled by the then Labour Party Deputy, Anne Ferris.

One of the submissions was from Dr. Enda Shanahan, who helped me formulate some of my amendments. He stated that two years prior to coming before the committee he was compelled to retire from the health service, where he worked as a specialist hospital doctor. He wrote to the management, and the then Ministers, Deputy Howlin and Senator Reilly, indicating he was able and willing to keep working in the public health sector after the age of 65. He explained he was physically fit, still running all distances up to and including marathons, and medically fit for purpose as certified by the Medical Council’s continuous professional development process. The answer was that retirement was mandatory on reaching the age of 65. At no point was any objective effort made to assess his suitability to continue working. He was retired purely because of a date in the calendar.

The health service is on life support. It is in dire need of resuscitation and reform. As a doctor and a Senator who is trying to be constructive, pragmatic and solution driven, I am bitterly disappointed the amendments have been ruled out of order on a technicality. The amendments would have helped in a small way to ameliorate the staff shortages which plague our health system. Last night, we saw the “RTE Investigates” programme which highlighted the shambles and cover-up that has become the norm in our health system. A simple “Sorry” does not cut it any more for the Irish people. We are embattled by staff shortages, a shortage of senior consultants, not enough GPs and a dearth of highly qualified specialist nursing staff. We have an ailing and failing health service. I intend to introduce to the House a new Bill comprising these amendments.

I remind Senators and the Minister of State that at present 250 consultant posts are unoccupied and 25% of all vacancies received no applications. I welcome Dr. Enda Shanahan, who contributed to the Oireachtas Joint Committee on Justice, Defence and Equality and who is in the Gallery.


Tuesday, 7 February 2017

Order of Business

I would also like to echo the sentiments around the House regarding the “Prime Time” report last night.It is shocking to think that 81,000 people are on a waiting list and 34,000 people are awaiting endoscopy procedures which are vital in the diagnosis of gastrointestinal cancers.

I call for an urgent debate on a separate issue, namely, to ascertain the plans the Minister has in place to safeguard the 50,000 or more employees who work in the pharmaceutical industry in Ireland. These people need safeguarding because of the policies of the President of the United States, Donald Trump. During his first press conference, the then President-elect decided to target the pharmaceutical and medical technology sectors. In doing so, the stock prices for major US pharmaceuticals dropped more than $25 billion in 20 minutes. It is the longer-term impact which can be more profound and about which we must be concerned.

My party colleague, Deputy Niall Collins, expressed his unease at President Trump’s comments at the time and also questioned the failure of the Government to spell out any plan to respond to the emerging threats to jobs in US owned companies in Ireland. One month on, the Minister for Jobs, Enterprise and Innovation, Deputy Mary Mitchell O’Connor, has yet to adequately respond to these threats or illustrate any kind of plan to deal with them. President Trump wants the US pharmaceutical companies to which Ireland is home to close up shop and return to the US. He has spoken forcefully about getting US pharmaceutical companies to make a return and imposing sanctions on those which do not.

It is worth remembering that Pfizer employs 3,200 people at six different sites across the country. AbbVie’s Irish operation employs more than 500 people in five locations across the country and Boston Scientific, which was founded in Galway in 1994, employs more than 4,000 people across Ireland. These are just a few of the companies that are providing jobs and benefitting the Irish economy.

If we have learned anything from the first 18 days of the reign of President Trump, it is that he was not simply paying lip-service throughout his campaign, and his plans for the pharmaceutical industry are no exception. He is a populist President and pharmaceutical companies are a popular villain. We cannot allow his comments, which are very likely to become actions, to rock a recovering country and one of our most fruitful industries.


Wednesday, 8 February 2017

Amendments to Councillors’ Conditions: Statements

I thank the Minister for taking the time to come to the House to address the concerns of local authority members. While not always a common feature in this House, there is unanimous support to have councillors’ pay and conditions comprehensively addressed.

Last year I compiled a comprehensive research report on mental health among local authority members that I sent to the Minister’s office. The findings give a stark insight into the immense pressures on local authority members. In 2014, local government legislation reduced the number of local authority members but, as the Minister will know, increased the size of the areas covered.

The measure had a knock-on effect on workload. It is little wonder that 82% of local authority members believe their responsibilities had increased in recent years; 79% said the role had impinged on family life; 68% said the demands of the job would make them consider not running for office again, as alluded to by Senator Boyhan; 67% have experienced mental stress as a direct result of their role; and over 50% have experienced sleep disturbance.

The term “24-7” was by far and above the most used phrase that appeared in the responses provided by the local authority members. The duties undertaken by local authority members are endless. As one respondent said: “Councillors are like social workers and sometimes we are the first to get a call when people are in trouble.”

There is a direct correlation between the terms and conditions of local authority members and the work, stress and pressures in their lives. One only needs to consider the sensible and realistic solutions given by councillors on how to alleviate some of their concerns. I beseech the Minister to listen to them and sort out this matter once and for all. I concur with Senator Davitt’s approach and proposals.


Wednesday, 8 February 2017

Oireachtas Joint Oireachtas Committee on Health

Catheterisation Laboratory Clinical Review: Discussion

I welcome Dr. Herity. I will follow up on something the Minister of State and Deputy Cullinane mentioned earlier with regard to the fact that 40% of the workload undertaken in UHW is performed by consultants Dr. Niall Colwell from South Tipperary General Hospital and Dr. Aidan Buckley. Why were these consultants not spoken to or consulted with? I would have thought it prudent for all stakeholders to be included in this process. Second, one of the recommendations in the report is an extra eight hours weekly in the cath lab in Waterford. I

t would take between 12 and 18 months using these eight hours to clear the current waiting list. This is not a solution; it is a sticking plaster. Why only eight hours? How many preventable cardiac deaths or events will have occurred in that 12 to 18-month period? In 2013, the lack of a second cath lab in UHW was noted by the HSE as being a “critical clinical risk on its risk register”.

Did Dr. Herity consider this when undertaking his report? In March 2016, the south west hospital group approved a second cath lab as a priority. It was signed off by the CEO and it was queued for funding? Did Dr. Herity consider this when he was conducting his report?


Wednesday, 15 February 2017

Order of Business

I wish to raise the incredible story of a concerned citizen, Paul Egan, who should be called a Good Samaritan. It started almost three weeks ago on 27 January in Keshkerrigan, County Leitrim, when Paul Egan, a HSE employee from Sligo encountered a very serious car crash. He witnessed an 18-year old woman, Tamara Jade Huxtable, from Drumshanbo, County Leitrim, wandering in the middle of the road after her friend’s car crashed into a wall.

As it was pouring with rain, he helped Tamara into the passenger seat of his car for shelter. They were soon joined by gardaí, and members of the fire brigade and ambulance service. During that time, Tamara began to lapse in and out of consciousness. Following very clear protocols, it was decided for fear of spinal injuries that Tamara would be cut out of the vehicle. This vehicle was not involved in the accident, but was the vehicle of Paul Egan, the Good Samaritan. In summary, his 2008 Opel Astra car was destroyed in the operation, including having its roof removed. She was then removed from the vehicle and airlifted away by helicopter.

The kindness of strangers such as Paul on that night helps prevent more serious injury. However, Paul Egan now has no car. A crowd-funding page has been set up by others to help him. He has had to hire a car to allow him to continue to work. Now the insurance company is passing the buck. It is an absolute scandal that a man who came to the assistance of somebody in serious danger that night in Leitrim is being given the run-around by the insurance company. It has even advised him that when he goes to renew his policy, it will treat it as if he had a claim from the accident, which is unbelievable.

I ask the Leader to intervene in this case with the Minister for Finance, and the Minister for Jobs, Enterprise and Innovation. Generous members of the public have raised money to get him back on the road and back to work. The insurance companies need to be brought to task over this. Despite all this, Paul Egan has said he would do the same thing again if he encountered the same scenario. He said, “I have teenage daughters myself and I’d be hoping someone would look after them if they had a problem.”


Wednesday, 15 February 2017

Commencement Matters

Coast Guard Services

I thank the Minister for coming to the House to address the glaring anomaly in legislation, or lack thereof, covering the Irish Coast Guard. As a medic on the west coast, I regularly liaise with the Irish Coast Guard and experience first hand the bravery and commitment of its members to serving the public while putting their own lives in danger. On every single call out they are exposed to dangers with which no other workers outside the emergency services are faced. As the Minister is aware, the Irish Coast Guard handles approximately 2,500 marine emergencies a year, assists 4,500 people and saves over 200 lives. It evacuates medical patients from the islands on hundreds of occasions. Irish Coast Guard helicopters are tasked around 800 times per year and the service makes 6,000 marine safety broadcasts to shipping, fishing and leisure crafts.

I am honoured to live and work on the coast with these brave volunteers and members of other emergency services which include the National Ambulance Service, the fire service, the Garda and the Royal National Lifeboat Institution, RNLI. When the bleep sounds, as a local general practitioner on call, all of the emergency services work as a collective unit. I have been privileged to take part in rescues at sea, on trawlers of Spanish fishermen and at the edge of cliffs, but,, sadly, there have also been drownings. When a casualty is taken ashore and dispatched via road in an ambulance or via an air ambulance and the emergency services discuss matters on the pier or wherever else, all of the responders are not treated fairly. That is the issue I have.

I support the call for the Irish Coast Guard to be designated as a stand-alone primary response agency. On a daily basis its members sacrifice and place themselves at the peril of the Atlantic Ocean and the dangers of the jagged coastline. It is within the Minister’s remit to legislate for this cohort of volunteers to put them on the same footing as other emergency service personnel. I am calling on him to engage personally and purposefully with them. Now is the time for action. There is no point in lauding them and telling them what we think of them. The fact of the matter is that there is a two-tier health system and we now have a two-tier emergency response service. Members of the Irish Coast Guard are being disenfranchised and treated differently from other emergency responders.This is unfair. It is time to show these heroes some respect. I invite the Minister to engage purposefully with them and to visit the west coast of Ireland in order to see, at first hand, the work they do so bravely. I think his eyes would be opened if he did so.


Wednesday, 22 February 2017

Symphysiotomy Payment Scheme: Statements (Resumed)

I will start with the words of one survivor of symphysiotomy:

They gave me gas and air and an injection, and took me to another room, where they tied my legs up on each side. There were two nurses on each side of me. I saw this doctor at the end of my bed with a big, long silver thing. They made a hole in your private parts, and he inserted this silver thing up and cut the pubic bone and pushed it over to widen your pelvis for you to deliver your baby yourself.

Petrified and in agony, the woman in question had just been subjected to a symphysiotomy. For the five days following the procedure, the new mother was ordered to lie completely flat with a corset around her hips to give her pelvis a chance to heal. For days, she was unable to see her daughter in the special care unit because there was no lift. To use her words again:

I have arthritis in my hip and in the bottom of my spine. I walk with a limp. No one can help – there’s no way back. I wear pads the whole time, and have been since the age of 23.

Symphysiotomy, which was seldom used in the rest of Europe after the mid-20th century, was carried out on an estimated 1,500 women in Ireland between the 1940s and 1980s. Ireland was the only country in the world where these childbirth operations were carried out in preference to caesarean section. Many attribute this to religious ideology and doctors who believed in child bearing without limitation. Whatever the reasoning, the outcome for women has been lifelong disability, chronic pain, mental suffering and in some cases family breakdown.

