Category: Health

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Statements on Tackling Obesity in Ireland, 17 June 2015

The Minister is always very welcome to the House. The time he has dedicated to today’s debate shows that he has an understanding of the importance of this issue and the serious health concerns associated with it. There is no doubt that we are IN the midst of a full-blown obesity epidemic. It is shocking that 61% of adults and 22% of children between the ages of five and 12 are overweight or obese. Given that this issue is so costly and damaging to the health and well-being of the nation, it is difficult to understand why we are still discussing strategies rather than implementing the excellent strategies we already have. The national task force on obesity has been operating for almost ten years, but its recommendations have been implemented in a partial and haphazard manner. The then Minister for Health, Deputy Reilly, established a special action group on obesity in 2011. This group highlighted priority areas and policy recommendations, such as an introduction of a sugar tax and the improvement of nutritional labelling. These are very cost-effective ideas, but four years on there has been no action towards implementing any of them. Children remain particularly vulnerable. The Government’s failure to act is having a particular impact on them. They are increasingly vulnerable to chronic diseases, premature deaths and disability in adulthood.

Given the negative impact of obesity on people’s health, it is understandable that we talk about it in a critical and negative way. However, we need to be mindful in our discourse that obesity and excessive weight are realities that people live with and struggle to overcome. This is especially important when we talk about childhood and adolescent obesity, which can have a significant impact on the self-image, self-esteem and confidence of the young person affected. For many years we have associated malnutrition with lack of food or starvation, but in fact that is under-nutrition. Obesity is the result of malnutrition, which is a poor diet with a lack of adequate nutrition for proper growth and development.Not everyone who is malnourished is overweight or obese but this does not mean that he or she is not seriously damaging his or her future health. It is imperative, therefore, that we shift the focus to a more holistic healthy lifestyle approach, with nutrition and exercise as its linchpins. We must tackle the unhealthy obsession that has developed about being fat, counting calories, “yo-yo” dieting and losing weight, all of which are serious issues among young adults, especially females.

As previous speakers pointed out, school is where children spend the majority of their time in the company of their peers. Physical education in schools is essential to a child’s physical and mental development. The children’s sport participation and physical activity study of Irish students in primary and post-primary education found that a mere 35% of primary pupils and 10% of post-primary pupils received the minimum 120 minutes of physical activity in school per week, as recommended by the national task force on obesity. One in four of the children surveyed was unfit, overweight, obese or had elevated blood pressure.

A 2013 report by the European Commission, Physical Education and Sports at School in Europe, found that the provision of physical education at primary level in Ireland is the third worst in the European Union, while at post-primary level, it was found to be seventh worst in the EU. This failure to ensure the weekly minimum of 120 minutes of physical activity for children is a serious blow to children’s health. We must promote physical activity, participation in physical education and non-structured play during school hours. Children should be encouraged to engage in team sports, join activity clubs in the community and simply enjoy the outdoors. When they learn these habits at primary school level they continue to be active throughout their teenage years, thus reducing the risk of obesity.

I am concerned that parents do not have control over children’s eating habits when they are outside the home. While healthy lunch policies are widely implemented in primary schools, they tend to be abandoned when children enter secondary school. Research carried out this year by the Irish Heart Foundation on food provision in post-primary schools found that 51% of students have daily exposure to foods that are high in sugar, fat and salt and that these are widely available not only outside the school gates but also in school tuck shops and vending machines. There is no statutory requirement on schools to provide meals and hot food to students throughout the school day, although many schools have canteen facilities. Given the obesity epidemic we face, it is alarming that no national guidelines or standards are in place on the types of food and drinks available for children to buy. With no time for exercise and sugary, fatty foods surrounding children everywhere, it is little wonder that childhood obesity rates are high. If we continue to ignore this issue, our children’s health will only worsen.

Obesity is also becoming a problem of poverty. Convenient cheap foods that are high in calorific value and low in nutritional value are becoming the norm for lower income families. Why are convenient healthy foods the most expensive option? Anyone who visits a canteen or shop will see that convenient healthy foods are the most expensive option. The cost of healthy food is becoming a barrier to a healthy diet for families. For this reason, I support the introduction of a sugar tax. The money generated from such a tax should be used to fund projects such as family food initiatives. These are projects that help to improve the availability, affordability and accessibility of healthy food for low income groups at local level using a community development approach. The objective is to help families to achieve a healthier lifestyle.

The Minister raised the issue of free general practitioner care for children aged under six years and the two health checks available for this age cohort. While these are excellent initiatives, one of the issues people have raised with me is that they do not provide access to a dietitian or nutritionist in cases where a general practitioner encounters a problem. The schemes present an opportunity for general practitioners to engage with parents and provide them with nutritional information. As the Minister is aware, I fully support free GP care for children aged under six years.

An issue arises regarding choice architecture. The Department organised a seminar some weeks ago on what is known as the nudge policy and a number of simple steps that could be taken in this area. One need only visit a local shop, supermarket or canteen to observe how choice architecture is being used. It is easy for shoppers to grab the unhealthy option. While many of us agreed with Senator Byrne’s interesting comments on food, these issues do not always click for us. If Members are not getting this information easily, how much more difficult must it be for someone managing a family and in a rush to do so?

I thank the Minister for his attendance. My message is that we have policy blueprints and it is now time for action.

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Statements on Alcohol Consumption in Ireland

I was happy to swap with my colleague Senator Rónán Mullen because I would not have wished him to feel he was being silenced by not being able to contribute to the debate on the forthcoming referendum. I welcome Ms Suzanne Costello from Alcohol Action Ireland, who is in the Visitor’s Gallery.

I welcome the Minister for Health, Deputy Varadkar, to the Seanad and applaud him for what he is doing in this area. I accepted an invitation from the Department of Health to attend a seminar entitled “Influencing Healthy Lifestyles: Nudging or Shoving? The Ethical Debate.” It was really informative, and I thank the Minister for extending the invitation to us.

The public health (alcohol) Bill 2015, as the Minister outlined, deals with labelling, minimum unit pricing, marketing, advertising sponsorship, availability and price-based promotions. The Joint Committee on Health and Children, chaired by our excellent Chairman, Deputy Jerry Buttimer, held a series of meeting on the subject and is finalising its report. The Minister came to the final hearing of this series of debates on the heads of the Bill to hear the views of the members. What the Minister said today in the Seanad shows me that he took on board a number of the committee’s sentiments with regard to the public health (alcohol) Bill. I thank him.

