February 18th, 2014
I welcome the Minister to the House. I thank Senator Zappone for taking the initiative on this debate. Instead of focusing on a single definition of homophobia, we need to acknowledge that homophobia presents itself in a wide spectrum, ranging from violent hate crimes to far more subtle forms of discrimination.
I, too, commend Panti’s address at the Abbey Theatre on 1 February, and my colleague, Senator Mac Conghail, on using our national theatre in the way it was so rightly used for a noble call. She articulated so succinctly the impact of subtle discrimination and homophobia on a person’s psychic and mental well-being, causing them, in her words, to check themselves at the pedestrian crossing. The number of views, and the number of languages in which that video has gone around the world, shows the power that words can have.
It is very important, however, that we do not have debates about important social issues in isolation from each other. Social issues are invariably interrelated – homophobia, self-harm, suicide and suicidal ideation – and, tomorrow, we will have a debate on mental health and well-being. This is particularly true for young people and, in this context, LGBT youths. A report in 2008 was published jointly by BeLonG To, GLEN and the HSE, called Supporting LGBT Lives. That report found that 50% of LGBT youths have thought about suicide and 20% attempted suicide. LGBT young people are seven times more likely than their heterosexual counterparts to experience mental health distress. It has also been established that young people identify their sexuality at age 12, on average, and the average age of coming out is 17. This five year period in which young people come to terms with their sexuality is vital. Living in a society where anti-gay bias exists can lead to many difficulties in this critical adolescent period.
All this demonstrates the extent to which homophobia presents in society and impacts on the individual. The survey found that 80% of LGBT people have been verbally abused because of their identity. This is simply unacceptable. LGBT people must be treated as equal citizens and we must actively work to eradicate homophobia and any type of discrimination from our society. I believe we live in a society that is obsessed by labels. We need to celebrate difference, and this can only be done through robust, open and constructive debate. I was involved in a campaign a few years ago for which the slogan was: “We need to keep labels for jars, not people”.
I, like many of my colleagues, am concerned by the speed and, indeed, indecent haste with which RTE responded to Rory O’Neill’s comments on “The Saturday Night Show”. The decision to issue compensation, an apology and a right to reply to some of those perceived to have been injured may well have been disproportionate in the absence of a legal finding of harm done, especially given that compensation was paid out of taxpayers’ money. I am also uncomfortable about the absence of commentary around the fact the presenter of the show in question prompted Rory O’Neill to identify individuals by name. I think RTE’s decision is worrying on a number of levels. I feel it has negative implications for freedom of expression and also the manner in which debates around marriage equality will be conducted in the future. We all need to accept that robust and sometimes volatile discussion will take place around sensitive issues, and we should embrace this, not censor it.
It is evident, in the aftermath of the comments debacle, that people on panels were tripping over themselves trying not to say the wrong thing. That does not bode well for healthy and open debate. The upcoming referendum on marriage equality will see many different views. We need to ensure freedom of expression remains intact at all times. We need to send a message to young people that discrimination will not be tolerated. Homophobia does exist. There are real consequences for the targets of this abuse.
It is of the utmost importance that our national broadcaster ensures open and fair debate where both sides can communicate their argument in a fair and sensible manner.
February 5th, 2014
Senator Jillian Van Turnhout speaking on the issue of Youth Guarantee: Statements. Seanad Éireann
I welcome the Minister and thank her for keeping the commitment she made during the debate on the social welfare legislation to accede to my request for a discussion on this plan. I also thank my colleague, Senator O’Donnell, for her very informative report.
I welcome the plan. This is the first occasion since the advent of the financial crisis that a comprehensive plan bringing together all the elements to tackle youth unemployment has been produced. We should acknowledge the role the Minister has played in this regard, both in terms of her brief and in the context of her personal commitment to youth employment. It is extremely positive that a concerted effort will now be made to support young people from unemployment to education, training and work experience.
During the debate on the social welfare legislation, we engaged in a lengthy discussion on youth unemployment. As a result, I will use the time available to pose some very specific questions on the youth guarantee. I fully support the decision to commence the engagement process relating to the youth guarantee with the 22,000 young people who have been on the live register for 12 months or more. This makes sense. May we take it that these young people will be offered quality and appropriate educational, training or work experience placements by the end of 2014? If that were made clear, it would send out a great message to people.