In 2014, the United Nations Human Rights Committee found the following in respect of Ireland:

The State party should initiate a prompt, independent and thorough investigation into cases of symphysiotomy, prosecute and punish the perpetrators, including medical personnel, and provide an effective remedy to the survivors of symphysiotomy for the damage sustained, including fair and adequate compensation and rehabilitation, on an individualized basis. It should facilitate access to judicial remedies by victims opting for the ex-gratia scheme, including allowing a challenge to the sums offered to them under the scheme.

In that context, we have done some of what the committee asked and I hope the publication of Ms Justice Maureen Harding Clark’s report on the surgical symphysiotomy ex gratiapayment scheme will bring some type of closure to the women who have been so badly affected by symphysiotomy. The historical indifference shown to survivors of symphysiotomy has meant some women still do not know exactly what procedures were performed on them without consent, resulting in some cases in them spending their entire adult lives in pain.

As a general practitioner, I swore the hippocratic oath. Historically taken by physicians, the oath is one of the most widely known of Greek medical texts. In its original form, it requires a new physician to swear by a number of healing gods to uphold specific ethical standards. It is considered a rite of passage for practitioners of medicine in many countries. While various modernised versions are often used nowadays, the message delivered is still the same – above all, do no harm. The medical practitioners who conducted the symphysiotomy procedure took the same oath but did not abide by it. I am glad this procedure plays no part in medicine in the 21st century.

The Fianna Fáil Party believes the scheme was a genuine attempt to bring a resolution to this matter. Many of the findings of the report make for very distressing reading. The practice of symphysiotomy had stopped in other countries many years before it ceased in Ireland. When it went wrong it caused many debilitating physical, psychological and emotional side effects and many women experienced medical problems for decades. I hope they will be able to access the treatment and supports they badly need. Unfortunately, four of the women affected passed away before the final report was published.

Thankfully, symphysiotomy is no longer an accepted practice in obstetrics. It is crucial that the medical profession learns lessons from the past. I sincerely hope the Institute of Obstetricians and Gynaecologists will study the report in detail.


Wednesday, 22 February 2017

Order of Business

Over recent weeks, the appalling condition of Ireland’s health system, particularly the unacceptable waiting lists, has been to the fore. The Euro Health Consumer Index has ranked Ireland’s health care system 21st out of 35 countries. Ahead of Ireland are countries with much lower incomes, such as Macedonia and Slovenia. Our accident and emergency unit waiting times are the worst in Europe. The report expresses surprise, which I imagine is tinged with disgust, over the low ambition of the HSE to have a target of no more than 18 months for a specialist appointment. We learned from the report that even if and when the target is reached, we will still have the worst waiting time in Europe.

I implore the Minister for Health to examine the Macedonian system, in which, through an uncomplicated e-booking system, a general practitioner can book an appointment with any specialist or any heavy diagnostic equipment in the country in real time while the patient sits in the room with him. The general practitioner has access to the diaries of consultants and can see where in the country a consultant has an opening. He can advise the patient based on need. In Macedonia, this system eradicated waiting lists in less than six months after start-up. In one year, the Macedonian rating in the Euro Health Consumer Index jumped from 27th to 16th. We could aspire to this.Experts have testified that Ireland would be a perfect candidate for a system such as this. Coupled with the Fianna Fail Party health policy proposal that all hospitals have 8 a.m. to 8 p.m. consultation times enforced and diagnostic scans available in public hospitals seven days a week, we could eradicate waiting lists here too.

I am well aware that the implementation of electronic systems in this country does not have a good track record. There will be plenty of people reminiscing on electronic voting and the Eircode system, but we need to realise that key targets on waiting lists were missed in 2014. The targets were widened in 2015 and still missed, and likewise in 2016. The current system is not working. We need a concerted common sense effort, such as the Macedonian system, and I will be bringing this to the attention of the Chairman, Deputy Michael Harty, in the Joint Committee on Health, for consideration.


Wednesday, 1 March 2017

North-South Interconnector: Motion

I welcome the Minister, Deputy Naughten to the House. I support this motion and I commend my colleagues Senators Gallagher and Wilson on calling for an independent expert review. I also welcome to the House Councillor Clifford Kelly who has been a long-term campaigner on this issue, as well as Deputy Cassells.

I have spoken today to a councillor of more 33 years’ experience from the region. He informed me that he has never seen such resolve by the public over one issue. It is his opinion, and I would have to concur with him, that any potential savings by placing these cables overground will be usurped through a lengthy legal battle in the courts and possibly in the EU courts. When we talk about costs it is also worth considering that €8 million was wasted on a flawed planning application three years ago, which was withdrawn at hearing stage. The current planning application by EirGrid to place cables overground may also be flawed as only 30% of the route was actually surveyed and 17% of the route was inaccessible. Obviously there are potential and widespread inaccuracies in this which could have subsequent cost implications.

In 2014, the then Minister for Health, our colleague, Senator James Reilly, decided to inquire about the potential health effects on people who are living in close proximity to high voltage overground power cables. By doing so he made the point that people feel a deep unease about living next to major electromagnetic fields. There have been claims and counter-claims about various illnesses that can be attributed to living close to electricity pylons.

As a GP, I can honestly say that if a patient who has attended my clinic for many years suddenly found themselves the unwilling neighbour of a 50 m high pylon and complained of symptoms they never had before, then I would wonder if there was a direct link. Scientific efforts to analyse electromagnetic fields around pylons and their possible relationship to cancer and other diseases began as far back as the 1970s, instigated in the US by reports of increased numbers of children with leukaemia who lived in the vicinity of power lines.

Professor Denis Henshaw, the British physicist and professor of human radiation effects at Bristol University, has listed the increased possible health risks of living close to power lines such as childhood leukaemia, adult leukaemia, Alzheimer’s disease, brain tumours, depression and many other illnesses.

The EirGrid chief executive at the time, John O’Connor, did little to calm fears when he admitted, before an Oireachtas committee in 2013, that he would not like to live close to a pylon. EirGrid dismisses these concerns and insists there is no evidence to support them. It may not have been proved but that does not mean it does not exist. Professor Anthony Staines, chair of health systems in the School of Nursing and Human Sciences at Dublin City University has said that there is simply not enough certainty. I for one would not like to take the risk.


Wednesday, 1 March 2017

Critical Health Professionals Bill 2017: First Stage

I move:

That leave be granted to introduce a Bill entitled an Act to ensure that critical health professionals who are employees of all organisations funded directly by the Department of Health, all organisations funded by the Health Service Executive, all organisations funded under section 38 of the Health Act 2004, and all other health and disability service providers, may, if they wish, postpone their retirement where they would otherwise have been forced to retire at a particular age that is stipulated in their employment contract, subject to dual consent being in place between the employee and the employer, and to provide for related matters.

I thank the Leader for amending the Order of Business. This pragmatic solution will allow critical health professionals to stay on in their roles beyond retirement age. It seems ludicrous that we haemorrhage vastly experienced personnel. It is an arbitrary age in the calendar. I hope this will get cross-party support in the House.


Wednesday, 1 March 2017

Order of Business

I wish to propose an amendment to the Order of Business to the effect that No. 10 be taken before No. 1 today. The former is the Critical Health Professionals Bill 2017, which would allow all critical health employees of the Department of Health, the HSE and section 38 organisations to prolong their working lives for an initial two years on the basis of dual consent. This issue was first raised as an amendment to the Health (Miscellaneous Provisions) Bill 2016, which passed through this House recently and which received widespread support from those on all sides. I am not suggesting that the Bill will cure the woes of our health system but it will help to ameliorate some of the issues surrounding staff shortages and the haemorrhage of talented and vastly experienced staff from our health service.


Wednesday, 1 March 2017

Commencement Matters

HIQA Reports

I thank the Minister of State for coming to the House to address this very serious issue. As the Minister of State is aware, HIQA released a report in December regarding financial irregularities in the Greenmount property at the St. Mary’s, Drumcar, campus of St. John of God. The report found that the residential centre for people with disabilities took thousands of euro from the private accounts of residents without their consent to fund services which the centre should have funded. At the time, the St. John of God campus was home to 22 residents with intellectual and physical disabilities. This fraudulent activity included taking €2,300 from a resident for a specialised armchair. Another resident was charged €2,500 for an armchair and a bone density scan and another resident was charged €552 for a body brace. Bone density scans cost, at most, €100. This is absolute exploitation of the most vulnerable in our society.

Last week, we heard recollections from the advocacy group, SAGE, of a patient with dementia being charged €20 per month for activities that she could not participate in. In addition, another resident was charged €100 for laundry identification tags. There was a weekly charge for a doctor, which was totally immoral because the patient had a medical card. This is absolute fraud and it needs to be addressed.

In response last week, four of the eight residential units at the St. John of God facility in Drumcar were deemed not fit for purpose by HIQA. As my party colleague, Deputy Declan Breathnach, has rightly pointed out, Drumcar needs investment and support, not to be closed down. He will be calling on the Minister in the Dáil for support to ensure the facilities at Drumcar are improved to provide modern delivery of care for the many who still need institutionalised care at the facility. We are trying to get away from congregated settings to community settings; we need integration and not segregation. Currently there are over 2,723 people in congregated settings. The Minister of State needs to initiate a full review of the services provided by St. John of God in Drumcar and to meet the needs of the facility head-on by investing in what is required.


Tuesday, 21 March 2017

Order of Business

Ba mhaith liom ar son Fhianna Fáil agus ar mo shon féin comhbhrón a dhéanamh le clann agus le cairde Martin McGuinness agus lena pháirtí, Sinn Féin. Polaiteoir den scoth ab ea é. Bhí ról an-tábhachtach aige i bpróiseas na síochána. Cuimhním go maith ar an lá stairiúil deich mbliana ó shin nuair a bhí sé i Stormont le Ian Paisley, Tony Blair, Bertie Ahern agus Peter Hain. Ar dheis Dé go raibh a anam dílis.

Ba mhaith liom freisin cúpla focal a rá mar gheall ar an tubaiste i gceantar Iorras i gContae Mhaigh Eo. Blacksod Lighthouse is situated at the very tip of the Erris Peninsula. It remains the centre of the search operation under way around Blackrock for Irish Coast Guard helicopter Rescue 116. Mr. Vincent Sweeney is the keeper of the lighthouse and it was he who was on duty awaiting the return of Captain Dara Ftizpatrick and her colleagues to refuel. Sadly, they never returned. As we all know, weather and sea conditions have played havoc with the search operation for Mark Duffy, Ciarán Smith and Paul Ormsby.

It is somewhat prophetic that a weather forecast from the same lighthouse, relayed by Mr. Ted Sweeney who was Vincent’s father, just after 2 a.m. on 3 June 1944 contained a warning about a force 6 wind and a rapidly falling barometer at Blacksod. On receipt of this information, General Dwight D. Eisenhower postponed by one day the planned invasion of Normandy by allied forces. The actions of one man in Blacksod, County Mayo helped to avert a military catastrophe and changed the course of the Second World War and eventually led to the fall of Nazi Germany. Despite immense technological advancements since that day in 1944, the perils of the north Atlantic Ocean and the unpredictability of the weather remain the same.