I note with sadness that according to the OECD report Tackling Harmful Alcohol Use: Economics and Public Health Policy, Ireland has the fourth highest level of alcohol consumption in the OECD, behind Estonia, Austria and France, at 11.7 litres per capitafor those aged 15 years and over. To be placed fourth in this category is not the position we want to hold on this league table.Several of my colleagues have referred to the executive summary of this OECD report, from which I will quote:

 

Alcohol has an impact on over 200 diseases and types of injuries. In most cases the impact is detrimental; in some cases it is beneficial. In a minority of drinkers, mostly older men who drink lightly, health benefits are larger. … Harmful drinking is normally the result of an individual choice, but it has social consequences. The harms caused to people other than drinkers themselves, including the victims of traffic accidents and violence, but also children born with foetal alcohol spectrum disorders, are the most visible face of those social consequences. Health care and crime costs, and lost productivity, are further important dimensions. These provide a strong rationale for governments to take action against harmful alcohol use.

 

People often talk about the consumption of alcohol by young people and children, but they do not necessarily refer to the impact of alcohol on children in families. We see the figures in reports on domestic violence. The example set by the parents’ lifestyle impacts on the household. Senator Colm Burke referred to the students who won the Young Scientist exhibition with their project entitled: “Does the apple fall far from the tree?”, who made a presentation to the Joint Committee on Health and Children. In their project they quoted from a recent ISPCC report in which one child noted: “If you see your parents get drunk, whether you like it or not, it will have an effect on your life.” What surprised me was that one fifth of parents surveyed were not concerned about the prospect of another parent or adult supplying their adolescent with alcohol. That shows me how normal it is for adolescents to drink alcohol. If the adults in these young people’s lives think it is acceptable to buy a young person alcohol, it shows how much needs to be done in informing and educating the adults as well. We have to focus on young people. There is an issue with young people and alcohol which is European-wide, but, as the saying goes, they do not lick it off the ground. The adults in their lives are the role models and they very often set the norms. It is the norm for adults to go to the pub to socialise. We do not have other avenues. We need to ensure we have other avenues and that we provide other examples for our young people.

I fully endorse minimum unit pricing. The excellent report by Dr. John Holmes and Dr. Colin Angus from the University of Sheffield is comprehensive and goes through everything. They have been very open. I have gone back and forth to them with questions and they have been open about addressing any concerns we have. I would be very happy to share this report with colleagues.

I am concerned that the code of practice must be placed on a very strong footing. I have observed how the drinks industry can find every loophole in the system. Could we look at the threshold for the audience profile measurement, which stands at 25% at present? That is far too high. It should be at 10%. I would prefer if there was no alcohol advertising, but at the very least we need to reduce the level of advertising. I raised the issue of online marketing at the committee hearings. We know that some years ago Diageo announced that 21% of its marketing budget would go to online marketing. Recently legislation was introduced in Finland to ban alcohol apps that contained games, location settings and information on the nearest place to drink. Clearly, these apps are targeted at children. It is a social engagement. As my colleagues have said, a young person who visits YouTube will see advertisements for alcohol that I do not see. The drinks industry is very skilled at targeting particular groups. They know what sites and YouTube videos people are looking at, and the advertising is targeted at them. I have seen the effects of this at first hand. If I walk into any classroom and ask children to name their favourite advertisement on television, I guarantee that alcohol advertisements are up there in their choice. The young people score highly on brand recognition.

This brings me to the issue of sports sponsorship. I really believe we should set a date, no matter how far forward it is, to cease all alcohol-related advertising. It is very telling that neither the drinks industry nor the sports organisations will tell us how much sports sponsorship is worth. We do not have a figure. I think that is unacceptable that we do not know what we are talking about. Youth organisations which do so much voluntary work across the country will not take a single cent from the drinks industry, and I do not see the Government being put under pressure to replace it. In fact, the funding of youth organisations was cut by 40% during the recession, yet these organisations are still delivering those services. I acknowledge that some sporting organisations have stopped taking money from the drinks industry, but the sporting organisations who are still taking sponsorship money should let us know how much we are talking about. Last year, a school principal from Munster spoke at an Alcohol Action Ireland hearing on the issue of sports sponsorship. When Munster won what in France is called the H Cup, he invited the team to visit the school and he was delighted a few team members said they would go. They had a great day, but when they arrived with all the sponsorship and drinks advertising, he realised that he, as the principal of the school, had brought alcohol advertising to the school and he apologised to his students for doing so.

How the drinks industry has a handle on us is subliminal and insidious. It is unacceptable and we need to examine it. At a recent hearing, Katherine Brown of the Institute of Alcohol Studies stated alcohol sponsorship of sport is a way past children’s bedroom doors because they have a picture of a sporting hero on the bedroom door with the nice alcohol branding linking it to sporting success. She stated that if we are really serious, we need to tackle and deal with the issue of separation.

We also need to address the drinks industry role in decisions taken. I am concerned when I see jobs advertised by certain drinks companies. According to the job descriptions, they want to stay one step ahead of regulatory developments. They want to ensure they can beat the system. They will tell us it is all about education and if we were all more informed, we would all make the choices. I know about education, healthy eating and lifestyle. I am not as good as I should be because it is not what changes my behaviour. This is where legislation is important and why the Minister has my absolute and full support. I want us to go further and to do more. I want us to follow policies like that recently announced by the HSE, whereby it will have no truck with the alcohol industry. Why are the Departments of Education and Skills and Health not coming out with similar statements? The Child and Family Agency is thinking about it. It should have no truck with the drinks industry. We must do a lot more in Ireland.

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Role of drinks industry in Schools – Commencement Matters

I thank the Cathaoirleach and welcome to the Visitors’ Gallery Ms Siobhán Creaton from the Royal College of Physicians of Ireland and Ms Suzanne Costello from Alcohol Action Ireland. The issue I have raised with the Minister for Education and Skills pertains to the role the drinks industry is trying to develop with regard to the education of children in Ireland. I will begin by applauding the Government on the public health (alcohol) Bill. As a member of the Joint Committee on Health and Children, I have been very much involved in the consultations and the process. If anything, I would like it to go further, but I certainly will do everything I can to ensure that it comes into law.

