Category: Health

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Adjournment Motion – National Stroke Awareness Week: Act FAST Campaign

Wednesday, 13th June 2013

Senator Jillian van Turnhout:

I thank the Minister for facilitating me and coming into the House. It is an extremely busy day but we both know stroke awareness is very important to both of us. This is national stroke awareness week, with this year’s focus on the Irish Heart Foundation’s Act FAST campaign, which was launched in 2010 to increase public awareness about the early signs of stroke and encourage speedy medical intervention. I welcome Mr. Chris Macey from the Irish Heart Foundation to the Gallery. Under an Adjournment motion in January last year I raised the issue of stroke rehabilitation services and the Minister knows I have raised it several times at the health committee before him.

An estimated 10,000 people suffered a stroke in Ireland in 2012 and the same number are estimated to suffer a stroke this year. Approximately 2,000 die as a result of stroke, making it Ireland’s third biggest killer. Stroke is the single most significant cause of severe disability and up to 50,000 people are living in our communities with disabilities as a result of strokes. In addition to the devastating impact stroke has on the sufferer and their families, the financial costs are huge. The Economic and Social Research Institute, ESRI, estimated that in 2010 the direct annual cost of stroke was €557 million of which as much as €414 million is spent on nursing home care and there is nothing to indicate that this cost has fallen in the past three years.

In the face of these stark figures, the Irish Heart Foundation’s Act FAST campaign is a commendable initiative which warrants State support. The campaign, while still in its infancy, has been a resounding success, particularly in raising public awareness of stroke warning signs through the first three letters of the acronym FAST, as follows: face, has the person’s face fallen on one side?; arms: can the person raise both arms and keep them elevated?; and speech, is the person’s speech slurred?

The most recent Irish Heart Foundation’s Attitudes and Behaviour study found that there had been a 190% increase in awareness of these warning signs. This increased awareness, along with the rapid development of the 24-7 thrombolysis services nationally by the HSE’s national stroke programme, has contributed to a 400% increase in the numbers receiving life-changing, clot-busting treatment and it has helped cut death and disability rates from strokes significantly against demographic and international trends.

However, the last letter of the acronym, arguably the most important one since it is the call to action, namely, “T”, time to call 999 if one sees any of the signs, has not had the desired impact. Just over half of the respondents surveyed said they would call an ambulance. Speedy medical intervention is imperative if we are to limit the detrimental impact of stroke. The average stroke destroys 2 million brain cells every minute, which means the quicker one gets emergency treatment, the more of one’s brain can be saved. The knock-on effect is reduced risk of death or severe disability and a considerable financial saving to the State.

The Irish Heart Foundation is entering a new stage of the campaign where there is clearly room to improve on awareness of the timely medical intervention, and it needs State support. In addition to financial assistance, there are other supports at the disposal of the State, such as providing advertising sites in high footfall areas of Government buildings and properties and maybe examining a way of reimbursing the 23% they have to pay in non-returnable VAT for the campaign, which is proving to save not only lives and quality of life, but is also saving the State money. I would like the Minister’s reassurance that both financial and alternative means of supporting the new phase of the Act FAST campaign are being positively considered.

Minister James Reilly:

I thank the Senator for raising this important issue and raising awareness in the week that is in it. She is right about the figures; they are staggering. Some 10,000 strokes a year is very serious. We should acknowledge the growth in public awareness of stroke warning signs, as the Senator has outlined, and the improvements noted and confirmed recently by the HSE. The FAST campaign coincided with a major development of stroke services nationally, including an increase in the number of stroke units around the country from six to 27 and the expansion of 24-7 thrombolysis treatment from a small number of hospitals mainly in urban areas to all hospitals that treat stroke patients. The FAST campaign has assisted health services to maximise the impact of the stroke service improvements. The HSE has advised my Department that it provided €268,000 last year and €308,000 this year to the Irish Heart Foundation to help with its various health promotion activities. Like the Senator I welcome the foundation’s presence here.