There are around 300 people, mostly volunteers, involved in the massive operation to find the helicopter and the remaining members of the crew. Unfortunately, weather conditions and the crashing waves of the Atlantic Ocean pose an immense challenge. All of us who have been involved with the volunteers – I include my colleague, Rose, in this – want to see the families reunited with their loved ones. There is a quiet resolve on the Erris Peninsula to complete the task in hand. The response of the local community has been truly incredible. They are responsible for three distinct aspects of the mission. The first involves the provision of local knowledge from fishermen neighbours and friends who have been instrumental in the search. The second is the land search by local volunteers that has yielded important parts of the wreckage. The third is the welfare of the searchers and members of the emergency services. Food has been provided for 250 people each day.

What is unique about the operation is the collaboration between the air accident investigation unit, the Garda, the Irish Naval Service, the Air Corps, Civil Defence, the Royal National Lifeboat Institution, RNLI, Mayo County Council and the Irish Lights vessel Granuaile. They have all worked together under the direction of the Irish Coast Guard.

As I have said previously in the House, on every single call-out members of the Irish Coast Guard are exposed to dangers, with which no other workers, apart from members of the emergency services, are faced. There are many people alive today in Ireland who owe their lives to the bravery and skill of Captain Dara Fitzpatrick and her fine colleagues. It has been touching to hear so many such stories as the nation has expressed its gratitude to these brave heroes. It was striking to listen to the brave words spoken by the family of Captain Dara Fitzpatrick: “We feel like the lucky ones now because we have her. We can kiss her. We can hold her.”

Over the weekend I was in Blacksod Lighthouse with Mr. Vincent Sweeney and some of the immediate family members of the three missing crew members. Another D-Day is being planned. I know that I speak for every person involved in the search operation in County Mayo and the nation when I say we all hope the families of Mark Duffy, Paul Ormsby and Ciarán Smith will have their own D-Day when their loved ones are discovered.


Wednesday, 22 March 2017

Order of Business

On behalf of myself and Senator Conway-Walsh I would like to welcome pupils and parents from Corclough national school in Belmullet here today.

Today we read in the newspapers that Ireland tops the list internationally for people drinking alcohol at home prior to going to the pub, with 85 % of people engaging in this practice. Considering that one in three hospital admissions is a direct result of alcohol consumption, can I ask the Leader when is it proposed that the Public Health (Alcohol) Bill will come back to this House?


Wednesday, 29 March 2017

Order of Business

An tseachtain seo caite, labhair mé anseo mar gheall ar an obair thábhachtach i gceantair Iorras i gContae Mhaigh Eo. Leanann an obair go stóchúil agus Dé Domhnaigh seo caite tugadh isteach corp Captain Mark Duffy.

The dignity with which Captain Mark Duffy, from Rescue 116, was borne ashore on Sunday last is something that will stay with me forever. He gave his life so that others might live. Along with his colleagues, he was a hero and somebody to hold up as a role model to our children. Heroes do not arrive out of nowhere. They are the embodiment of their family and often their communities.

Captain Mark Duffy will be laid to rest tomorrow in his home village of Blackrock in County Louth. It is striking that his funeral notice reads: “Mark’s wish would be for you to carry an organ donor card.”

It is very fitting that this notice by the Duffy family comes just at the start of Organ Donor Awareness Week that has been organised by the Irish Kidney Association. Many people here in the Seanad have done great work to promote the importance of organ donation, including my colleague, Senator Mark Daly. Approximately 700 people in Ireland await life-saving heart, lung, liver, kidney and pancreas transplants. Thanks to the gift of organ donation over 3,000 people in Ireland enjoy an extended life. Just like the thousands rescued by the Irish Coast Guard, they too have been rescued and given a new lease of life.

While the focus of Organ Donor Awareness Week is to raise awareness, I was heartened to hear what the Minister for Health said yesterday. He said:

[He has prioritised] the development of legislation to provide for an opt-out system of consent for organ donation. My Department is currently working on this in the context of the work required to develop an overarching human tissue policy and legislative framework.

He also said that he intends to bring a memorandum to Government shortly on this matter. I urge the Leader and his Government colleagues to keep the pressure on so that this can happen as it will save lives.


Tuesday, 4 April 2017

Critical Health Professionals Bill 2017: Second Stage

I move: “That the Bill be now read a Second Time.”

Cuirim fáilte roimh an Aire Stáit, an Teachta Corcaran Kennedy as bheith anseo inniu. I mo thuairim féin agus mo pháirtí Fianna Fáil, tá an Bille seo an-tábhachtach agus ba mhaith liom buíochas a ghabháil le mo pháirtí Fianna Fáil agus ár seanadóirí. Freisin, fuair mé go leor tacaíocht leis an Bille ó dhaoine sa tseirbhís sláinte, agus roinnt comhairleoirí. Is mór an onóir dom ar son Fhianna Fáil an bille seo a chur chun tosaigh sa Seanad. Ocht seachtain ó shin, i rith díospóireacht eile anseo, labhair roinnt seanadóirí i bhfabhar an rúin. Seanadóir Devine agus Conway-Walsh ar son Sinn Féin, Seanadóir Reilly ar son Fine Gael agus bhí mé an-sásta leis on tacaíocht ó Seanadóir Marie-Louise O’Donnell freisin.Tá na fadhbanna leis an tseirbhís sláinte níos tábhachtaí ná aon fhadhb eile agus tá an fhadhb níos measa anois ná riamh.

It goes without saying that the problems with the health service are the most important problems we face in Ireland today. Unfortunately many of these problems are getting worse with time, not better. It genuinely gives me no pleasure in saying this, but it is an important backdrop to this legislation and the thinking behind it. It is important to acknowledge the huge interest shown in this Bill by fellow Senators, and it demonstrates to me the determination from members to be constructive and solution driven, for our health system here in Ireland. The Minister of State, Deputy Corcoran Kennedy, and her officials are all most welcome and I look forward to hearing her thoughts on the issues which this Bill raises.

I acknowledge the support from Senators on all sides of the Chamber for what is contained in this Bill. As Members and the Minister of State will recall, I attempted to introduce a series of amendments to the Health (Miscellaneous Provisions) Bill 2016 when it was before us two months ago. Unfortunately, the ruling was that the amendments were out of order as they involved a potential charge on the Exchequer. It was on that basis that I produced a new Bill, the Critical Health Professionals Bill 2017, which contains exactly the same provisions as the previous amendments that I had proposed. I am very grateful for the public support expressed by Senators Reilly, Devine, Conway-Walsh, Wilson and Marie-Louise O’Donnell, and by the numerous other Senators who spoke to me after that debate, urging me to continue to pursue the matter through a Private Members’ Bill. Senators Mark Daly and Robbie Gallagher kindly co-signed the Bill to get it to where we are now, and I thank them for that, as I do Councillor Damien O’Reilly of Fianna Fáil from Dunboyne in County Meath who has played an important role in helping to get this legislation to the floor of Seanad Éireann.

When I spoke about this issue previously in the house, I welcomed Dr. Enda Shanahan to the Public Gallery. His insights, research and dedication to this issue are an inspiration to us all. He is a man whom the laws of this land forced to retire from the public health system due to an arbitrary date. When we met here a number of months ago, his research and his folder of notes on the matter were a sight to behold, and he quietly encouraged me that day to keep the flag flying on this issue. I salute Dr. Shanahan for his service to this State in the public health system and my only regret is that he is unable, unfortunately, to benefit from the changes planned under this Bill as he has retired from the public health service.

This Bill is designed to address the situation of mandatory retirement for critical health professionals within the public health system. It is one part of a range of solutions that can be addressed easily, and I am very grateful for the time which Minister for Health, Deputy Simon Harris, spent with me going through the various aspects of this Bill. He is to be commended on the interest that he has shown in this, and he has informed me that he wants to see this Bill move along speedily through the legislative process, if at all possible. There are too many times when critical health professionals within the Health Service are forced to retire due to their age and no other reason. This Bill sets out to change that while at the same time seeking to address chronic staffing problems in the health service.

An interesting question was raised with me about this Bill. What category of professional within the health service is a critical health professional as outlined in the Bill? This is a really important question and I am happy to inform the House that I have addressed that specific issue in section 2 which requires that the Minister introduce procedures by regulation that can set out the category of health professionals to whom this would apply. It is worth noting that the global shortage of health professionals is unlikely to change any time soon. There is however a compelling logic in allowing the Minister for Health to renew or revise periodically the categories of health professionals that are covered by the Act. This is similar to how certain aspects of employment legislation operate, such as the employment permits legislation which governs the critical skills employment permits, as well as the highly skilled eligible occupations list operated by the Department of Jobs, Enterprise and Innovation.

I am conscious that this legislation has to be workable, and while I have very strong personal and professional views about the arbitrary retirement age as it exists, I know that there is an urgency to the issue I seek to address. There is little point in introducing legislation to this Chamber that has no hope of being enacted. In the previous Seanad, the former Senator, Professor John Crown, did great work on this very topic, and I suggest that Members review that debate in 2015 if they wish to get a deep understanding of where he was coming from with his legislative proposal. His Bill was entitled the Longer Healthy Living Bill and was supported through Second Stage in Seanad Éireann by Fianna Fáil, Sinn Féin, the Labour Party, Fine Gael and the Independent Senators. I know Professor Crown is critical of an aspect of this Bill as proposed, specifically with regard to the dual consent provision. I will explain why I have included a dual consent provision, because this is central to this Bill being able to make an immediate impact, which I hope will ensure it does not get bogged down in legal or contractual challenges.

I believe mandatory retirement is an archaic system, but I do believe that in the absence of a more formalised system in its place, we must tread carefully. This Bill could have gone further, but upon careful examination of the law, I have chosen to deal with the issue in this manner. Under this Bill, as proposed, the option for an employee to retire is not affected and nobody will be required to work past their retirement age unless they wish to do so. This is the first part of the dual consent process. The second element of this process required under this proposed legislation would mean that both the employee and the employer would have to consent to an extension past the mandatory retirement age. In having this provision, it allows both parties to contract out the new arrangements and does nothing to impact upon the legal rights of others.

In addition to the Bill presented in 2015 by former Senator Crown, this is an area where a lot of legislation has been proposed. In the previous Oireachtas, the Employment Equality (Abolition of Mandatory Retirement Age) Bill, was put forward by Deputy Anne Ferris from the Labour Party. Just a few weeks ago, the Dáil had a Second Stage debate on a Bill sponsored by Deputy John Brady from Sinn Fein, called the Employment Equality (Abolition of Mandatory Retirement Age) Bill 2016. From what I could see from this Bill from Deputy Brady, it is worthwhile and Fianna Fáil supported it in the Dáil. Separate to that, my Fianna Fáil colleagues, Deputies Willie O’Dea and Mary Butler, have also produced an important Bill, namely, the Employment Equality (Amendment) Bill 2016. They too have engaged widely on the matter and have been very clear in their desire to see change in this area.

I highlight these other Bills to outline to the House the exact difference with this Bill. It is, I believe, one that could have a very immediate impact on the crisis in our health system. During the debate on this issue in February in Dáil Éireann, the Minister of State, Deputy Stanton, illustrated that the Sinn Féin Bill would involve unilaterally setting aside the retirement provisions of most existing employment contracts and would have serious implications for public sector employment, pensions policy and the wider labour market. These are all things that can be addressed, I am sure, to strengthen that Bill as it goes to Committee Stage. It does, however, highlight the legal minefield that exists in this area.