However, as part of those consultations, the first red flag went up for me when I saw, for example, the Alcohol Beverage Federation of Ireland saying how the industry decided in 2014 to refocus its initiatives in the education space and to concentrate activity on drinkaware.ie. It currently is establishing Drinkaware as an organisation whose work will be modelled upon the influential UK Drinkaware Trust. Unfortunately, if one looks at independent evaluations of Drinkaware in the United Kingdom, one concludes that it is not a model we wish to see in our schools. It has not come out well from an evaluation. Not surprisingly, the drinks industry believes it is excellent, which makes me even more worried about it. The second flag for me was the Stop Out-of-Control Drinking campaign, rolemodels.ie, which is due to produce its report shortly. I can nearly see what this report will say. It will state that we need to educate children, because this is the constant mantra of the drinks industry – namely, that education is needed and that, were everyone educated, it would reduce our risk regarding alcohol-related harm. All the evidence shows that education informs our behaviour but that it does not change or influence it. That is why we introduce laws in respect of, for example, speeding. We all know what is good or bad for us, but legislation is often necessary in order to ensure that we do what is right. A recent Drink Aware advertisement relating to the post of education programme manager refers to the successful applicant working directly with schools. This is despite the fact that a spokesperson for Drink Aware indicated that this is not intended to be the case. If that is so, then the advertisement to which I refer misrepresents the position, because it refers to working with teachers, unions, principals, the Professional Development Service for Teachers, the Department of Education and Skills and the National Council for Curriculum and Assessment. It is obvious that those responsible for Drink Aware want it to become embedded within the education system. I know someone who applied for the position of education programme manager but whose application was unsuccessful. The person in question was informed about the rolemodels.ie campaign, which is going to lead to what I have just outlined. There are no surprises here.

The HSE is not often applauded, but I want to take this opportunity to applaud it most heartily. On 23 April the executive issued a statement to the effect that it is no longer prepared to take any money from the drinks industry and that it will not be associated with said industry, particularly in the context of public health advice or any form of partnership. The statement in question was quite unequivocal in terms of public health advocacy. In my opinion, it reflects what the World Health Organization has said, namely, that public health policies concerning alcohol need to be formulated by public health interests without interference from commercial interests. I am seeking an assurance from the Minister of State that the drinks industry will play no role in our schools. The HSE has worked on the SPHE model with schools. I am concerned by the fact that the National Parents’ Council Primary has put its name to the rolemodels.ie campaign, and I really hope it will withdraw its support. The National Parents’ Council Post-Primary has distanced itself from the campaign and indicated that it would question the motive behind any campaign funded by the drinks industry and aimed at educating our children.

I tabled this matter because I believed the time was right to do so. What I have stated reflects Government policy. We cannot just leave matters stand and wait to discover what people think. The majority of people do not know that Drink Aware equals the drinks industry. The idea of representatives from the tobacco industry going into schools and telling children about anti-cessation measures relating to smoking is abhorrent. We should also abhor the fact that those in the drinks industry even think it is acceptable for their representatives to go into our schools. It will be reprehensible if the Department of Education and Skills says that it is sorry but there is nothing it can do about this matter. It is not acceptable for those in the drinks industry – regardless of whatever costume they may choose to wear – to have any hand, act or part in the education of the children of Ireland.

Minister Kevin Humphreys (response):

I am taking this matter on behalf of my colleague, the Minister for Education and Skills, Deputy Jan O’Sullivan, who sends her apologies.

The Department of Education and Skills is working very closely with the Department of Health in respect of the overall Healthy Ireland agenda. This encompasses co-operation in a range of areas including physical activity, healthy eating and student well-being, as well as substance misuse. At national level, the Department of Education and Skills is represented on key Government structures that provide a co-ordinated approach to addressing substance misuse. These include the national co-ordinating committee for drug and alcohol task forces. The Minister does not believe it appropriate for her to write to schools to prohibit particular materials or resources that may be developed by certain organisations, including the drinks industry. This could form a dangerous precedent for the future. However, officials at the Department of Education and Skills will continue to co-operate with the HSE and the Department of Health to ensure a co-ordinated and partnership approach to alcohol misuse and the range of other areas that are encompassed by the Healthy Ireland agenda. One recent example of such co-operation is the development of healthy lifestyle guidance that is currently being finalised. This guidance is intended to encourage schools to promote physical activity and healthy eating. It is also designed to encourage their participation in the health-promoting schools initiative, which is supported by the Department of Health and the HSE.

It is important to recognise that while education has a role to play in addressing the problem of alcohol misuse, behavioural change will not happen without the support and co-operation of parents, industry and society as a whole. Parents have a responsibility to help children and young people to adopt sensible and responsible attitudes and behaviours regarding alcohol and drug abuse. At present, the education sector is supporting national policy on substance misuse. In particular, schools are equipping students with the key skills and knowledge to enable them to make informed choices when faced with a range of difficult situations.This includes providing students with age appropriate information on the issue of alcohol abuse through aspects of the curriculum such as the social, personal and health education, SPHE, programme. This programme is mandatory in all primary schools. It will also form part of the new mandatory Wellbeing component of junior cycle, along with physical education and civic, social and political education, CSPE. Schools are also encouraged to deliver the SPHE programme in senior cycle. The substance use module of the SPHE curriculum focuses on the issues relating to the use and misuse of a range of substances. It actively seeks to promote healthy and responsible choices by students in a range of areas, including alcohol.

The latest data taken from Department of Education and Skills’ Lifeskills survey 2012 indicate that 90% of primary and 100% of post-primary schools provide their students with information on alcohol abuse through SPHE and other means. These results were almost identical to the position reported by schools through the 2009 Lifeskills survey. The 2015 Lifeskills survey is currently being completed by schools and the Minister hopes to publish the results before the end of the year. This will allow for the measurement of schools’ progress in this area since 2012.

Schools have access to a number of programmes and resources that support the delivery of SPHE and increase students’ awareness of well-being, including drug and alcohol issues. Examples include the Walk Tall programme for primary pupils and a post-primary resource available from the Professional Development Service for Teachers, called On My Own Two Feet. It is a matter for schools and teachers in the first instance to determine what resources and supports they will use to support their implementation of the curriculum. Teachers are equipped to make such decisions as a result of their initial teacher education and the ongoing support provided by the Professional Development Service for Teachers. I am confident that teachers are best placed to identify the most suitable resources to assist them in delivering the SPHE curriculum in their classrooms.

I listened carefully to the Senator’s contribution. She has raised red flags in respect of alcohol awareness and the industry in regard to that. She has been strong and logical about this. The Senator also referred to education, behaviour and role models and expressed concern about the involvement of the drinks industry in both primary and post-primary schools. She made some good points and I will ensure they are highlighted to the Minister. I will ask her to consider the important issues the Senator has raised.

Jillian van Turnhout:

I thank the Minister of State and appreciate that he was not in a position to answer my questions but perhaps he will also relay these questions to the Minister. The drinkaware.iejob advertisement for education programme manager states: “To manage relationships with relevant stakeholders, including the Department of Education, the National Council for Curriculum and Assessment and the Professional Development Service for Teachers”. These are all within the Minister’s remit. I cannot see any reason for the drinks industry to have a relationship with the Department or the NCCA. I seek the Minister’s assurance that they will not have a relationship with the industry.