I welcome the personal progression plans and the focus and early intervention for young people with a low probability of exiting the live register, PEX, score. There is a need for a two-way process between case officers and young people. Will there be a commitment to changing focus from needs of education and training providers to those of the unemployed and local labour markets? A greater number of and more intensive engagements can only happen if sufficient case workers are available. Is the Minister in a position to provide details with regard to the number of case officers and hours that will be assigned to the youth guarantee in 2014 and 2015? It is not clear from the youth guarantee implementation plan how much of the education-training provision is existing and how much will be new. This is important because it is clear, in view of demand, that merely rearranging the existing provision will not be sufficient. Will the Minister indicate, particularly in the context of education and training, where new provision will be available? I welcome the changes to schemes such as JobsPlus, particularly as these will allow employers to take on young people and obtain the wage subsidy for those under 25 who are on low to medium PEX scores and who have been unemployed for four months rather than being obliged to wait for 12 months. This is a welcome initiative and I thank the Minister for putting it in place.
The Minister correctly pointed out that some of the targets are ambitious. I was very happy when I discovered that the expected number of new JobBridge places for young people is set at 5,000 for 2014. Given that 6,000 young people under 25 have participated on the scheme since July 2011, however, this means that the Department proposes to almost reach in one year a target it previously took two and a half years to achieve. Will the Minister provide further information in respect of this matter and on the proposed JobBridge scheme for disadvantaged youth? I am interested in the latter but I would welcome additional detail in respect of it. I welcome the strong focus in the plan on disadvantage. Those in this category are often missed by plans of this nature because we tend to go for the low-hanging fruit and forget about that which is difficult to reach. I am disappointed that the opportunity to harness the capacity of the youth work sector in the context of supporting the implementation of the guarantee has been missed. I know the Minister has had some very positive meetings with representatives from the National Youth Council of Ireland and other youth work organisations on this issue. The reality is, however, that it will be challenging for State agencies to reach and engage with young people who are most disadvantaged. This is because those agencies lack the connections into the community that those youth sector already have in place. As already stated, the plan represents a missed opportunity and this regard and perhaps it might be possible to review the position that has been adopted.
The Minister may be able to answer some of the questions I have posed now. Perhaps she might respond in respect of the others at the earliest opportunity. I thank her for her vision, commitment and proposal to drive the youth guarantee forward. We are focusing on the right area and my questions are intended to achieve the results we all want to achieve.
February 4th, 2014
Senator Jillian Van Turnhout speaking on the issue of the Charities Sector: Statements. Seanad Éireann
I hope not to use all my time. I agree with what my colleagues have said, so I will not repeat, in particular, what my colleague, Senator Mary Ann O’Brien, has said. It is important to instil confidence and trust and also that there is ease of access to information. Senator Feargal Quinn gave us some examples from the US. I wish to pick up a point raised by Senator Mary Ann O’Brien in regard to the use of SORP and compliance and the proposal that all salaries above €75,000 be declared. We have had a huge focus on chief executive officers. I have seen organisations finding a way to skew this by employing their chief executive part-time but having other officials within organisations at much higher salaries on a full-time basis.
I wish to add to what Senator Mary Ann O’Brien said by proposing that we would know all salaries above €75,000. When I talk about salaries I am talking about the remuneration package, any health insurance benefits, pension benefits and anything extra, such as cars, that are not in the normal cut and thrust. I would also like to know how much time that person is giving to that job, whether it be 100% or 50%. In that way we should know pro rata what is their salary. We have seen organisations appear before various committees which have worked only part-time for a public service and part-time for a private service and yet seem to be able to get a multiple times salary for that work.
I am somewhat concerned over the use of the term “charity”, which is being used quite broadly. My real concern is over the use of public money and how the State is funding organisations. Regardless of whether an organisation is set up as a private company or a charity, I want to know that that public money is going to good use. I want the same scrutiny to apply to them and I do not want a public company to hide behind company law and claim that as a public company it does not need to declare this.
I have a concern where the State is funding 100% or 90% of some services. In those cases should the State not run the service rather than it being called a charity? I believe there is an historical legacy for us here. We have organisations which started with really good purposes – traditionally religious organisations providing services mainly in the medical field. They have now professionalised and are running organisations with multi-million euro budgets. However, if we question their work they will rely on that historical legacy to get them out of trouble. I have a major issue with that because the same yardstick should be used regardless of the service provided. There is an issue with the State funding some organisations which historically get an increase of 2% or a reduction of 5% on the previous year. It is just up or down with the normal trend and all organisations are dealt with by way of the same measure. There is an issue where no tenders are sought and no responsibility on the State to outline what service it is expecting for its money. Let organisations come in and bid to provide those services.