The reason I have chosen the dual consent model is to navigate the complexity of Article 15.5.1° of Bunreacht na hÉireann. The Constitution precludes the Oireachtas from declaring unlawful acts which were not so at the date of their commission. It would certainly give ample opportunity for substantive legal challenge as the Bill in the Dáil, as I understand it, appears to apply retrospectively to pre-existing contracts of employment. I am no constitutional lawyer, but I am certain that the Attorney General will have something to say about that.

In the previous Oireachtas, the Committee on Justice, Defence and Equality examined in detail the broader issue of mandatory retirement, and it received incredible submissions and presentations from the public on the matter. I want to read again a passage from Dr. Enda Shanahan’s formal contribution and testimony to that Oireachtas committee. In November 2015 he said:

“Two years ago I was compelled to retire from the health service where I worked as a specialist hospital doctor. I wrote to management, [then Minister for Public Expenditure and Reform, Deputy Brendan Howlin] and to [then Minister for Health, Deputy James Reilly], indicating that I was able and willing to keep working in the public health sector after age 65. I explained that I was physically fit – still running all distances up to and including marathons- and medically fit for purpose as certified by the Medical Council continuous professional development process … The answer was that retirement was mandatory on reaching age 65.”

“At no point was any objective effort made to assess my suitability to continue working. I was retired purely because of a date in the calendar.”

I will now take Members through each section of the Bill. Section 1 is a standard section setting out the various definitions used in the Bill. The key element of section 2 would allow the Minister for Health to introduce regulations to allow critical health professionals remain in their roles past the age at which they otherwise would be required to retire.In practical terms, it would allow the mandatory retirement clause in the employment contract to be set aside, to allow health professionals to continue working under the same conditions they would otherwise have enjoyed had they not been required to retire at that age.

There are two parts to section 3. The option for an employee to retire is not affected by this legislation and nobody will be required to work past their retirement age, unless they wish to do so. There is an important dual consent process required under the proposed legislation, which would mean that both the employee and the employer would have to consent to an extension past the mandatory retirement age.

Sections 4 to 6, inclusive, can be viewed together and they confirm that the same terms of conditions of employment would continue for staff, as set out in the conditions of employment.

Section 7 sets out that in order for health professionals to have their mandatory retirement age clause ignored, they would be required to inform the chief executive officer or the equivalent within their respective organisation, not less than three months before they reach their mandatory retirement age. This is to allow for management and the employee to engage constructively and formalise an agreement.

Section 8 has four parts. Part 1 specifies that the dual consent process to allow this to happen requires the written consent of both employee and employer. This written consent must be in place before the employee reaches the mandatory retirement age. Part 2 sets out that this agreement would include the timeframe permitted for an extension of employment, which may be up to two years initially and may be extended once, for a further two years, as long as the dual consent remains in place between both parties.

Part 3 states that these changes are not available to an individual who has previously availed of early or voluntary retirement. Part 4 is a practical section to make provisions so that if individuals who have availed of an extension of employment become unfit to work as per their work contract, they shall retire immediately under the terms of their employment.

Section 9 has two parts. Part 1 specifies that the legislation, if enacted, will apply to all organisations funded directly by the Department of Health, all organisations funded by the HSE, organisations funded under section 38 of the Health Act 2004, and all other health and disability service providers. In conjunction with the commencement of the Act, the Minister shall publish a list of all the organisations that the Act shall apply to. Importantly, it is provided that the Minister shall update the list to reflect any changes to organisations, including mergers, name changes and newly-established entities. Section 10 deals with the Title and commencement details.

I want to see this Bill become law, but I also want it to become good law and I know from speaking to the Minister, Deputy Harris, that he is committed to this also. In my career in medicine, I have encountered many highly-skilled consultants, doctors and nurses who did not want to retire but received a letter informing them that they were no longer of service to the State. This makes no sense to me. There have been too many instances where critical health professionals within the already overstretched health service have been forced to retire due to a date on their birth certificate and no other reason.

As a doctor I know that our current health system is embattled by staff shortages, shortage of senior consultants, not enough GPs, and a dearth of highly-qualified specialist nursing staff. Therefore, we need to do something, as the status quo is not working. This Bill is one step in the right direction in helping to erase those problems.

I thank Senator Davitt for seconding the Bill and I welcome everybody’s comments. I acknowledge Senator Colm Burke’s work in the health sector. This Bill is not confined to consultants although the Senator spoke extensively about them. It involves many health professionals. It is important to realise that this Bill will allow the Minister to revise and review periodically the categories of health professionals covered in the Act. That is included in the Bill. The dual consent is designed to navigate the complexity of Article 15.5.1o. The Constitution precludes the Oireachtas from declaring unlawful acts “which were not so at the date of their commission”.

I also welcome Senator Devine’s comments and acknowledge the balance she mentioned regarding the younger and older members of the health service. I fully condone her comments on equality in the health service and thank her for supporting the Bill. I value the sentiments expressed by Senator Buttimer. I know that he speaks from his experience as Chairman of the Oireachtas Joint Committee on Health. He acknowledged that we are losing practical knowledge and experience unnecessarily due to an arbitrary date in the calendar.

I agree that it is a shame that Senators are not members of the Oireachtas Committee on the Future of Healthcare because we all want to achieve the same goal and improve the outcome for patients.I welcome the Minister of State’s comments. The last thing we want this Bill to do is be discriminatory in nature. We are trying to get over that hurdle. This is why I included in the Bill a provision that the Minister can periodically revise the categories included in the Bill, for example, therapists mentioned by the Minister of State, in the same way as applies with the employment permit legislation. Regarding the Minister of State’s concerns about employees covered by the Bill and agencies that might be included under section 39 of the Health Act, I look forward to working with the Minister and the Department to clarify this matter in the coming months.

In respect of dual consent and contractual issues, it is important to realise that this Bill allows both parties – the employee and the employer – to contract out the new arrangements. There is nothing that will impact on the legal rights of others. From speaking to colleagues, I honestly believe that many health professionals would take up this offer if it was on the table. I look forward to the Bill coming before the House in six months.


Wednesday, 5 April 2017

Adult Safeguarding Bill: Second Stage

I, too, commend Senator Kelleher on the effort she put into this Bill. It is fantastic. Fianna Fáil is happy to support and co-sponsor this Bill which aims to put additional protections in place to protect all adults from the possibility that at some stage in their lives they may be at risk of abuse or harm. I also welcome members of the Support and Advocacy Service for Older People, SAGE, and the National Safeguarding Committee as well as members of Senator Kelleher’s family.

This Bill’s goal is to ensure cases like Grace, Áras Attracta, with which I would be very familiar in my area, and many others will never happen again. This Bill provides for mandatory reporting by certain professionals and others where an adult has suffered abuse or harm, is suffering abuse or harm or is at risk of suffering abuse or harm. It is important to identity what is meant by abuse and harm. Harm includes assault and sexual and financial abuse. Abuse includes acts, failure to act or neglect which results in a breach of a person’s constitutional or legal rights, physical and mental health, dignity or general well-being and may include, ill treatment, intimidation, humiliation as we saw in the Áras Attract programme, overmedication or undermedication, censoring communications, invasion or denial of privacy or denial of access to visitors.

In 2014, the RTE “Prime Time Investigates” programme exposed the high levels of abuse of adults in the Áras Attracta setting in Swinford, County Mayo, with which I am very familiar. It heightened the awareness of abuse of adults nationally and solidified the need for comprehensive action and legislative reform. We were all shocked, and certainly I was, at the disgusting behaviour of health professionals on the night of that programme, and I was truly hurt and embarrassed as a health professional to witness what we did on that night. I hope we will never see the likes of it again.

The proposed legislation is informed by the following principles: the promotion of individual physical, mental and emotional well-being, and the right to assistance, support and an independent advocate. We might ask what is an independent advocate. It is important that a person speaks or writes in support or defence of a vulnerable person. That is what an advocate is. Other principles include the right to protection from abuse and neglect; interventions in people’s lives must be necessary and appropriate; and there must be respect for people’s autonomy in decisions and interventions affecting them.

It is also worth acknowledging that a great deal has been done in recent years. The Health Information and Quality Authority, HIQA, is now ten years old. The enactment of the Children First Act is another welcome development and improvement. Similarly, the passage of the Assisted Decision-Making (Capacity) Act is a further manifestation of improving standards. It is to be hoped we will soon see the passage of a disability (miscellaneous provisions) Bill to ratify the UN Convention on the Rights of Persons with Disabilities as a another positive step. I commend Senator Dolan on all his work in this regard and the Minister, Deputy Harris, on his commitment to reform.

With respect to the HSE’s response to the Grace case, one of the most important and significant recommendations of the Conal Devine report was the provision and the implementation of a safeguarding policy for vulnerable adults. The HSE launched a national safeguarding policy for vulnerable adults in 2014, and while the safeguarding policy is currently not supported by legislation, it is a significant development in the protection of vulnerable adults, both those in residential services as well as those living at home. I would welcome that safeguarding being placed on a statutory basis.

I am delighted to lend my support and that of my party to this Bill. I once again commend Senator Kelleher on her hard work on it. Her efforts were Herculean.


Wednesday, 5 April 2017

Misuse of Drugs (Supervised Injecting Facilities) Bill 2017: Second Stage

In the words of Deputy Michael Harty, “The aim of this piece of legislation is to provide for the licensing of supervised injecting facilities in order to enhance the dignity, health and wellbeing of those who inject in public places.” Fianna Fáil supports this Bill, which would introduce supervised injection facilities. It is designed to avoid drug-induced deaths. It is obviously not the sole answer to the drug scourge we have. The Government will have to increase funding to detox centres to allow people who want to tackle their addictions to get the support required. Increased investment in education is also much needed.

I understand some of the legitimate reservations raised, but the centres should provide safe space for drug users to help ensure they use clean needles and dispose of them properly. At present, people are injecting on street corners across Dublin city and, as such, measures to tackle this, even in the short term, must be piloted. We want to see regular reviews, including feedback from stakeholders, undertaken to measure the Act’s success if passed. For too long we have invested taxpayers’ money in schemes which do not work and which are a waste of money while being of no benefit to the user. This Bill must not turn out this way.

Ireland has the highest proportion of intravenous heroin users in Europe, and the rate of drug related deaths in Ireland is three times higher than the European average. This is a shocking statistic which again leads me to call for greater investment in education and detox centres. A supervised injection centre must be a gateway to effective treatment, rehabilitation and intervention aimed at harm reduction for those suffering from addiction. This cannot be another Band-Aid on a failing health service. The injecting rooms should be based in centres and as part of a network of services and supports so that they facilitate early intervention and offer a pathway to recovery for drug users.

The centres, if successful in tackling drug related harm, have the potential to become a longer-term viable public health measure which seeks to provide a safe and supervised space for people to deal with their addictions. Nonetheless, this is only one part of a solution to the overall drug problem in Dublin in particular. However, it has the potential to be a part of that answer so that, at the very least, individuals ravaged by addiction have the opportunity to retain some dignity while we work to try to help them beat their terrible addictions.