I appreciate the Minister cannot write to schools to say they cannot do this but, at the very least, could she write to them to advise them that drinkaware.ie equals the drinks industry. It is nothing else. drinkaware.ie is the costume the industry chooses to wear today. It will come up with something else when drinkaware.ieis exposed to people. Schools need to be warned and a warning bell is needed in this regard.

Minister Kevin Humphreys:

I thank the Senator. I will raise those points. I have a meeting with the Minister later this afternoon at which I will ask her to look at the Senator’s contribution and reply to her directly.

Jillian van Turnhout:

I thank the Minister of State.

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Statements on Homelessness Wednesday 3 December 2014

PLEASE CHECK AGAINST DELIVERY

According to the Dublin Simon Community, the official count for rough sleepers last month was 168. This represents a 30% increase in numbers since Spring 2014 and double the number since November 2012.

This is a time of many sickening firsts and all-time highs:

  • Emergency accommodation now has over 1600 adults plus 680 children. That’s never happened before!
  • Of the 1600 adults in emergency accommodation, 39% are women. That’s never happened before!
  • Emergency accommodation is turning into long term accommodation with no viable options to transition onto. That’s never happened before.
  • Many have given up looking for emergency accommodation.
  • Others believe themselves to be safer on the streets than in emergency accommodation.
  • Individuals and families are being are evicted from private rental properties every day of the week, unable to meet rent increases in an unfettered market.

We have an Emergency on our hands and it is winter. A very cold winter.

The numbers are steadily increasing and we need to act. Really act. Not a knee-jerk panicky reaction following the tragic death of Jonathan Corry. A dedicated and sustained response that looks at the crisis holistically.

For it is not just a homelessness crisis. This is a housing crisis.

A housing crisis characterized by a shortage in the social housing sector and a serious lack of affordability in the private rental sector, exacerbated by an absence in rent regulation, a rent supplement scheme completely out of sync with actual rental prices and the absence of measures to prohibit landlords discriminating against tenants on rent supplement.

The unprecedented crisis in the social housing and private rental sectors is pushing non-typical candidates into risk of homelessness and homelessness itself, for example, there are as many as 150 families in emergency hotel accommodation, the majority of whom have been pushed out of the private rental sector by spiralling rents.

Aside from the massive cost to the State, this hotel  and B&B accommodation is completely inappropriate, hugely disruptive for families and children, who may have to move schools as a result, and potentially unsafe.

I call on Government to immediately family proof all forms of emergency accommodation and to coordinate with the Child and Family Agency and emergency accommodation staff concerning child protection.

The crisis is in turn putting unprecedented pressure on frontline services and pushing those more “typically” vulnerable to homelessness (those with addiction issues and mental health difficulties and in complex situations such as young people aging out of State care, victims of domestic violence leaving the home) it pushes them  further and further to the margins only to resurface to public and political attention when they die in their sleeping bag, sleeping rough on the door step of the National Parliament.

The recently published Private Residential Tenancy Board Consultant’s Report found that rent control would make the housing market worse.

Focus Ireland rejected this finding. It maintains that rent regulation is a crucial part of a suite of measures, including an increase in rent supplement to reflect the actual cost of rent and tax breaks for landlords to encourage them to rent their properties.

I would also subscribe to a measure of rent regulation against an index as in many European countries or in line with inflation.

There are many initiatives to be commended, however there are “buts” attached to nearly all of them. For example:

  • Housing 2020 and the recently announced Social Housing Strategy but realistically we are 1.5/2 years away from meaningful delivery.
  • The new rent increase protocol agreed with the Department of Social Protection for families at imminent risk of homelessness but it is only available in Dublin and what we really need is a level of flexibility throughout the system and at an earlier juncture.
  • The Housing Assistance Payment, which is receiving a positive response from Landlords in terms of there being a guarantee around rental payment but doesn’t actually prohibit landlords from refusing to accept tenants in receipt of financial support. Also, how are people to find suitable accommodation within the maximum rent limits?

Excellent recommendations have been made in these regards and more by Focus Ireland, Threshold,  Dublin Simon Community and Peter McVerry Trust. The solutions are there. They just need to be implemented.

In closing, I would like to briefly discuss something a number of colleagues in this House said yesterday concerning Jonathan Corry and the fact that he had been offered assistance and accommodation over the 30 years he had been homeless, which de declined to take up.

I sympathise deeply with Jonathan Corry’s family and friends following his death. I didn’t know him or anything about his mental health status but I think these examples of people failing to take up an intervention and seemly choosing to remain homeless needs to be viewed in light of the Dublin Simon’s recent statistics on mental health difficulties among their service users, whereby 71% were identified as having a mental health difficulty.

Of those identified with a mental health difficulty:

  • 63% of individuals have been diagnosed with depression.
  • 46% have been diagnosed with anxiety.
  • 11% have been diagnosed with schizophrenia.
  • 11% have been diagnosed with psychosis.

A very high proportion of people who are homeless have addiction issues.  Furthermore, a very high proportion of people who have a mental health difficulty also have an addiction issue.

I call on the Government to urgently implement the key recommendations from Mental Health Reform:

  • Fully staff homeless outreach mental health teams.
  • Ring fence local authority housing for people being discharged from psychiatric hospitals.
  • On-tap, in-house mental health expertise within homeless services. E.g. Merchants Quay Ireland has an in-house mental health nurse full time, to provide support to clients that other staff members have concerns about. There are anecdotal reports that this has reduced the number of people having to access mental health supports through A&E when in a crisis.
  • Establish a dual diagnosis services for people with a mental health and addiction/alcohol misuse problems.

We have the reports. We have the plans. We have the expertise, particularly in the NGO sector. What we need now is action. Sustained and dedicated.

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Mother and Baby Homes: Statements

Wednesday, 11th June 2014

I warmly welcome the Minister to the House. Everyone in the Chamber will agree that the recent revelations are yet another deplorable stain on our collective conscience. In preparing for my statement, my personal shame as a member of the collective that turned a blind eye to the abuse and suffering of women and children, out of fear and deference to the powerful, is as acute as ever before. It is the same shame I felt reading each of the reports – Ferns, Ryan, Murphy and Cloyne – into the systematic abuse and exploitation of vulnerable children in State and church institutions in Ireland. It is the same shame I felt reading the harrowing testimony from survivors of the Magdalen laundries and symphysiotomy procedures performed by medical professionals in Irish hospitals.

I share the overwhelming sense of shame and compunction over the unthinkable fate suffered by our sisters, cousins, friends and daughters labelled “fallen women” by church and community for becoming pregnant out of marriage and sent to these homes for their sins and rehabilitation. The isolation, hardship and suffering to which these young women were subjected in the name of honour and respectability is almost unthinkable in contemporary Ireland. How many of these young women fell pregnant against their will, by way of rape, incest and familial abuse, and found themselves arbitrarily and extra-judicially detained in these homes? It is the worst injustice imaginable when the victim is punished. It reminds me of punishment by stoning for adultery under Sharia law for women who have been raped.