Did the Minister know that the new Child and Family Agency will fund 700 organisations? I still do not know what all those organisations are. We have a responsibility and we have an opportunity to change it.
The Minister is moving as quickly as he can on the issues of the regulator and the board. While the regulator needs to be resourced it needs to be given the teeth such that if it has a concern it can address it. I have come across statements at committees or in the media which I have read repeatedly and tried to understand what they are telling us. It is like a secret code and it is necessary to parse the words. I still do not know if I understand what they are telling us or if they are telling us the truth. When the regulator is set up, some organisations will rush to compliance, but I am worried about agencies that believe they will swing around to compliance or use such terms. If the regulator is not getting the information it needs about these organisations, we need to be sure we will be able to back it up.
I totally agree with my colleagues and simply wanted to add those comments.
Question 3: Childhood Obesity
In light of the growing childhood obesity epidemic in Ireland and Government policy as set out in Healthy Ireland-A Framework For Improved Health and Wellbeing 2013-2025, to ask the Minister for Health why under the new Framework for Junior Cycle the status of physical education and SPHE (amongst others) has changed from a subject to a short course, thereby reducing recommended teaching time, and what will now be done under Healthy Ireland to ensure physical education and social, personal and health education in schools gets the priority they need?
I am aware that on 4 October 2012, the Minister for Education and Skills, Ruairí Quinn, TD, published A Framework for Junior Cycle which outlines his plan to reform the junior cycle in post-primary schools. I understand and am supportive of the overall vision being pursued with the framework and my Department will assist the Department of Education and Skills in achieving this vision. We believe that if the reforms are implemented as envisaged, they may increase student engagement with school due to the decreased emphasis on rote-learning and the broadening out of areas in which students can achieve recognition for their achievements. This will have a positive impact on health and wellbeing. I am aware that the Department of Education and Skills is supportive of health and wellbeing and I welcome the inclusion of wellbeing as one of the eight principles underpinning the Framework for Junior Cycle.
A position paper on Social Personal and Health Education and Physical Education has also recently been developed by a working group of relevant experts in the HSE which has been shared with the Department of Education and Skills. It is worth acknowledging that several health indicators in Ireland demonstrate positive trends in the health and wellbeing of adolescents in the last 10 years. Trends in the Health Behaviour of School-Aged Children Reports (ESPAD), for example, record declines in cigarette use, alcohol use, binge drinking and illicit drug use.
Research evidence from an international perspective points to the need to have comprehensive all-encompassing strategies for health behaviours which involve multiple settings, including the school setting, if progress is to made in improving health and wellbeing. Improvements in the trends on health behaviours are most marked since 2002/2003, the years that the SPHE programme was required in junior cycle. It is likely that the roll-out of the SPHE programme has had a positive influence on the health behaviour of young people.
Healthy Ireland which was launched in March contains a commitment to fully implement SPHE and PE and this was agreed with the Department of Education and Skills. As the Senator will be aware, Healthy Ireland contains a vision of an Ireland where everyone can enjoy physical and mental health and wellbeing to their full potential, where wellbeing is valued and supported at every level of society and is everyone’s responsibility.
Clearly, the creation of healthy generations of children, who can enjoy their lives to the full and reach their full potential as they develop into adults, is critical to the country’s future. Responsibility for prevention programmes cannot rest solely with my Department, the HSE or, indeed, the Department of Education and Skills but must be shared across Government Departments and all of society.
Officials in my Department will continue to meet with officials in the Department of Education and Skills to address issues of concern including these matters.
Question 4: National Consent Policy
What implementation plans are in place for the new National Consent Policy (May, 2013) for use in health and social care, particularly the education and training of staff who are expected to implement and deliver the policy
The HSE Consent Policy was developed by an advisory group and a wider stakeholder group. These groups included representatives of the staff who will use the policy on a day to day basis and the document reflects the needs of practitioners. The principle of consent and the knowledge of the importance of obtaining consent are expected of all staff employed or contracted by the HSE. Knowledge of the importance of consent is, and has long been, a professional requirement for health and social care professionals. Therefore the main focus of support for the policy is providing guidance rather than training and education of staff. At a local level there is a training requirement for new staff on local protocols and documents/forms used for consent, and this will continue.