Notwithstanding my comments, I have liaised with many people involved in this sector, including Councillor Frankie Keena, who is based in Athlone and who has done much voluntary work over the past 20 years in the Athlone and Westmeath region. He highlighted some very valid concerns, one of which is whether this legislation would effectively legalise the possession of heroin within the four walls of these centres. The Act states that if a service provider identifies an area that needs such a centre, the Minister has the power to decide where the centre goes and there is no provision for consultation with elected members of local authorities or the public. My other concern is the staffing of these centres. What if, God forbid, a service user overdoses and dies in such a centre? What emergency facilities will be in place? How will staff members be protected from a medical and legal viewpoint? This issue must be teased out further. Finally, it is somewhat disconcerting that we are almost dependent on drug pushers, and the criminality associated with that, to feed this service.

I hope these valid concerns can be explored on Committee Stage. We are not ruling out proposing further amendments to the legislation.


Wednesday, 5 April 2017

Order of Business

I concur with the sentiments of my colleague, Senator Rónán Mullen, in respect of post-traumatic stress disorder and the supports necessary for our Defence Forces. I have first-hand experience of the bravery shown by the navy divers and the Garda underwater unit in Blacksod Bay last weekend, when I spent some time on the ILV Granuaile in a medical capacity. It is vital that we support our Defence Forces in this regard.

Yesterday it was confirmed that St. Joseph’s psychiatric day centre in Ballaghadereen is to shut temporarily due to staff shortages. This comes in spite of an assurance given to Oireachtas Members by HSE management last October that there were no plans to close any day centre in County Roscommon, and that if a closure was proposed, public representatives would be consulted in advance. This is an issue which my colleagues, Senators Hopkins and Feighan, and indeed Deputy Eugene Murphy have raised before. I understand the HSE has pledged that the centre will reopen on 18 April. However, I am genuinely worried as to the future of the centre in its current situation.

It is my intention today to praise, commend and applaud the people of Ballaghadereen. Last week in The Irish Timesthere was a fabulous story of locals inviting Syrian refugees for a game of soccer. Mothers are donating buggies for babies. A welcome wall has been created. These Syrian people have come through hell, as we can only imagine. The people of Ballaghadereen should be highly commended for their welcoming efforts. I was also very happy to see that an initial €97,000 of health funding is to be allocated to medical resources in Ballaghadereen for the 80 refugees who are to be relocated there. However, that news is entirely blighted now by the closure of the psychiatric day centre. Lest we forget, the Syrian conflict is now the longest ever conflict, outlasting World War Two. What Ballaghadereen needs to become that shining beacon is intensive funding and investment, not cuts and closures.


Wednesday, 5 April 2017

Commencement Matters

Primary Care Centres

I thank the Minister of State, Deputy McEntee, for coming to the House to answer questions which have been worrying the community of Kinlough, County Leitrim. While canvassing the area during the Seanad elections, I had the pleasure of visiting the health centre and speaking with the local public health nurse. It was clear from speaking to the various people I met in the area that they felt very let down by the HSE in respect of the primary health centre.

A GP service is currently offered at the health centre twice weekly, on Tuesdays and Fridays, by appointment. In June of last year, I made representations to the HSE regarding the lack of adequate GP cover in the area and I was informed that there are no plans to increase the level of GP cover in the area. I was also informed that on Mondays, Wednesdays and Thursdays there is GP cover at the health centre in Bundoran, which is three miles from Kinlough, or at the primary care centre in Ballyshannon, which is seven miles from Kinlough. A person in the full of their health would have no problem travelling these distances but we need to keep in mind that the people visiting GPs and care centres are not in the full of their health. They are in need of medical attention and, as such, we can rightly assume that they are in some form of pain or distress. The fact they cannot visit a doctor in their own locality only adds to this distress and, in my opinion, it is disgraceful in this day and age. There are other rural locations with a full-time GP service, for example, Bangor Erris and Glenamoy in County Mayo.

For 150 years following the Great Famine, the population of Kinlough village stood at just 350 people. The 2006 census showed an increase for the first time, the 2011 census figures had the population at just over 1,000, an increase of 47% on 2006. The preliminary results from the 2016 census show that this trend is continuing. Kinlough is the third largest urban area in County Leitrim and has the county’s largest primary school, which 270 pupils currently attend. It also has three preschools and, like the rest of the country, is home to an aging population.

As a GP, I am only too aware of the pressures on general practice. However, I also feel that, in this instance, there is a compelling argument for an enhanced service. I ask the Minister of State to examine the feasibility of returning the responsibility for Kinlough health centre to the Leitrim primary care area, as opposed to the Ballyshannon-Bundoran area. The community of Kinlough deserves better. They need services which will address the needs of the population, both young and old.

I thank the Minister of State. I have liaised closely with local councillor, Justin Warnock, on this issue. There are a few important issues arising which I will refer to briefly. Over 10% of the total population of Leitrim live in the Kinlough area. Currently, hearing and dental checks are not being conducted in the health centre, but in the local school which has 270 pupils. This causes major disruption. The village continues to grow. The people of Kinlough deserve a full-time GP service, five days a week. I welcome what the Minister of State has said but I will continue to lobby on this issue.


Wednesday, 5 April 2017

Joint Oireachtas Committee on Health

Cannabis for Medicinal Use Regulation Bill 2016: Discussion

I thank Senator Mullen. I will be going to the Seanad in a few minutes and so will be very brief.

From a medical viewpoint, we know that cannabinoids bind with receptors in the brain. Some of those receptors are in the amygdala, which is involved in processing fear, stress and paranoia. My first question is to Professor David Finn. Would he agree or disagree that these products could possibly exacerbate paranoia?

I am somewhat reassured that there would be a list of specific conditions for which products could be used. Am I correct in stating that these could be circumvented in some way by consultants if they deemed it necessary? Would only consultants be allowed to prescribe or would specialist GPs be allowed to do so? Every GP on the specialist register, such as myself, is called a “specialist GP”. So would I be allowed to prescribe that? If so, what safeguards are in place for rogue prescribing? Would that be covered by this legislation or would it be covered by the Medical Practitioners Act?

Finally, I am struggling to distinguish between certification and prescription. If a doctor prescribes a product, he or she issues a prescription. I am struggling to get my head around this because, if the consultant gives a prescription for this product, is this classified as a high-tech product? Does the patient bring that to the pharmacy and is the product dispensed there or is it bought like a high-tech drug for rheumatology or such? What often happens is that the consultant would give a prescription to a patient, the patient would come to the GP, and that would be transcribed on a medical card prescription or whatever else. That is something of a grey area. Those are my three points.


Wednesday, 12 April 2017

Order of Business

I wish to inform the House that the other day I wrote to the management, shareholders and directors of MidLink M7/M8 Limited to complain in the strongest terms about the treatment of the Carrick-on-Suir water rescue service. As we all know, a Herculean effort is being made in Erris to bring home the bodies of Paul Ormsby and Ciarán Smith. Last weekend almost 1,000 people were involved in the search on land and sea. Let us be clear that there is no second-class emergency service in this country. However, the treatment of the volunteer emergency workers involved was appalling. It was an insult to their dedication, bravery and selfless work that they were charged tolls for emergency vehicles while on their way home from the search. In my letter I called on the company to without delay publicly express an apology to the Carrick-on-Suir water rescue service and arrange for a full refund. This is not about the money but the principle. I want the company to immediately initiate a revision of its policy. I hope the Leader and my fellow Senators agree with my sentiments.


Wednesday, 10 May 2017

Misuse of Drugs (Supervised Injecting Facilities) Bill 2016: Committee and Remaining Stages

The Fianna Fáil Party did not propose any amendments to this Bill. We believe that the measures that have helped to avoid drug-induced death should be taken, yet we see this as a pilot programme that will lead to regular reviews. We have many questions regarding the function of such facilities that we hope will be teased out through protocol.

An amendment we had considered submitting was one that would take the decision of granting a licence for such an establishment solely from the Minister and would compel him or her to consult with members of local authorities, An Garda Síochána and the HSE before granting a licence. Our reasoning was such that there should be a greater consultation process with key stakeholders and local authority members who know their own areas inside out and are best placed to participate in decision-making such as this. I ask the Minister to take this into account and to seriously consult with the local authority members before decisions are made with regard to the granting of licences for supervised injecting facilities.


Wednesday, 10 May 2017

Declaration of Independence Day Bill 2017: First Stage

I move:

That leave be granted to introduce a Bill entitled Bill entitled an Act to recognise the meeting of the First Dáil and the Declaration of Independence made on 21 January 1919 and to provide for a “Declaration of Independence Day” to be held on 21 January annually and to provide for related matters.


Wednesday, 10 May 2017

Commencement Matters

Hospital Closures

I will be very brief. I thank my colleague, Senator Gallagher, for allowing me to share his time on this very important issue. The closure of the Sacred Heart unit in Dungarvan is absolutely devastating to the community and will send shivers down the spines of other community hospitals which are experiencing the same issues with recruitment. Most hospitals are only a couple of staff away from ward closures. As a director of Belmullet hospital, I am too aware of it. I also concur with my colleague’s sentiments that the closure was underhanded in the manner in which it was executed over a bank holiday weekend in an attempt to bury the story. At the very end of last year, the Minister for Health said he had no magic wand to recruit more nurses into the health service. He also said he was satisfied with the package on offer to graduate nurses and that many nurses are returning here to be closer to family and friends.

This is in direct contrast to what the INMO reported only a few weeks ago. The organisation undertook surveys of all nursing and midwifery students on the final leg of their degree to examine whether they would seek employment upon qualification in September 2017. It found that 78% of respondents are considering emigrating and 70% have already been approached by overseas recruitment agencies. That is compared to 29% who had been offered permanent positions in the Irish public health service at that time. Surely all of the students who are in their final 36-week placement should be offered competitive, permanent contracts to be entered into following successful graduation of their course. The people of Dungarvan are now without 16 vital beds, which provided much needed rehabilitation, respite and step-down care and undoubtedly alleviated some of the pressure on the struggling University Hospital Waterford.

Community hospitals facilitate discharges from university hospitals and prevent admissions to university hospitals. Another important aspect of the community hospital is that it acts as an interface between the fair deal system and the university hospital. If a loved one is waiting for the fair deal scheme in a university hospital, he or she can be transferred to a community hospital for the intervening period before being transferred to a nursing home. This is another vital element. I ask the Minister of State to review these closures as a matter of priority.


Wednesday, 10 May 2017

Commencement Matters

Health Services Provision

I thank the Minister of State for coming into the House to take this matter. I am hopeful she will be able to allay the fears of the communities of Elphin and Strokestown who are hearing reports of the potential closure of one or both of their health centres once the new primary care centre opens in Boyle, County Roscommon. The opening of the new centre is warmly welcomed. Providing dental services, occupational therapy, physiotherapy, speech and language therapy and public health nursing services all under the one roof will be of fantastic benefit to the community. I know this because of my experience in general practice in Belmullet, County Mayo, but I am also aware of how destitute my patients would be without these services and the hardship it would cause if they were forced to travel 50 miles to Castlebar to avail of them.

Shortly before the Easter break, the Minister of State at the Department of Health, Deputy Helen McEntee, reiterated in the House that one of the Government’s key priorities was to implement a decisive shift in health services towards primary care. She stated: “Our ultimate goal and, as Minister of State with responsibility for older people, my goal is to make sure that people get the care they need as close to home as possible and have access to a greater range of health and social care services within their community.” Will the Minister of State, Deputy Corcoran Kennedy, advise what “as close to home” and “within their community” mean in this context? Does it mean within walking distance or the county boundary? Whatever way we look at it, a healthy person would have no problem in travelling a distance to a primary care centre for treatment, but, as I have said previously, we need to remember that most people visiting GPs and care centres are not in the whole of their health. They are in need of medical attention and we can assume in pain or distress. The fact that they cannot visit a doctor in their own locality, in close proximity to their home, only adds to their distress.