Such improvements in stroke services were envisioned in the policy document Changing Cardiovascular Health: Cardiovascular Health Policy 2010 – 2019 which was launched in 2010. This established a framework for the prevention, detection and treatment of cardiovascular diseases, including stroke, which seeks to ensure an integrated and quality assured approach in their management, so as to reduce the burden of these conditions.
I could go through the rest of this but I would much prefer to talk about prevention. In this country we have a long history politically of engaging in expensive developments. They are necessary, and politicians are always very pleased to open a new wing of a hospital or an MRI scanner but have been reluctant in the past to invest in public health initiatives that can save many more lives. When we look at the causes of stroke we see our old enemies again: tobacco is a major cause of stroke and if we could keep our children and the next generation from starting on this habit it would be a lot easier than trying to get them to quit and would prevent a huge number of strokes per year.

Obesity is another issue which leads to diabetes and hypertension, which is well known to be associated with stroke. The issue of alcohol must be mentioned also because it has peculiar properties with regard to blood pressure. It is known to cause vasodilation peripherally so one would imagine it would drop one’s blood pressure, but it causes vasoconstriction which causes one’s blood pressure to go up. It is a risk factor also.

Many of our figures relating to stroke are preventable if these areas are tackled. Earlier I mentioned the Government’s commitment to healthy Ireland. I am the Minister for Health but I often feel as though I am the Minister for ill-health because all we speak about is disease and illness when what we need is to keep people well. The Department of Health cannot do this alone. It needs the Department of Justice and Equality to keep our streets safe so people can exercise. It needs the Department of Finance and the manner in which it taxes and incentivises certain types of behaviour. It needs the Department of the Environment, Community and Local Government to give us safe well-lit places at night to exercise. We also very badly need the Department of Education and Skills on board and I know the Minister, Deputy Quinn, is very committed to this area.

This is about developing healthy lifestyles early in life which will stay with people. Early habits are the hardest to break. This has also been proven with regard to tobacco. If one does not start smoking before the age of 21 one is unlikely to take it up. We know this industry goes after our children. It wants to replace with new recruits those who have died, including the 5,200 who died from tobacco related illnesses this year, and those who give it up, and these new recruits are children. According to a survey 78% of smokers stated they started smoking before the age of 18. It is wonderful we have a new stroke programme and we are saving a life a week, and I am told the new initiatives we have undertaken save a life per day. While all this must be done to help those who fall ill now, we must look down the road and realise the actions we take now could save the next generation from much hardship and grief. If we do not tackle the obesity epidemic among young people and the rising epidemic of diabetes we may very well be the first generation to bury the generation behind us which is an appalling thought. No parent wants to be at his or her child’s graveside.

Senator Jillian van Turnhout:

I support the Minister on the preventive measures on tobacco, alcohol and obesity. Strokes are Ireland’s third biggest killer and I ask the Minister to give consideration to the financial assistance I have suggested and perhaps consider other measures such as using public buildings for billboard spaces or reimbursing the 23% VAT. This is a public health awareness campaign and one could argue the State should be running it. Perhaps there is a way the Government could support it such as refunding the 23% VAT to the Irish Heart Foundation.

Minister James Reilly:

I am very happy to state we have cross-Government support for these initiatives, particularly the healthy Ireland initiative. I will have to engage with my colleague, the Minister for Finance, to achieve the VAT reimbursement the Senator seeks. This is not the only area where I feel VAT needs to be examined, as we also have VAT on condoms and vaccines. There is no VAT on tablets or liquid medicine but because vaccines are in injectable form they are subject to VAT. I would like to discuss a range of areas with the Minister. We are in very constrained financial times and it is difficult to seek to reduce the Exchequer return in any real sense.

We must get the people of Ireland and Europe off their addiction to nicotine but we also need to get the governments of Europe off the addiction of the income which tobacco products bring.