The definitive document (HSE National Consent Policy) is in itself a guidance document and has been supplemented by the publication of a brief summary entitled ‘Seeking Consent: A Brief Guide for Health and Social Care Workers’. This provides practitioners’ guidance on how to use the policy in service settings.
To support staff in the hospital services the HSE will review the consent forms that currently exist for common procedures with the view to development of nationally agreed forms/templates. This will reduce variation in information provided and improve the quality of the consent process; and reduce training requirements as staff move around the system.
Children and Family services provide particular challenges in the area of consent. The Children and Families Services are developing an implementation plan to address particular requirements that arise in the delivery of services. The plan is being prepared at the moment.
Two service user guides have also been developed and published to help patients and service users understand the consent process and what they can expect from their healthcare provider and professional.
A log is maintained of all queries raised with the Quality and Patient Safety Directorate in regards to the use of the policy and these will inform the updating of the policy and other guidance as required.
Question 5: Counseling service for mothers.
Given that an estimated 28,500 women in Ireland are diagnosed with perinatal depression, post-natal depression and pregnancy or childbirth related post-traumatic stress disorder each year, to ask the Minister for Health what efforts are being made to tackle delays of 9 months and more for mothers to be seen by a professional counsellor in the public health care system?
Pregnant women access a range of services including primary care, obstetrics and ante-natal and post-natal services. If the individual herself, or any of the healthcare professionals caring for her during her confinement have a concern, they should first access their GP or Primary Care team in the normal way. Where an individual is assessed as requiring referral for specialist mental health services, their GP would refer to their local General Adult mental health service.
For women with a recognised mental health need, they may discuss the management of their pregnancy with their consultant psychiatrist as it may be necessary to alter their treatment programmes as some medications as contraindicated in pregnancy.
All community mental health teams would have experience of such presentations and collaborate with the obstetric services to ensure a safe delivery and appropriate aftercare.
For women with a previous history of post-natal distress or depression, there is an elevated risk of recurrence and this would be actively managed through high frequency review by the GP who assess when it would be necessary to engage with the specialist mental health services if at all.
Access to counselling for all medical card holders, including pregnant women, is now available through the Counselling in Primary Care Service. The detail of this new service and pathway of referral is attached in Appendix 1.
If an individual is being treated within the specialist secondary care mental health services and counselling is indicated clinically then the appropriate intervention by a trained health professional would be made available.
There are 123 General Adult Community Mental Health Teams nationally. The HSE, in its 2012 Service Plan, prioritised €35m and 414 WTEs for reinvestment in mental health to progress the objectives in the Programme for Government. One of these objectives was to enhance General Adult and Child and Adolescent Community Mental Health Teams.
The HSE, in its 2013 service plan intends to build on this investment with a further €35m to strengthen General Adult and Child and Adolescent Community Mental Health Teams.
In addition, there are three peri-natal Psychiatrists based at The National Maternity Hospital Holles St, The Coombe and Rotunda Maternity Hospitals reflecting the number of births at these centres each year.
Of the 414 posts allocated in 2012, 389 posts have either been filled, or under offer or awaiting clearance. These posts include multidisciplinary team members across all the health professions.
Of the 477 posts approved in 2013, 133 posts have been accepted by candidates. A further 16 offers have been made from existing panels. The HSE is establishing new panels and other arrangements to fill the remaining posts.
Currently, our mental health data system is a manual system and the information in respect of service users who may be pregnant is not captured nationally.
Question 32: Provision of Neuro- Rehabilitation Services
Following the publication of the National Policy and Strategy for the Provision of Neuro-Rehabilitation Services in Ireland 2011-2015 (December 2011), an undertaking was given to publish an implementation plan “forthwith”. Why has this implementation plan not been published to date? When will it be published? And, will it meet its 3-year implementation schedule by December 2014?
The Department of Health and the Health Service Executive (HSE) have developed and published the “National Policy and Strategy for the provision of Neuro-Rehabilitation Services in Ireland 2011 – 2015”. In addition, the HSE is developing its Rehabilitation Medicine Programme within the Clinical Strategy and Programmes Directorate. The Report is the overarching policy on neuro-rehabilitation services and includes proposals for a framework for the future of neuro-rehabilitation services in Ireland, including key elements such as:
• guiding principles;
• implementation structure;
• methodology for implementation; and
• information and communication.