Due to the time limit, I will limit my main observations to the issue of adoption, including the legality of adoptions prior to the Adoption Act 1952. Although the national adoption contact preference register contains data on only a small number of adoptions, the 2011 Adoption Authority of Ireland audit of the records found 50 cases of illegal adoptions. Given that the vast majority of adoption records are held by the Health Service Executive, HSE, and Child and Family Agency, CFA, we have seen only the tip of the iceberg of illegal adoptions. The area of adoption legality is extremely complex and technical and the commission will need an expert on adoption law to deal with what is likely to be a huge body of work. The Mahon tribunal had two to three experts working together.

So many of the issues thrown up by the mother and baby homes are not just legacies of the past but prevailing issues today, from which an examination of the past can yield lessons for legislation and policy today. Earlier today, I met several survivor groups, and we must ensure any inquiry, and the process to establish it, will hear their voices and involve them. The latest revelations have once again brought to the fore the trauma and suffering of many of the survivors. We must ensure we care for the living. I welcome, so early in the Minister’s new term of office, his speedy and committed response to establish a statutory commission of investigation. We are all waiting to find out the scope of the inquiry and which homes and what period will be included. Will the State take responsibility for collating all the records or will it do the same as in the report into the Magdalen laundries, namely, receive the records and then return them to the church-run institutions?

The inquiry must deal with many inter-related matters. The prevailing issues are adoption, the right to identity, lone parents, the role of women, poverty, social strata, and the rights of unmarried fathers, whose names are still not necessarily recorded on birth certificates. Will the investigation have the resources it needs and the appropriate expertise to deal with the myriad issues I have outlined? We must find a way to prioritise the truths from which there can be learning. We have recently seen the role social historians and archivists have played and can continue to play in investigative teams. Can we learn from the Murphy report experience? Should the inquiry find a way to do its work by sampling to find the appropriate balance between truth, expediency, bearing witness, and establishing and identifying causal and contributing factors, thereby maximising the scope to learn lessons?

Lest we forget, each and every one of these children had a name, and to ensure they get the memorial they deserve, their names must be listed in their honour. They are the children we promised, at the formation of the State, to cherish equally.

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Statements on the Participation in Sport

April 2nd, 2014. Senator Jillian Van Turnhout speaking on the issue of Participation in Sport: Statements. Seanad Éireann

 

I welcome the Minister. I particularly welcome his openness to all sports and like the emphasis he placed on increasing the participation of women and young people in sport. We need to pay greater attention to this aspect. Previous speakers have referred to the positive role sports play and the benefits are endless. We have a proud sporting tradition in Ireland. One of our proudest moments as a nation was, undoubtedly, hosting the Special Olympics which highlighted our national strengths and celebrated our wonderful athletes.

Sports have many positive effects on society and, as legislators, we have a role in increasing participation and interest. Colleagues have referred to the economic benefits, but I would focus on the physical benefits and mental well-being of society. If we can improve mental and physical well-being positively, this will reduce health care spending in the long term, which everyone would like to see.

The Minister mentioned the GAA. I will not get into the current debacle about pay-per-view television and so on. However, he referred to emigrant clubs. One person tweeted me and asked about creating a role for these clubs which promote the GAA abroad and giving them a voice. There should be a two-way conversation.

Like many colleagues, I was on the edge of my seat as I watched the Six Nations match between Ireland and France which demonstrated the power of sport. We all became video referees that day in deciding on whether there was a forward pass. I congratulate the team, but I also congratulate the national women’s rugby team on its success last year.

We have a fantastic history in sport and the development of new sports. One example is the mixed martial arts, MMA, fighter Conor McGregor who is promoting the sport on the world stage and acting as a role model for a different group of young people by promoting new possibilities in sport. We must encourage the development of new sports. It is imperative that we recognise the contribution of Irish women on the sports field because they encourage participation. Katie Taylor brought back a gold medal from the Olympics Games held in London in 2012. Little work was done in the country while her gold medal fight was on. The participation of females in sport can sometimes be under-reported. It is welcome that RTE has begun to broadcast women’s rugby matches, but I would like other sports to be treated more equally. I do not expect coverage to be equal, but it needs to increase. It is welcome that women’s rugby games are being moved from lesser stadiums to the main grounds such as Wembley Stadium and the Aviva Stadium. This should be encouraged in other fields.

I spoke to a camogie player who wanted to participate in women’s rugby 7s as an opportunity to go to the Olympic Games. Opportunities are opening in sports to be part of the games. Paralympic sports have also developed. I recently read a fascinating article about wheelchair hurling and how it was developing. The possibilities are endless. While preparing for the debate, I learned more about ultimate frisbee and tag rugby. Cricket has also become popular at grassroots level, given the national team’s success. I know many young people who are involved in the sport. Initiatives such as the get-into-cricket scheme are welcome because they provide a significant boost for the game.

We should support all sports to enhance choice. One of the issues I have relates to schools. If pupils attend a large school, they usually have a choice of sports to play, but they do not in small schools. Children are either good or bad at a sport and may not necessarily be exposed to other sports.

That is why I wanted to raise the issue of the French municipalities and the centres sportifs. Bringing sports together in a community is something we really need to look at. We must decide whether club or community will dominate. I would like to see that communities would have a stronger role and when we, as a State, are investing, we encourage organisations to come together.

The Minister mentioned the GAA. In my community, it is not the sole sporting organisation which will have territorial rights on pitches and on its turf where one cannot use it. Even though those pitches and sporting facilities lie idle during certain times of the day and certain times of the year, they have a dominance at one time, they lie idle, but they belong to that sporting discipline and they cannot share it. We need to look at how we can encourage people to share. When we are looking at the sports capital grants, we should ask what other sports in the community will be able to use this facility when it is not actively being used by the particular sporting discipline.

We need to discourage fragmentation and give young people the opportunity, as they do in France, where there can have different sports, such as tennis, swimming and rugby, under the one roof together, working in harmony rather than being seen to be in that competitive space, because we need to give people an exposure to the different types of sports.

I say, “Well done”, to the Minister on the Giro D’Italia. I wish Ireland every success in the tender for the rugby world cup. It is great to see us coming together as an island to work to hopefully bring it here in 2023. Sport is of immense importance.

I thank my colleagues in Fine Gael for moving this motion. It has given me an opportunity to research and learn more, which is part of our role as Senators.

I will finish with a powerful quote that I found from a US legend, Dean Karnazes. He said, “Some seek the comfort of their therapist’s office, others head to the corner pub and dive into a pint, but I chose running as my therapy.” That sums up sport. We should be encouraging people to get out and participate in a community. That is what we should be looking for as a society.