The journey from the health centre in Strokestown to the new primary care centre in Boyle is at least a half an hour’s drive. The smaller care centres around the country are vital in so far as they act as a filter to the larger centres and the wider hospital network, thus preventing an additional workload at these highly pressurised sites. In response to a parliamentary question submitted by Deputy Billy Kelleher on the future of services in Elphin and Strokestown health centres, Mr. Frank Murphy, head of primary care services, stated the services being provided from existing health centres would be reviewed in the context of whether they would be more appropriately delivered from a primary care centre. I am referring to two small health centres in two small villages facilitating older people in rural communities. Will the Minister of State provide further clarity on the future of these centres which cater for a large ageing population in great need of them?


Wednesday, 21 June 2017

Mental Health (Amendment) Bill 2016: Second Stage

I congratulate the Minister of State, Deputy Jim Daly, on his appointment and welcome him to the House. I thank Senator Freeman for introducing this important legislation, which Fianna Fáil is happy to support. This Bill, which proposes to end the practice of admitting children to adult psychiatric units, legislates for what is already the stated policy of the HSE and the Department of Health.

The admission of a child to an adult ward can make the inpatient experience far more distressing for the child. It does not place the child in an environment that supports his or her recovery. The inappropriate admission of children and adolescents to adult inpatient units is undoubtedly a matter of significant concern. Resources must be brought to bear as a matter of urgency to provide for the community-based service and the age-appropriate acute care that would reduce such admissions.

My party colleague, Deputy Browne, also has a mental health (amendment) Bill in process. Thankfully, it has been allowed to skip pre-legislative scrutiny and go to Committee Stage straightaway. This is in part as a result of a commitment to give mental health a level of priority which has usually been reserved for physical health. That mental health issues are featuring on the legislative agenda of both Houses with such support is a demonstration of increased awareness of mental health issues on all sides of the House.

Senator Freeman’s Bill is to be highly commended. I say that as a doctor who has worked in the mental health service in Dublin, St. Ita’s Hospital and the NHS system in Wales. If this Bill is passed, it will create a statutory basis for ensuring the practice of admitting children to adult psychiatric units can no longer occur. Generally speaking, admissions are covered by section 14 of the Mental Health Act 2001. The Bill before the House intends to amend the 2001 Act by inserting new provisions to the effect that, “No admission order shall be made in respect of a child under the age of eighteen to an adult inpatient unit save in exceptional circumstances where it is in his or her best interests to do so”, and that, “Where a child is admitted to an adult inpatient unit he or she shall be accommodated in an area separate from adults in an age-appropriate environment with age-appropriate facilities.” That is very important.

Mental health advocacy groups have expressed concern that this Bill, as drafted, could have unintended consequences. We would like these matters to be addressed as the legislation proceeds. There is a risk that the simple provision of a legislative lever that prohibits child admissions could have the effect of overbalancing resources towards the provision of more inpatient beds in a reactive manner. The provision of a better-resourced, community-based mental health service, in conjunction with some preventive measures, could be expected to have the effect of reducing the need for inpatient beds overall. It is expected that improvements in community-based services, including a seven-day service and a 24-7 community-based crisis intervention service, would lead to a significant reduction in the number of inappropriate child admissions to adult units.

It is critical to build the capacity of the primary care sector to provide comprehensive mental health services, with a particular emphasis on providing crisis out-of-hours mental health supports in every community. Similarly, we must develop local alternatives to inpatient services, such as assertive outreach, early intervention in psychosis and other community-based incentive supports, in addition to family-centred supports. It is vital that we increase accessibility to specialist child and adolescent mental health services, including both inpatient and outpatient services where necessary, to avoid inappropriate child admissions to adult units. There is also a concern that the effect of the establishment of a law that allows child admissions to adult units in exceptional circumstances, as set out in the Bill, could be the opposite of the intended aim. This could happen if a legal basis for inappropriate admissions that does not exist currently is created. We will tease this out at later Stages.

I am aware that many Members of this House want their local child and adolescent mental health services to receive better funding and resources. There is a need for a considerable increase in recruitment to community mental health teams. The HSE has admitted that it has just over half the staff it needs to operate such teams if it is to comply with A Vision for Change. One in four of the population of Ireland is under the age of 18. According to the HSE, there were 648 staff in the child and adolescent community teams at the end of 2016. This represents just over 54% of the staffing level of 1,195 that was recommended in the A Vision for Change policy document on the basis of 2016 population levels. Such insufficient staffing levels in our mental health services must be addressed with urgency. The inadequacy of current provision has the potential to pose serious knock-on effects.

While I understand that there are some problems with recruitment, I am sick and tired of hearing that the Government is doing everything possible in this respect, as I believe this is simply not true. According to the 2015 annual report of the Mental Health Commission, “there is still a most unsatisfactory situation whereby children are being admitted to adult units, there were 95 such admissions in 2015.” It should be noted that the Mental Health Commission’s code of practice, which has been accepted by the HSE, states that inappropriate admissions of children to adult units should not take place. Obviously, this has not translated into practice. There is a clear need for legislation to prevent such admissions. That is why I am supporting the Bill before the House.


Wednesday, 21 June 2017

Tobacco Investments 

Everyone is aware that, according to the WHO, half of all users of tobacco will die from it. The tobacco industry is no friend to anyone and most definitely not to the people who are, unfortunately, addicted to the product. The Senators will recall that I have been campaigning for some time on the incredible situation whereby the State held investments in some of these tobacco companies through the National Treasury Management Agency, NTMA, and the Ireland Strategic Investment Fund, ISIF. Thankfully, through exposing this in the Seanad and with support from all sides of the House and from the Minister for Health, Deputy Simon Harris, changes were made last December that saw the NTMA divest itself of all tobacco investments.

Through research and through information supplied to me I recently uncovered that other State and semi-State agencies are still investing money in the tobacco industry. These are under the remit of the Minister for Justice and Equality, Deputy Charlie Flanagan, to whom I wrote last week. His predecessor, Tánaiste Frances Fitzgerald, did not act on my correspondence on this though I wrote to her on a number of occasions over the past few months.

The first organisation in question is the Charities Regulatory Authority that administers the charity investment fund on behalf of 410 charities. They have confirmed to me that the value of this fund was approximately €38 million. They have also confirmed under questioning from me that they have invested part of this in the tobacco industry. It raises the question as to whether these 410 charities know that they are investing in the tobacco industry. Are any of these charities related to health? I have asked the Charities Regulator if they have informed the charities how they are investing money on their behalf. I await a response.

The second organisation in question is the Courts Service. It invests huge sums of money, approximately €1.675 billion, on behalf of wards of court and children under 18 who have received significant rewards. I wrote to the CEO of the Courts Service three weeks ago and have had no response to date. I have written to the chairperson of the investment committee of the Courts Service, Justice Peter Kelly, to point out that it is unconscionable that money for wards of court and money awarded to children, often arising from serious medical or health issues, be invested to prop up the balance sheets of global tobacco giants.

This is an absolute joke. I propose to move a motion in this House in the near future and I hope that it would have unanimous support. I ask the Senators to send a strong unanimous message supporting motion 22 on the motion paper today and I formally propose that this be taken before No. 1 on the Order of Business.


Wednesday, 21 June 2017

Commencement Matters – Office of Public Works Properties

I warmly welcome the Minister of State to the House on his first official engagement here. Before I speak on the specific topic, I want to publicly put on the record of the House my praise for the Minister of State for the bravery he has displayed in recent weeks in highlighting his battle with literacy and the challenges it poses in his life. His actions have spoken louder than any words which is why I believe he will inspire many people to put their hands up for help. Now that it has put the issue on the agenda I would be happy to work with the Minister of State in progressing it in any way. As Nelson Mandela said, the brave man is not the one who has no fears, he is the one who triumphs over his fears. I say “Well done” to the Minister of State.

I am very glad it is the Minister of State, Deputy Moran, taking this Commencement matter today. He is from a neighbouring county of mine. It is a subject of which he has spoken in favour before and he will be making proposals which will come before the Cabinet on this very issue. I agree entirely with the Minister of State when he says the long-term benefits of opening all Office of Public Works sites freely to children will be huge.

There has been much talk recently about how we need to move our education system away from the reliance on memory and recitation and focus more on learning through experience. Visits to various sites steeped in history will not only inspire creativity but also create lifelong memories. Paris is one city that can be looked to when examining such a plan. Anyone who has visited Paris is aware it is an expensive city. However, if one is under-26 and a citizen of the European Union, one is entitled to free entry into some of the finest and most popular museums and monuments of the city such as the Louvre, the Arc de Triomphe and the Panthéon, which ordinarily cost €12, €9.50 and €9, respectively, to enter. They are some of the most well-known tourist attractions in the world so it would save a young visitor a very incentivising €30.

We have some fantastic sites here in Ireland which are spread all over the country and draw many visitors every year. The opening of heritage sites managed by the OPW for free on the first Wednesday of every month for the duration of their seasons has proved very popular. The number of visitors to OPW heritage sites rose to 6.6 million last year, which was a significant increase on the previous year. The most popular site in 2016 was the National Botanic Gardens where over 583,000 visited, up more than 30,000 from 2015. The number of visitors to Castletown House and parklands in County Kildare nearly doubled last year with 547,000 visiting the 18th century mansion and its surrounding gardens, which was up from 297,000 in 2015.Kilkenny Castle has also seen record-breaking numbers come through its gates with 384,000 visitors to the castle and its grounds. The completion of the new visitors’ centre in the old Kilmainham courthouse saw the number of visitors to Kilmainham Gaol rise by 64,000 to 390,000 in 2016. While these numbers are testament to the great work of the 1916 commemoration committees, figures show that the numbers were rising before 2016 as a reflection of the increasing popularity of our heritage product nationally and internationally. All across Ireland, visitor numbers are up. Areas outside the big cities have seen a huge rise in the number of visitors, for which we can thank the OPW sites.

As we all know, the greatest threat to Ireland currently is Brexit. Its effects have already been felt on the island with the numbers arriving from the UK falling by almost 11%. The post-Brexit fall in sterling has made it more expensive to travel. Coupled with the sheer uncertainty of the negotiations, this is forcing the British people to think twice about visiting their nearest neighbours. If we want the number of visitors to these sites to continue to rise and not to decline, opening them up freely for entry by children is the smart option. According to a response to a parliamentary question submitted by my party colleague, Deputy John McGuinness, the then-Minister of State, Deputy Canny, stated that the popularity of OPW sites was a key driver in terms of the economic benefit being generated for the tourism sector and that receipts in this area had increased year on year to over €11 million in 2016. With this in mind, I beseech the Minister of State not to rest until he has carried out his plans to open all OPW sites to children free of charge.


Wednesday, 5 July 2017

Declaration of Independence Day Bill 2017: Second Stage 

I move: “That the Bill be now read a Second Time.”

Cuirim fáilte roimh an Aire, Teachta Humphreys, go dtí an Teach inniu. Is mór an onóir dom ar son Fhianna Fáil, agus Seanadóirí Diarmuid Wilson, Paul Daly agus Mark Daly, an Bille seo a thairgeadh sa Seanad inniu. Ba mhaith liom buíochas a ghabháil le mo pháirtí, Fianna Fáil, agus lenár Seanadóirí go léir as ucht tacaíocht a thabhairt don Bhille seo.