The Report recognises that given the current economic climate, the focus in the short to medium term has to be on re-configuration of services, structures and resources and the enhancement of the skills and competencies required to meet the changing context.
The key priority areas, as identified in the HSE’s National Operational Plan for 2013 are to:
• Map and develop Integrated Service Area level rehabilitation networks;
• Implement the model of care for rehabilitation services within the networks with a focus on community rehabilitation.
An implementation plan beyond the overall operational plan commitments would not be beneficial, as the work involved to progress networks and teams will require to be flexible and responsive to the areas identified and to their specific service profiles.
The Rehabilitation Medicine Programme has been working in collaboration with the National Disability Unit as part of an expert Working Group planning for the implementation of the Report. The Rehabilitation Medicine Programme has incorporated key elements of the Report into its own Model of Care and adopted the Strategy’s recommendation of “hub and spoke” model for specialist rehabilitation services and is keen to progress with a comprehensive model for the continuation of such service into the community. This co-operation will continue in 2013.
Question 33: Neurologist waiting lists.
What plans are in place to tackle waiting lists to see a neurologist in public hospital out-patients clinics, which are over 4 years for more than 1,000 patients? And, what will be done to cut the waiting time for neurosurgery, which is currently over 6 months for 37% of patients requiring this treatment?
An Outpatient Services Performance Improvement Protocol has been developed to improve the provision of outpatient services in all publically funded healthcare facilities providing outpatient services which will include neurology referrals. A minimum standard has been established of no patient waiting greater than 12 months by 30th November 2013. A primary target list has been developed for each hospital identifying all patients that will breach the target if not seen by 30th November 2013. Capacity analysis is currently being undertaken in all hospitals with regard to meeting this target. All hospitals are developing plans by specialty including neurology at present to address long waiting lists. Solutions being considered to tackle waiting lists to see a neurologist in public hospital out-patients clinics include data validation, patient level validation, additional clinic slots, additional clinics and capacity within the region.
In relation to inpatient neurosurgery services there are currently 452 patients awaiting inpatient/day case neurosurgery. Of this total 288 are waiting 0-6 months and 164 are waiting > 6 months.
The maximum wait time guarantee for all adults awaiting any type of inpatient or day case surgery is 8 months in 2013. The aim is for all hospitals to systematically reduce this maximum wait time each year by matching capacity with demand, eliminating inefficiencies in the patient pathway, ensuring the strict chronological management of patients of equal clinical priority and implementing the recommendations of the Surgery Clinical Programme
Question 34: Children’s palliative care programme
To ask the Minister for an update on the children’s palliative care programme currently funded by Irish Hospice Foundation (IHF) and HSE. In particular: an assurance that all 8 children’s outreach nurses (5 IHF funded/3HSE funded) are now in post and if not, why and when will they be in post?; to outline the plans the Department of Health and HSE have to identify sources of sustainable funding for the Children’s palliative medicine consultant post (IHF funded) and the 8 outreach nurses when the IHF funding ends in 2016; and to confirm that children with terminal illness are entitled to the medical card without means test in the same way as adults.
The HSE and the Irish Hospice Foundation work in very close collaboration in relation to children’s palliative care services and the National Development Committee for children’s palliative care is jointly chaired by both organisations.
• Provides national strategic guidance in relation to children’s palliative care needs
• Makes recommendations in relation to the resourcing of children’s palliative care services.
• Oversees the preparation of development plans for each HSE Region
In support of this work and to ensure streamlined services across the country, a network of Outreach Nurses, Consultant ‘champions’ and Directors of Nursing has been established.
Four Palliative Care Outreach Nurses are already in post and the process of recruiting the remaining 4 is at a very advanced stage, with candidates selected for the 4 posts.
The HSE continues to work with the Irish Hospice Foundation to develop a sustainable model of funding post 2016.
Other priorities for the Committee are
• Developing an appropriate monitoring and evaluation process for the Children’s Outreach programme
• Identifying the respite and home care needs of children with life limiting conditions including the development of a ‘Hospice-at-Home’ service model
• Improving clinical Governance, education and development
• Developing minimum information data sets
Children with terminal illness are entitled to a medical card without means test in the same way as adults. No means test applies to an application by a terminally ill patient and all terminally ill patients will be provided with a medical card number for a period of six months once their medical condition is verified by a GP or a consultant.