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04 March 2014: Quarterly Meeting of the Joint Committee on Health and Children, The Minister for Health, James Reilly TD, and The HSE.

Questions submitted in advance by Senator Jillian van Turnhout and response received:

Question 9: Work undertaken by the HSE’s National Oversight group

Question 10: Allowing Pronouncement of death by advance Paramedics

Question 11: Poor performance in Children’s rights alliance report card 2014

 

Question 9: Work undertaken by the HSE’s National Oversight group

To ask the Minister to outline the work undertaken thus far by the HSE’s National Oversight Group that was set up to coordinate a response to requests for day service or rehabilitative training places for young adults with a disability, and to detail particularly the work undertaken in engaging with young people who require these services and their family members.

Revised Process to support School Leavers and those exiting Rehabilitative Training 2014

In line with the Social Care Division Operational Plan 2014, a revised process is being implemented this year to ensure a more streamlined approach to the assignment of places to School Leavers and those exiting RT places. A summary of key elements of the process is outlined below:

 

  • Providing for the emerging needs of the estimated 1,200 additional young people leaving school and rehabilitative training programmes using a newly developed streamlined approach (€7m and 35 WTE) and for emergency cases (€3m and 15 WTE).

Implement a standardised process to:

  • Identify, in conjunction with the Dept of Education and service providers the young people who will be leaving school or exiting a RT Programme who have a requirement for ongoing HSE-funded supports by 1st February, 2014.
  • In respect of those identified as having a requirement for ongoing support, identify and agree the supports required, with a specific focus on responses to those who have complex service needs.
  • Identify the service providers with capacity to respond to the individuals who require support by 1st April, 2014 and agree the allocation of additional resources in respect of individual placements as required.
  • Advise the school leaver and their families of the placement location and service they will be receiving in September, 2014.  Notification of placement will commence in May and all families will be advised no later than the 30th of June.
  • Implement a communications process with all stakeholders.
  • Building on the learning from 2014 review and refine the process for engagement and implementation in 2015.

 

An important aspect of the new process has been the establishment of a National Oversight Group, consisting of representatives of umbrella organisations, representing the Disability Service Providers, service user representation and senior staff from the health service. In addition, the health service has assigned a full-time Project Lead to work to co-ordinate the implementation of the Project in 2014.

Work has been ongoing on the 2014 process since October/November 2013. The Oversight group met and agreed the timelines. A template was agreed for collection of information regarding each individual seeking to access health funded services. A letter was circulated by the National Council for Special Education to all mainstream schools to ensure that individuals with disabilities and their families would be aware of the revised process. The Health Service Guidance officers engaged with the special schools directly. The National Disability Governance Group, which includes Lead Area managers and disability specialists meets monthly and receives updates on progress.

Following the meetings of the Oversight group the Regional Disability Specialists/Disability Managers engaged with local service providers to ensure a complete profile of each individual seeking to access service was submitted.

Each application is being reviewed to establish if the applicant is appropriate to specialist disability services, has the capacity to attend rehabilitative training programme or attend day services.

In relation to engagement with service users and their families the position is that in Dublin for example Individual meetings have occurred with the following:

a) School Leavers

b) Parents/Guardians

c) Teachers/Principals

d) Clinicians/Health Care Professionals (as appropriate)

 

Continuous communication with school leavers and parents/guardians on any issues or concerns arising regarding transition from school are ongoing with the Guidance service.

I am pleased to report that the deadlines set in the Operational Plan have been met in that in excess of 1400 applicants were received by February 1st 2014. The next milestone is 31st March and Disability Services are online to meet that target date where a review of service users’ needs and current service provision will be completed.

Tbe process commenced on October / November 2013

  • We achieved an agreed approach across the disability sector.
  • We will identify and implement a prioritisation process by the end of April 2014
  • We will consider appropriate placement options by end of May 2014
  • We will advise Individuals/Parents/Guardians of placement no later than 30th June 2014

A summary of the current position is that:

A total of 1407 number has been identified, 905 school leavers, 427 RT exits work is continuing on a further 75 who have been classified as other or no category.

Throughout the engagement a range of challenges continue to arise as the process is streamlined. The process is flexible enough to address many of these however a consistent theme that is emerging relates to some locations where the physical infrastructure is at maximum capacity and alternative accommodation will need to be identified. The health service is committed to appropriately supporting this group of young people to ensure that optimum outcomes are achieved

 

Question 10: Allowing Pronouncement of death by advance Paramedics

To ask the Minister for Health/HSE to give an update on progress regarding allowing pronouncement of death by advanced paramedics (as is allowed in other jurisdictions but currently not in Ireland) as recommended by the Pre-Hospital Emergency Care Council, and on allowing pronouncement of death by senior nurses. 

 The Pre-Hospital Emergency Care Council (PHECC) is responsible for clinical practice in pre-hospital care. PHECC approves clinical practice guidelines (CPGs) for all aspects of the clinical work of registered paramedic practitioners in Ireland.

There are two key PHECC CPGs in relation to the death of a patient – for recognition of death and for cessation of resuscitation. The procedures set out in these guidelines allow practitioners to cease treatment and resuscitation where a patient cannot be revived.

Currently, Irish paramedics, unlike paramedics in other jurisdictions, do not pronounce death. After a paramedic makes a clinical decision to cease treatment, a medical practitioner is required for pronouncement of death.  I am advised that PHECC is examining this issue through the Forum on End of Life in Ireland, with a view to engaging in broader consultation on this matter and developing appropriate and recognised clinical and legal procedures to resolve it.
The Nursing and Midwifery Board of Ireland (NMBI) is responsible for specifying standards of practice for registered nurses and midwives. NMBI has developed a Scope of Practice framework to enable decision making and development of practice for all aspects of a nurses’ clinical practice in Ireland. In addition NMBI provides guidance to nurses and midwives on their scope of practice and has published professional guidance to nurses regarding their scope of practice for pronouncement, verification or certification of death. The guidance outlined the processes required to develop an organisational policy to include the appropriate clinical governance supports and the professional responsibilities and authority for nurses to be involved with the pronouncement of death in a care setting. The HSE is consulting with the Directors of Nursing Reference Group on this matter.

 

Question 11: Poor performance in Children’s rights alliance report card 2014

To ask the Minister to give an update on the worrying E Grade his Department received for Mental Health in the Children’s Rights Alliance Report Card 2014, with emphasis on a number of key areas including the need to ensure all children under 18 receive age-appropriate and timely mental health services and treatment and can the Minister advise when the Child and Adolescent Community Mental Health teams will have the appropriate provision of in-patient beds and the 150 staffing posts filled to achieve this end. 