Ar, tá sé an-suimiúil scrúdú a dhéanamh ar an gcéad díospóireacht sa Dáil. Ba iad na céad fhocail labhartha i nDáil Éireann: “Molaimse don Dáil Cathal Brugha, an Teachta ó Dhéisibh Phortláirge do bheith mar Cheann Comhairle againn indiu.”With those words, Dáil Éireann, an Chéad Dáil, was born. I do not wish to be too parochial but they were spoken by Count George Noble Plunkett, a Deputy from Roscommon North, who was oldest of all elected Members present. The next to speak was Cathal Brugha as Ceann Comhairle, who called upon Fr. Michael O’Flanagan, who said the prayer that formally opened the first public session of the First Dáil. Fr. O’Flanagan was born in Kilteevin just outside my native home of Castlerea, County Roscommon.

There are many aspects of the First Dáil on which one could speak, including the fact that Michael Collins and Harry Boland were missing from the first meeting as they were arranging the release of Eamon de Valera from Lincoln Jail. The attendance of Boland and Collins was incorrectly called to conceal their mission to rescue de Valera. I will dispense with the historical anecdotes for a moment to outline the broad purpose of the Bill.

The Bill, if enacted, will formally introduce a Declaration of Independence Day in Ireland ensuring it is formally recognised on 21 January each year. The First Dáil met in the Round Room of the Mansion House in Dublin on 21 January 1919 and asserted the exclusive right of the elected representatives of the people to legislate for the country. During the meeting, the elected Members present adopted a provisional Constitution and approved a Declaration of Independence. Dáil Éireann, a new national parliament for the Irish nation, ratified and gave democratic legitimacy to the Proclamation of Independence made in the Easter Rising of 1916.

Cathal Brugha was nominated as Ceann Comhairle and read the Declaration of Independence in Irish. It was followed in French by George Gavan Duffy and finally in English by Edmund Duggan. On that day, the Dáil approved the Democratic Programme based on the 1916 Proclamation of the Irish Republic and read and adopted a message to the free nations of the world in Irish, English and French. The following day, on 22 January 1919, a private sitting of Dáil Éireann was held which elected Seán T. O’Kelly as Ceann Comhairle and Cathal Brugha as President of the Ministry. The Dáil also approved the President’s nominations to the ministry. They were Minister for Finance, Eoin MacNeill, grandfather of our colleague Senator McDowell; Minister for Home Affairs, Michael Collins; Minister for Foreign Affairs, Count Plunkett; and Minister for National Defence, Richard Mulcahy.

In April 1919 Cathal Brugha resigned and Eamon de Valera was elected President of Dáil Éireann. The British Government decided to suppress Dáil Éireann and on 10 September 1919, it was declared a dangerous association and prohibited. The Dáil continued to meet in secret and Ministers carried out their duties as best they could. The Dáil held 14 sittings in 1919. Of these, four were public and ten private. Three private sittings were held in 1920 and four in 1921. It has always struck me that the meeting of the First Dáil and the Declaration of Independence on 21 January 1919 have not been commemorated to the level they should. In January 2009, in a speech on the 90th anniversary of Dáil Éireann, the then Taoiseach, Brian Cowen said:

“Ninety years ago tomorrow, the elected representatives of the overwhelming majority of the people of this island who were not otherwise detained or in flight from the forces of occupation, met in Dublin’s Mansion House with the purpose of asserting the self determination of a sovereign, democratic, Irish Republic. Dáil Éireann — a National Parliament for the Irish nation — ratified and gave democratic legitimacy to the Proclamation of Independence for which the republican vanguard had laid down their lives at Easter 1916.”

He continued:

“When, in 1998, the people of Ireland voted by a majority, and by majorities North and South, in favour of the Good Friday Agreement, it was the first occasion since the general election of [14 December] 1918, the election at which the people selected the representatives who sat in the First Dáil, that the people of this island had voted on the same day on the issue of their constitutional status.”

This has only happened on two occasions in the past 100 years.

I will now deal with the various sections of the Bill. Section 1 is a standard section providing the Short Title and commencement provisions for the Bill. Section 2 deals with the definitions of the terms used in the Bill. Section 3 specifies that 21 January will be known as “Declaration of Independence Day” and it will be celebrated irrespective of the day on which it falls. The section does not propose to make the day a public holiday as understood in the Holidays (Employees) Act 1973.

I look forward to the input of Senators and to hearing the remarks of the Minister, Deputy Humphreys, who is with us this evening. When I first raised in the Seanad the need to formally recognise the meeting of the First Dáil and the Declaration of Independence, I was struck by the genuine messages of support and encouragement I received. However, not every message was positive. Some wanted the day to be made a bank holiday and some said we have too many bank holidays as it is. Some commented it would take away from St. Patrick’s Day, which is our national day, but St. Patrick’s Day is first and foremost the feast day of our patron saint. Some referred to the absence of a united Ireland. I was struck by Deputy Ó Snodaigh of Sinn Féin last November in the Dáil when he said:

“We do not have a national patriotic or independence day similar to other countries. It is not necessary to have full independence to have such a day. Cyprus, for example, has an independence day even though it is partitioned … The two Koreas, even though they are separated by a wall, have a liberation day on 15 August.”

To give credit where credit is due, the first person I ever heard suggest this idea was Eamon Gilmore when, as leader of the Labour Party during the 90th anniversary celebrations in 2009, he said “May I suggest that we consider making 21 January our national independence day?” In January 2017, Sinn Féin Leader, Deputy Gerry Adams, said on RTE Radio 1:

“Yesterday was the anniversary of the First Dáil. Was it commemorated anywhere? Did the State do anything about it? Did RTE do a special programme about it? The only party, that I understand, commemorated that, was the Sinn Féin Party.”

No one party should claim ownership or attempt to claim ownership of the First Dáil or the Declaration of Independence. Many of the political figures involved went on to play significant roles in Irish life and included future Taoisigh, Presidents and Ministers. There will always be difference of opinion about how we remember the past but difference is the essence of democracy. We are all here in the Houses of the Oireachtas as successors to those elected to the First Dáil in the election held on 14 December 1918. If we were in full agreement on everything, there would be something wrong. Ideas should be tested and opinions challenged. We should all unite around this one act of national self-determination because the period that follows gets more complex and divisive, with the War of Independence, the Treaty and the Civil War.

A story that illustrates the complex and divergent history of this period can be seen in the events of 100 years ago this month. The Redmond family from Wexford were steeped in the tradition of Charles Stewart Parnell and the Land League and became interwoven with the struggle for Home Rule. Willie Redmond, MP, was killed at the Battle of Messines Ridge on 7 June 1917.

One hundred years to the day, in one of his final acts as Taoiseach, Deputy Enda Kenny, the then leader of Fine Gael, attended a ceremony to commemorate the Battle of Messines Ridge alongside Britain’s Prince William, the leader of the Democratic Unionist Party, Arlene Foster, and others, including Fianna Fáil Deputy Darragh O’Brien, who is here today and whose grandfather and two great grand-uncles, Robert, Peadar and Eoghan O’Brien, served with distinction in the 1916 Rising in Dublin, the War of Independence and the Civil War as members of the 4th Battalion, Dublin Brigade of the Old IRA.

This battle, which started on 7 June 1917, was the first time that the 16th Irish Division and the 36th Ulster Division fought side by side in battle. I understand it was one of two occasions when Protestant and Catholic soldiers from Ireland fought side by side on what was known as the western front. The death of Willie Redmond in June 1917 caused a by-election in East Clare that was held 100 years ago next Monday, on 10 July 1917. Eamon de Valera was elected a member of the House of Commons for East Clare. His grandson, Deputy Éamon Ó Cuív, serves in the Lower House. This by-election victory, alongside the earlier victories of Count Plunkett in the Roscommon North by-election of February 1917, Joseph McGuinness in the Longford South by-election of May 1917, and W.T. Cosgrave in Kilkenny city in August 1917, created the start of the momentum for the Sinn Féin movement to sweep to electoral victory in December 1918.

There is no plan to designate independence day as a public holiday but if we pass this legislation, it will allow schools, public bodies and community groups an opportunity to commemorate this hugely important day in an appropriate way. It would allow members of the diaspora, like my sisters in New Zealand and America, to celebrate this historic day. There are different views on how to commemorate our history. The 1916 centenary celebrations, from the national events to the individual events hosted by each local authority, were uplifting and educational.It helped create awareness about the events of the 1916 Rising and the impact that it had on our country. A new generation of Irish people have been introduced to the story of 1916. This Bill is another step on this journey and it recognises the truly historic meeting of the First Dáil and the Declaration of Independence.

I am overwhelmed and humbled by the support across the House today. Our political forefathers who sat in that First Dáil and mothers – on 21 January 1919 would be very proud of the contributions from the Senators on all sides of the House today. We need to keep reminding ourselves that we are the successors to that first election on 14 December 1918. I thank Senator Wilson for co-sponsoring this Bill and for his kind comments. I thank Senator Hopkins for supporting the Bill. As she said, Roscommon was well represented at the time. Senator Boyhan made some very pertinent remarks when he said that in accepting this Bill, we are showing political maturity. That is why in my speech the narrative was deliberately non-confrontational.

This declaration of independence does not belong to any one party. It belongs to us all. We need to respect the diversity of the people of Ireland, North and South. It is an excellent idea that this is recognised in communities, schools and among the diaspora who are particularly close to my heart because one of my sisters lives in New Zealand and another in America. It would be an important day to include all our family members who were forced to emigrate years ago.

It is important that this Bill be recognised in the Houses of the Oireachtas. It was an excellent idea of Senator Ó Donnghaile’s to display a copy of the declaration in the Houses. I thank him and Sinn Féin for their support. He quoted the phrase from the declaration, “equal right and equal opportunity for every citizen”. That is what it is all about. Those words are as relevant today, almost 100 years on, as they were in 1919. That is why we enter public life and are elected, to improve the lives of those people in our communities who are less fortunate than us. That is the essence of the Bill. I am happy it received widespread support. I also thank Senators Davitt and Horkan for their kind comments. I hope this Bill will pass quickly through the House.

I welcome the Minister and thank her for her kind sentiments. I am delighted the Government is accepting and supporting this Bill. I am delighted the expert advisory group is getting involved in this. Senators would welcome feedback from the advisory group as the discussion progresses to the different Stages.

I also acknowledge the hard work of Dr. Maurice Manning and his sentiments. I thank Senators for their support.


Wednesday, 5 July 2017

Life Saving Equipment Bill 2017: First Stage

I move:

That leave be granted to introduce a Bill entitled an Act to provide for a specific offence of interfering with Life Saving Equipment and to provide for related matters.


Wednesday, 5 July 2017

Order of Business

I welcome the news this morning that the Cabinet is to consider a new €2 billion cancer strategy programme. The plan, which will see between €1.5 billion and €2 billion spent on improved services and medicines over the next decade, comes with a warning that the number of cancer cases will almost double over the next 20 years. This is not news. We have known that an increase in patients presenting with cancer would be inevitable with our ageing population. Over the next 30 years, the number of people in Ireland over the age of 65 will double and the number over the age of 85 will quadruple. The percentage of deaths attributable to cancer has risen from 20% in the 1980s to over 30%. This percentage will continue to rise. The plan also stresses that as much as 40% of cancers are avoidable. That fact is important.