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Closing Statement – Heads of Bill: Protection of Life During Pregnancy Bill 2013

Tuesday, 21st May 2013

 

Thank you very much.  The 1992 Referendum was actually my first Referendum vote.  Over the following 21 years, I spent 15 years working in the private sector and then headed up different children and youth NGOs both in a voluntary and professional capacity.  In these roles I listened carefully to the debate around abortion but I never actively formulated a position.   So, I do feel a little bit nervous.  This is the first time I am publically stating how I feel on this issue.

The hearings we [Joint Oireachtas Committee on Health and Children] held in January 2013, and over the last three days, have given me an opportunity to form a definitive position.  I would like to begin by thanking all of the experts, across both sets of hearings, for their informative inputs.  At times we heard from more than one expert from the same discipline giving contradictory evidence. It has been a difficult process to work through but extremely useful.  I would like to thank my colleagues, the secretariat and in particular our chair Jerry Buttimer TD.

I can now say with confidence that I support the Government’s decision to legislate.  This Bill only deals with difficult, rare and complex circumstances.

Of course I have some caveats.  I am concerned about us separating out physical and mental health.  I feel in the wider public debate on mental health that it is a retrograde step.  I believe that that Heads 2 and 4 should be merged. While I have heard conflicting legal arguments and reasoning, I do not believe a sufficient argument has been made to distinguish between the manner through which a “risk of loss of life” manifests. As noted by the Expert Group, a differentiated treatment does not appear to be required for medical or practical reasons.  In the words of Dr McCarthy to the Committee “suicide in pregnancy is real, a real risk, it does happen.”  There is no distinction in Article 40.3.3 and so to distinguish physical and mental health in this Bill would be to alter the law. I do not believe we should have differentiated treatments.

I am concerned about the scope of Head 19.  I think it is extremely broad, in fact too broad.  It covers a wide range of activities including and beyond that previously covered by sections 58 & 59 of the Offences Against the Person Act, 1861.  Some of the scope is unclear-what exactly is covered? The penalties are disproportionate.   I have concerns over the appeals process timelines and conscientious objection. I think we need a further discussion to explore these issues.

I am concerned about the silence in the proposed legislation on children, particularly young girls.  I believe we need specific legislation to address many of the issues raised over the past few days.   I am troubled that we will compound voiceless children who are in the care of the State in this legislation.

Our hearings have also highlighted the importance of the forthcoming Assisted Decision Making (Capacity) Bill, which is urgently needed.

I must say I found any association, actual or implied, between abortion in Europe and the Holocaust, to be distasteful in the extreme. Besmirching the memory of millions of murdered Jews by turning them into a pawn in the abortion debate displays a woeful ignorance of the Holocaust, and a woeful disrespect to the memory of the victims.

Whatever one’s opinion on the abortion issue, the debate is between well-intentioned people on both sides of the argument. There are no two sides of the Holocaust.  I would respectfully encourage my colleagues to desist from making this highly offensive connection during the continuing debate.  We must not allow the 6 million victims of a diabolical premeditated attempt to eradicate an entire people to be dragged into this abortion debate.

In ending, I was appointed by the Taoiseach, Enda Kenny TD, particularly in recognition of my work on children’s rights.   Advocacy on children’s rights has not been an easy road to travel and therefore on this decision and talking about child protection I did have to consider my position.  I stand here with confidence.  I will continue to constructively engage with care, conviction and compassion.

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Order of Business, 17 April 2013

Wednesday, 17th April 2013

I am disappointed the matter I wished to raise on the Adjournment was not taken as it was lodged before some of the others that were accepted.

I welcome the Government’s acceptance of the cross-party Private Members’ Bill, along with Senator Ivana Bacik, to set aside the Statute of Limitations for the survivors of symphysiotomy. I am aware from the debate in the House last May that many Senators advocated this position. It is a horror story which I have followed closely as a member of the victims of symphysiotomy all-party support group. I pay tribute to the survivors, their families and supporters and those who advocated and campaigned tirelessly on their behalf. I pay tribute to Deputy Caoimhghín Ó Caoláin, convenor of the all-party group, whose determination and commitment to seek justice for the survivors has kept the issue firmly on the Oireachtas agenda. While I do not condone the length of time it has taken to get here, this is how things should be done. It has restored my faith in consensus politics and how we can work together to achieve good. While the agreement by the Government to support the Bill through Second Stage is welcome, I ask the Leader to urge the Government to begin actively engaging with the survivors and their representative groups to address their immediate health and support needs and, in parallel, to put a structure in place that will ensure redress.