 

The Government has prioritised reform of all aspects of mental health services in line with A Vision for Change, including additional and improved quality care for children in both residential and community based settings. Total HSE Mental Health funding in 2014 is significant at around €766m. In this context, additional funding of €90 million, and around 1,100 new posts, has been provided over the last three Budgets. This has been primarily directed to strengthen Community Mental Health Teams for adults and children; specialist community mental health services for older people with a mental illness, improving services for those with an intellectual disability and mental illness, and enhancing Forensic Mental Health services.

Key to developing Child and Adolescent Mental Health Services (CAMHS), as per A Vision for Change, is the establishment of 99 multi-disciplinary CAMHS Teams providing acute secondary mental health care in the community, including hospital liaison and Day Hospital services. In 2008, there were 54 CAMHS Teams. There are now 66 Teams in place – 60 Community, 3 Adolescent, and 3 hospital liaison mental health teams.

The additional €90m provided for mental health over 2012–14 is being used, in part, to expand and enhance the skill mix of CAMHS Teams.  Around 230 new posts were allocated to CAMHS Teams over 2012-13, and recruitment of these is well advanced.  Of the 150 posts approved in 2012, 136 or 91% are complete with 8 further posts at an advanced stage in the recruitment process.  Of the 80 posts approved in 2013, 35 or 43% are complete, with a further 18.5 or 23% at an advanced stage of the recruitment process.  In summary, of the 230 new posts approved to CAMHS in 2012 and 2013, 197 or about 85% have been filled or are well advanced in the recruitment process.  Outstanding CAMHS posts will be filled as quickly as possible.

There are a number of posts for which there are difficulties in identifying suitable candidates due to various factors including availability of qualified candidates and geographic location. Alternative approaches being considered for posts not fillable in the normal way.

Just over 14,000 referrals were received by the Child & Adolescent Mental Health Teams in 2013.  This represents nearly 1,000, or 8% more, than projected in the HSE National Service Plan 2013, while the target of 70% of referrals being seen within 3 months was maintained.

A Vision for Change recommends the provision of 80 Child and Adolescent psychiatric in-patient beds nationally.  In 2008, there were 16 such beds and at present there are 51 beds operational country-wide, with more planned.   Capacity will be enhanced also, with the completion of the CAMHS Forensic Unit as part of capital developments now underway for the National Forensic Mental Health Service, and the National Children’s Hospital. In addition, improved community based services, coupled with increasing bed capacity, are all aimed at discontinuing the practice of placing children and adolescents in adult acute in-patient units, except in exceptional circumstances.  Admissions of children to adult units have decreased by almost 60% from 2008, when there were 247 reported, to a provisional figure of 106 in 2012.

The review of the Mental Health Act 2001, already well progressed, is a key step in providing a revised and more modern mental health legislation in this country. The Programme for Government contains a commitment to review the Act, informed by human rights standards and consultation with service users, carers and other stakeholders.

The review has been delayed due to a number of factors, including the wishes of members of the Expert Group to first see details of the Assisted Decision Making (Capacity) legislation, which was published in June 2013. Due to the high level of inter-connectivity between both sets of legislation, members of the Expert Group reviewing the Mental Health Act felt it would be necessary that the Capacity Bill should be finalised before they completed their own review.

Work is continuing on the completion of the report of the Expert Group, and members are carefully deliberating, re-examining and refining their recommendations on key central issues such as consent to treatment, capacity, criteria for detention, and treatment of children under the Act. It is expected that the final report will be completed in the near future, after which its recommendations will be considered at Ministerial level.

While noting the contents of the recent report by the Children’s Rights Alliance on Mental Health services, real and significant improvements have taken place on implementing A Vision for Change and modernising mental health services across the country over the last three years.  Nonetheless, historic deficiencies remain to be addressed.  The aim is to strive for equity in providing high quality services, while balancing residential and community-based provision.  This approach has already been proven in many areas at local level. The Government will retain its commitment to mental health, and focus on up-grading all aspects of mental health care, in line with evolving service demands and resources available overall for the Health sector, for 2014 and beyond.

to move to the following access targets:

–          6 month target inpatient / day care

–          9 month target for outpatient

–          again with hospitals effecting full compliance with performance targets in the first half of the year and subsequent maintenance for the remainder of the year

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27 March 2014: Quarterly Meeting of the Joint Committee on Health and Children and the Minister for Children and Youth Affairs, Frances Fitzgerald TD

Questions submitted in advance by Senator Jillian van Turnhout and response received:

Question 9: Figures in relation to Special Care Placement.

Question 10: EU Commission Recommendation ‘Investing in Children: Breaking the cycle of disadvantage’.

Question 11: Amendment to Childcare Act 1991.

 

Question 9: Figures in relation to Special Care Placement

To ask the Minister for Children and Youth Affairs to provide the most up-to date figures on the following, in relation to Special Care Placements:

a)   What is the current waiting list for Special Care Placement?

As of 11th March 2014, there was one young person waiting for a special care placement. There have been ten admissions to Special Care since 1st January of this year.

 

b)   How many applications have been made to date since the beginning of 2013?

From 1st January 2013 to 5th March 2014 there were 116 special care applications – 22 of these applications were re-referrals.

 

c)    How many of these applications were successful?

Forty applications were successful, 27 were withdrawn or removed by the relevant Social Work Department, 46 were not approved and there were three in 2014 where further information had been sought and a decision has not yet been made. A Social Worker making an application for a Special Care place will also work to put in place other supportive mechanisms for the child while they await the outcome of the application. Where it is found that the alternative supports are meeting the needs of the child without the necessity of detaining the child for his/her own safety, the preference is to continue with the alternative programme. Where a child has been sentenced to detention in a Detention School, the child’s application for Special Care is withdrawn.

There is an appeals process available to Social Workers if they disagree with the decision where a child’s application to Special Care was unsuccessful. The Social Worker will also consider the Care Plan for the child and make other arrangements to find the most appropriate placement for that child. An unsuccessful application does not preclude the Social Work Department from applying at any other stage, especially in light of a child’s needs changing.

 

d)   How many State provided places are there in mainstream residential care and

e) How many are provided by Private Providers?

All Special Care placements in Ireland are operated by the Child and Family Agency and placements are under the direction of the High Court. There are no private providers of Special Care Services in Ireland, however some children with complex needs are placed out of State.

More generally, in December 2013 there were 142 Children’s Residential Centres in operation throughout the country; 47 of which were Agency-managed; 28 were run by the voluntary Sector; and 67 were operated by private providers.  These centres are typically found in domestic homes in housing estates, on the outskirts of towns and villages. The centres typically have between three and six children. These children are usually in their teens.  There is always some flux in placements available as services adapt to meet the needs of the resident children.