I have raised this matter in the House previously in the context of legislation relating to tobacco. Tobacco use is the leading cause of preventable death in Ireland and is linked to approximately 6,000 deaths per year. The estimated cost to the health care system of smoking is more than €500 million per annum yet there are still organisations under the remit of Departments that facilitate tobacco company investments. It beggars belief and flies in the face of the aim of a tobacco-free Ireland by 2025. I uncovered the fact that the Courts Service has invested more than €6 million of a trust of €1.6 billion in the tobacco industry. This includes moneys relating to wards of court and moneys awarded by the HSE to children due to medical misadventure. This needs to stop and the Courts Service needs to divest itself of these investments as a priority. I ask the Government to introduce legislation on this matter.

I move that leave be granted to introduce the Life Saving Equipment Bill, No. 11 on the Order Paper. This is a Bill to provide for a specific offence of interfering with life-saving equipment such as defibrillators and lifebuoys. I welcome Deputy Casey, who helped me draft this legislation, to the House. I will hold a briefing in the audio-visual room at 12.30 p.m. with members of the Community First Responders Network and Irish Water Safety. They will explain the role their organisations play in fund-raising, installation and training in the use of these vital pieces of equipment and, in particular, the knock-on effect of acts of vandalism and theft. I hope to see many Senators attending the briefing and I would be grateful for cross-party support on this issue.


Wednesday, 5 July 2017

Commencement Matters

Hospital Waiting Lists

I also welcome Councillor Coyle to the Chamber. I thank the Minister for coming to the House to discuss this very important issue. As he is aware, my patients are in fear because the treatment they so badly require could be in jeopardy due to the constant staffing crisis which is crippling our health system.

I have listened with great sadness and shame, as has the Minister of State, to the stories of very young children and adolescents with scoliosis who are waiting inexcusably long times to receive treatment. Today, however, I am raising the issue of adults with scoliosis who are also at the mercy of long waiting lists.

It was brought to my attention by Councillor Walter Lacey that a patient of Mr. Pat Kiely, consultant orthopaedic surgeon in Tallaght hospital, was recently advised that he was no longer working in the hospital and the waiting list would be outsourced to a different hospital under a different consultant. Unfortunately for some, that is the sum total of the communication they have received.

One woman was diagnosed with scoliosis in 1995. In September 2014, she had a two-part operation carried out under Mr. Kiely and requires further treatment on her spine, specifically an injection and a fusion of the spine. In June 2016, more than one year ago, she was advised she would be seen as a priority case. In January 2017, she was advised by her doctor that Mr. Kiely had moved on and she would now be under the care of a different consultant in a different hospital. She has yet to receive any further update on her case. In the meantime, she struggles on and minds her three children despite her disability. Her GP telephoned the hospital on her behalf to be told not to ring any more. It is frustrating and is not acceptable that a health professional who is advocating for a patient was dismissed in such a fashion. Patients like her are being left in a painful limbo.

As the Minister knows, the management of scoliosis is complex and determined by the severity of the curvature and skeletal maturity, which together predict the likelihood of progression. According to the HSE’s action plan for scoliosis treatment, to achieve the target of a four-month waiting list, 447 patients will need to receive treatment before the end of 2017. As the Minister will probably agree, these targets will not be met. Some 447 patients need treatment before the end of 2017. It is a significant ask for the staff of the theatres concerned to facilitate that number of patients. To lose one consultant is a major blow.

I would also like to put on the record of the House my acknowledgement of the work of Mr. Kiely. He does fantastic work in this field. He is the co-founder of Straight Ahead Ireland, which operates on a voluntary basis. Surgeons perform operations on a pro bonobasis. They change the lives of children who might otherwise have to wait longer for treatment or surgery. They do this selflessly and give up their personal time. The operations are conducted on weekends and Christmas during down times in theatres in Our Lady’s Hospital in Crumlin. Mr. Kiely and the Straight Ahead team are fighting a battle against waiting lists which is not theirs to fight.

Does the Minister agree that a new approach is needed in the field of recruitment and that the current recruitment process is not working at the pace or rate which is required? When will Mr. Kiely be replaced? Will his list be addressed in Tallaght hospital or off site in a different hospital? When will the young mother of three to whom I referred be accommodated for her surgery, along with the approximately 70 other patients still on the waiting list?


Thursday, 6 July 2017

Seanad Public Consultation Committee

Children’s Mental Health Services: Discussion

I thank all the contributors. I will be brief. It comes as no surprise to me that only 3% of the health budget is spent on general practice, which facilitates 25 million consultations per year with a satisfaction rating of greater than 95%. It also comes as no surprise to me but it saddens me that for the first time ever in the history of the State, GP training posts this year are unfilled. There are just 171 GP trainees embarking on a career in general practice. The training programme will take four years. I do not know how many of them will qualify or how many of them will stay in Ireland but what I do know is that 900 GPs will retire over the next five years. That will have a direct impact on the provision of mental health services in this country. General practitioners are excellent at diagnosing mental health problems in adults and young people. They are the first port of call. They are the foot soldiers in the community. That is why I believe the lack of GP trainees will have a direct impact on the provision of mental health services. The Minister and the HSE need to address the elephant in the room and to resource the sector adequately.

I agree wholeheartedly that psychologists should be attached to general practitioners. It would be a good idea to have one psychologist shared among three or four practices. Sometimes there is an overemphasis on the bricks and mortar of primary care centres rather than on the activity within those centres, and this needs to be addressed.

I call on the Minister to facilitate a rapid access 24-hour CAMHS referral service for general practitioners. We heard stories from parents last week and the common theme was that every parent ended up in an emergency department with their child. That is improper. A 24-hour rapid access referral service to a CAMHS team would prevent children attending emergency departments unnecessarily. It would not be abused. When the report is complete there will be a chance for a debate with the Minister. Dr. Brendan Doody said that there were 12 inpatient beds in 2007 and there are 76 now, some of which are not always filled due to staffing problems. What is the number of beds filled in an average week?


Wednesday, 12 July 2017

Joint Oireachtas Committee on Health

Evaluating Orphan Drugs: Discussion

I concur with many of the points my colleague mentioned, particularly in respect of Respreeza. It is bad enough to have a chronic obstructive pulmonary disorder, COPD, condition due to smoking but it is a terrible condition to have as a result of alpha-1-antitrypsin deficiency. I would also like a timeline for when that product may be available.

I know there was some discrepancy about the savings mentioned. Approximately €150 million in savings was mentioned since the agreement with the Irish Pharmaceutical Healthcare Association, IPHA in August 2016. Since then only 11 medications have been approved for reimbursement. That seems a low figure. Can we do better? I take on board what Professor Barry said about dealing with 20 drugs in 2012 compared with 70 now. Does the National Centre for Pharmacoeconomics, NCP, need more resources?

The important point to remember about rare diseases is that they have very high mortality rates. Up to 30% of the kids with these diseases die before they reach the age of five. Treatment exists for only 5% of these patients. I understand that it can take up to 50% longer for orphan drugs to go through the process of reimbursement, even up to two years. The national rare disease plan identified the current process as disadvantaging orphan drugs. Are the HSE and the NCP tracking the time taken to reimburse medicines, orphan or traditional, from the initial application to the final decision and do they know the orphan status of the drug and the clinical data implications associated with such small patient populations when assessing the applications?


Wednesday, 12 July 2017

Autism Spectrum Disorder Bill 2017: Committee and Remaining Stages

As a medic, I am delighted to wholeheartedly support the Bill. It is good, pragmatic, solution-driven and concise. The Fianna Fail Party is happy to see it proceed through the respective Stages as it provides for a cross-departmental, multi-agency strategy. We are happy to support the principles behind an autism spectrum disorder strategy which seeks to address the specific needs of people with autism using a cross-departmental approach.

During the debate on Second Stage Senator James Reilly said – I wholeheartedly agree with him – that while we had excellent medical experts, as well as allied experts in speech and language and behaviour therapy and other areas, the experts on a child were his or her parents. In my own practice on many occasions I have seen parents who are so frustrated because they know what their child requires, but often he or she never receives a service. They are the ones who spend every waking moment with their child and know what he or she excels at and with what he or she may need help. They are crying out for assistance, whether it be in the area of education, health or welfare, to give their son or daughter a greater quality of life which is what it is all about at the end of the day. We are here to improve the quality of life of children who suffer from autism.

A national review of autism services was undertaken by the HSE in 2012. It concluded:

Geographically, current services can vary from robust, comprehensive and integrated to isolated, patchy and ineffective. This model is no longer appropriate or sustainable in providing equity of access and intervention.

“Isolated”, “patchy” and “ineffective” are the terms with which I would be most familiar when speaking to parents. Across Ireland there are different models and approaches to the provision of health services in local health office, LHO, and HSE areas, but this is no longer appropriate or sustainable in providing for equity of access and intervention. There is no joined-up thinking, but I hope there will be after the passage of the Bill which offers an integrated approach to meeting the needs of people with an autism spectrum disorder, as well as generic health needs, which can be met at primary care level and which should be addressed by primary care teams. I am delighted with Senator James Reilly’s amendment No. 2 which would be very inclusive of all of the agencies and experts involved. Where specialist knowledge, skills and expertise are required, a child should be referred to specialist services, including in education. A strategy that cuts across all Departments and acknowledges that every Department has a role to play will ensure a more streamlined approach is adopted.

In summary, we are very happy with the Bill and I commend Senator James Reilly for bringing it before the House. I am delighted that it is receiving cross-party support.

I take the opportunity to welcome to the Visitors’ Gallery a delegation, all good friends of mine, from Doohoma, County Mayo.


Wednesday, 12 July 2017

Order of Business

Everyone knows people in their communities or families who are able to stay in the comfort of their own homes rather than a nursing home or hospital. Often only minor adjustments are required to allow this to happen but each day I encounter inordinate delays to home care packages.

Six months ago, my Fianna Fáil colleague, Deputy Willie O’Dea, introduced legislation to provide for a statutory right to a home care package. The Government kicked this down the road for six months and we still have not seen this. I want to know where is this legislation and where is the priority?

Last week we were asked to rush through and underwrite a bid for the Rugby World Cup, which I support 100%, but where is the same urgency to deal with the scandal of home care packages? This needs to be debated. The savage cuts in the past six years to housing adaptation grants for older people and people with disabilities, as well as mobility grants, is a scandal. In 2010, at the height of budgetary cuts, this area was protected. In 2010, the Exchequer provided approximately €77 million to local authorities for this vital work. This fell to about €36 million in 2014, causing some local councils to effectively close down the scheme. It has risen slightly in recent years.

I read the press release from the former Minister for Housing, Planning, Community and Local Government when he announced €59.8 million for 2017 but the real figure from the Government is only €47 million, as the larger figure includes 20% local authority funding. We need more transparency. This is the type of creative accounting that was exposed in the banking inquiry. The Exchequer funding for 2017 is €30 million less than 2010. A sum of €30 million would help many families get wheelchair ramps, grab rails, hoists and other basic adaptations. We need to have a debate about this because, as local councillors will attest, funding remains too low. I have often said that the mark of a society is how we treat our old people, our sick and our young and our Government is failing in this regard.