I wish to raise the plight of the 32 thalidomide survivors. At an Oireachtas briefing they shared some of their specific support needs. Regrettably, they are being shunted between Departments. I ask the Leader to urge the Government to engage with them and their representative groups at the earliest opportunity.

On Monday, in response to the publication of the European Commission’s report on trafficking in human beings, I called on the Government to transpose immediately the EU anti-trafficking directive into national legislation. This was due to be done by 6 April. The directive has the potential to impact significantly on the lives of trafficked victims and will help prevent others from falling victim to this heinous crime. I welcome the publication yesterday of the criminal law human trafficking Bill to give effect to certain provisions of the EU anti-trafficking directive. I look forward to comparing the Bill against the directive and hope to find all the necessary elements incorporated. Significantly, the Bill defines forced labour in accordance with ILO convention 29. This is something I have called for in the past and I welcome its inclusion. I ask the Leader to commend the Government for initiating the Bill in this House.

I welcome the appointment of the members designate of the new Irish Human Rights and Equality Commission. They are of fine calibre and will bring extensive expertise to their role. I hope a suitable chair can be found at the earliest opportunity.

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Statements on the Mobility Allowance

Thursday, 21st March 2013

I, too, thank Senator Marie Moloney for initiating this debate and the Leader for allowing time for it. However, I note the fact that no Minister or official has attended the House for the debate, which is very disappointing. I am happy that the working group on the mobility allowance will be meeting shortly. Under the chairmanship of Ms Sylda Langford, I have no doubt that it will take into account what we have to say. As I had the pleasure of working a lot with Ms Langford in her role when director general of the Office of the Minister for Children and Youth Affairs, I have faith in her.

The two relevant schemes in question are the mobility allowance and the motorised transport grant schemes. Up to 4,700 people with disabilities receive the mobility allowance, while 300 are in receipt of the motorised transport grant. The schemes were closed on 26 February and a new legally compliant scheme will be devised in the next three months. The €10.6 million allocated for the schemes has been ring-fenced for the new alternatives.

The mobility allowance is a means-tested, monthly payment made by the Health Service Executive. At the highest rate, it comes to €208.50 per month; at the lowest, it comes to €104.25. The allowance is for people with severe physical disabilities who are unable to walk or use public transport and would benefit from a change in surroundings. It is to meet transport costs which are currently unvouched and the occasional taxi journey. The Department of Health anticipated that revising the scheme to bring it into compliance, that is, to remove the upper age limit, would translate into an additional cost of €100 million per annum in the case of the mobility allowance and €200 million over a three year period in the case of the motorised transport grant.

To remove the upper age limit would translate into a cost of €100 million per annum for the mobility allowance and €200 million over a three year period for the motorised transport grant, not to mention the large administrative costs to, and burden on, the HSE. These estimations are outlandish. The eligibility criteria are very strict. How many disabled people over the age of 66 are unable to walk, even with the use of artificial limbs or any other suitable aids or whose health is such that the exertion required to walk would be dangerous? That is not to mention the other requirements for qualification. I did a calculation on the estimation from the Department. It is based on the expectation that there would be an extra 39,968 applicants if the upper age limit was removed. Can we just note that in 2012, 43 people over the age of 66 applied and were rejected, which is nothing near the 39,968 figure? I seriously question the figures provided.