In December 2013, there were 356 children in care placed across the different types of residential care. Of these there were 143 children placed in the 67 privately run centres.

 

f)    What is the allocated budget for private provision?

The cost of the provision of mainstream residential placements in the privately-owned children’s residential centres for 2013 was approximately €50m. To date private placements have been commissioned on the basis of a child’s needs which will influence staffing ratio, the need for live-staff at night and additional supports to the child in the placement. There has been a consistent and predictable spend in respect of this type of residential provision, which reflects demand.

Significant work is under way within the Agency to secure the most appropriate and cost-effective care for children in the different settings in which they are accommodated. In early 2012 the HSE’s Children and Family Services undertook a tendering campaign to secure 80 places at a cost of €18.7 m per annum or €4,500 per place purchased for a two year period (extendible for a further two years if required). This arrangement will be for children whose needs can be met in a centre caring for 3 or 4 children. The process is now complete and contracts are currently being awarded in respect of 2014. It is estimated that the procurement arrangements utilised will reduce the spend in this area by €3.9m in 2014.

Any additional places that will be required will be purchased on an individual basis and in some cases may be more expensive where bespoke placements are commissioned for young people with particularly challenging needs.

The Agency has been working to increase value for money in this area by, as outlined above, seeking to promote cost effectiveness within the different options available and also moving to fostering where appropriate.

The Agency intends to undertake a centre activity audit of all aspects of residential care in 2014, and this will allow for a level of comparison of cost of placement across private and public group children’s centres and individual placement arrangements.

 

Question 10: EU Commission Recommendation ‘investing in children: breaking the cycle of disadvantage’.

To ask the Minister what action the Government is taking to implement the EU Commission Recommendation (20 February 2013) Investing in children: breaking the cycle of disadvantage, concerning child poverty and well-being and, having acknowledged that tackling poverty requires a whole-of-Government approach, will DCYA carry out a social impact assessment on any fiscal adjustments in Budget 2015 and onwards?

Ireland, led by the Department of Children & Youth Affairs (the first such Department in any EU member state), is committed to improving the lives and experiences of Ireland’s children and young people.

Many of the actions being implemented by this Government are in line with the EU Commission recommendation on ‘Investing in Children’ which was adopted by the Council of Ministers in 2013. These actions include:

·     Protecting and enhancing children’s rights on foot of the decision of the people in the Children’s Referendum 2012;

·     Improving child protection, welfare and family support services through the newly established Child & Family Agency;

·     Implementation of the recently-reviewed Youth Homelessness Strategy;

·     Continuing to be a world leader in both the areas of children’s participation (through the national Dáil na nÓg and local Comhairle na NÓg model); and childhood research (through the ‘Growing Up in Ireland’ longitudinal study and ‘State of the Nation’s Children’ reports).

Tackling Child Poverty

The EU recommendation on ‘Investing in Children’ includes a significant focus on tackling child poverty, referencing the ‘setting of national targets for reducing child poverty’ and access to quality services.

The draft National Policy Framework for Children & Young People, which is being prepared by my Department and which is due to be considered by Government shortly, currently includes a commitment to address child poverty.

With respect to services, my Department is responding through initiatives such as establishment of the Child & Family Agency (with an enhanced focus on prevention, early intervention and family support) and the roll-out of the €30m Area Based Childhood (ABC) Programme.

 

Early Years/Childcare

The EU recommendation on ‘Investing in Children’ recognises the importance of early childhood education and care. The EU Commission has set a target of member states having at least 95% of four year olds in pre-school. Ireland is in compliance with this target through provision of the free pre-school year.

The EU recommendation on ‘Investing in Children’ also recognises the importance of access to affordable childcare. In this context I announced a review of existing targeted childcare schemes to consider how best to structure future childcare support, to both support working families and to incentivise labour market activation, which could be expanded to more families as resources allow.

Delivering improvements in quality standards and staff qualifications is a critical precursor to any future expansion of universal childcare provision and/or Government supports. I have prioritised implementation of an eight-point Quality Agenda, and there has been significant and unprecedented progress in the implementation of this agenda over the past eight months. This will continue in 2014 with establishment of landmark new National Quality Support Service, which is being seen a significant development in the context of developing EU policy.

 

Social impact assessment

In February 2012, the Government decided to develop an integrated social impact assessment to strengthen implementation of the new national social target for poverty reduction and to facilitate greater policy coordination in the social sphere.

Work in the area of social impact assessment is being led by the Department of Social Protection. A social impact assessment of Budget 2014 was published in February 2014 by that Department.  My own Department liaises regularly with the Department of Social Protection to ensure a child-centred approach informs such assessments and consequently provides learning to use in the development of our policy and service responses for children.

 

Question 11: Amendment to Childcare Act 1991.

 

Can the Minister provide a timeline for the delivery of the legislation to amend the Child Care Act, 1991, to provide a statutory right to the preparation of an aftercare plan for eligible young people leaving care and will the Minister consider extending this statutory support to young people leaving detention, as they often present with very similar needs?

The amendment to the Child Care Act 1991 to strengthen the aftercare provisions for children in care was approved by Government on 25 February 2014 for publication, and has been submitted to this Committee for its consideration.

I understand that the Committee plans to consider the matter during the month of April. Following the Committee’s deliberations the text of the amendment may need to be refined in conjunction with the Office of the Parliamentary Counsel, after which a timeframe for the progression of the legislation will be discussed and agreed with the Houses of the Oireachtas. I am very appreciative of the work of the Joint Committee and the contribution of the members.

Regarding children leaving detention, on average approximately one third of such children normally would have care orders and so would, in the main, be required to have an aftercare plan prepared by the Child and Family Agency.

At present, the mechanism for supervision of a child post-release from a sentence of detention (other than those who were in the care of the Child and Family Agency) is by the Probation Service if the courts impose a “detention and supervision” (i.e. in the community) order at conviction stage. Extending the right to an aftercare plan to all children completing a sentence of detention would require significant and detailed examination by officials in the relevant units of my Department, and the relevant other Departments and agencies involved, before any recommendations in relation to the matter might be formulated.

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25 July 2013: Quarterly Meeting of the Joint Committee on Health and Children and the Minister for Children and Youth Affairs, Frances Fitzgerald TD.

Question 3: Childhood Obesity

Question 4: National Consent Policy

Question 5: Counseling service for mothers

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.

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23 May 2013: Quarterly Meeting of the Joint Committee on Health and Children, the Minister for Health, James Reilly TD, and the HSE.

Question 32: Provision of Neuro- Rehabilitation Services

Question 33: Neurologist waiting lists

Question 34: Children’s palliative care programme

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?

Outpatient Services
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.

Inpatient Services
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.

This Committee;
• 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.