As I have said already, the eligibility criteria are very strict and I wish to put those criteria on the record. An applicant must be unable to walk, even with the use of artificial limbs or any other suitable aids; his or her health must be such that the exertion required to walk would be dangerous; the inability to walk must be likely to last for at least a year; he or she must not be medically forbidden to move; he or she must be in a position to benefit from a change in surroundings; he or she must be living at home or in a long-term institution; and he or she must pass a means test. The decision on whether or not an applicant meets the medical criteria is made by the HSE’s senior medical officer in the relevant area. In that context, one must question the figures from the Department of Health.

The estimate for the motorised transport grant is €200 million over three years. The Department of Health estimates that 19,000 older people over 66 would apply for that grant if the age limit was removed. This grant is aimed at assisting people in accessing employment, so how did the Department arrive at that figure? Perhaps the Department knows something I do not know.

There are many outstanding questions and so much insecurity and uncertainty for those who are in receipt of the allowance or grant, who have been told that their payments will cease on 26 June. What if the alternative scheme is not ready to be rolled out by then? In devising the alternative scheme, will the Department consult with the disability sector and the recipients of the allowance or grant to ensure personal choice and autonomy, in terms of the applicable transport service, is preserved? We talk about personal budgets, money following the patient, maximising independence and so forth but I am concerned that the new scheme will, in effect, remove or diminish personal choice. What is safe and appropriate for one person is not safe and appropriate for all. A community transport service is not safe and appropriate for a person with severe autism, for example. Furthermore, community transport schemes are not always the most cost effective choice. Two of the providers in Dublin, for example, Vantastic on the northside and ACTS servicing the southside, charge a higher price and mileage rate, equivalent to a private taxi, and only operate between 7 a.m. and 10 p.m., with a limited number of choices. Senator Moloney has already referred to the challenges in rural areas for community transport schemes.

Will the working group examine the possibility of adding a mobility component to the disability allowance and the supplementary welfare allowance? Given the means test associated with these benefits, I suggest that such a move would keep the expenditure within budget. I have serious doubts about the figures given by the Department of Health and seek clarity on them. I also want to know why the decision to scrap the schemes happened overnight. Anybody who has attended a management or leadership training course will know that one does not raise a problem if one does not have a solution. A solution should have been devised because the problem did not arise overnight. We have known for a long time that the schemes were problematic. It is unacceptable. This is a spreadsheet decision when really, it should be about people.

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Adjournment Motion – Rehabilitation Services

11th January 2012

I raise the issue of stroke rehabilitation services. An estimated 10,000 people will suffer a stroke in Ireland in 2012 and approximately 2,000 will die as a result, making strokes Ireland’s third biggest killer.

Stroke is the single biggest cause of severe disability and up to 50,000 people are living in communities with disabilities as a result of a stroke. In September 2010, the Irish Heart Foundation published the “Cost of Stroke in Ireland” report, which was compiled by the ESRI, which showed that the wider availability of stroke units and clot-busting treatment countrywide would reduce the number of deaths and cases of permanent severe disability from stroke by at least 750 a year. It would save the State approximately €230 million in the next decade, mainly due to the reduced need for nursing home places. These findings were accepted by the HSE and the Government and specific funding was provided by the HSE’s 2011 service plan to pay for extra consultant, nursing and therapist posts to deliver significant improvements to acute services.

The report also painted a stark picture of the deficits in community rehabilitation facing stroke survivors after their hospital treatment has been completed. No action has been taken to rectify these deficiencies.

The ERSI calculated that the direct annual cost of stroke is up to €557 million, of which as much as €414 million is spent directly on nursing home care. However, only €7 million is being spent on community rehabilitation services that could keep more of Ireland’s 50,000 stroke survivors living in their own homes and, thereby, improving their quality of life and also reducing costs. In effect, the vast majority of money for stroke is spent after the point at which it could help people the most. An average of less than €140 is spent on the rehabilitation of each stroke survivor which is only sufficient to pay for a couple of physio sessions each year for people with often very complex physical, communication and psychological needs.

As no doubt the Minister will be aware, the National Audit of Stroke Care, which was also carried out by the Irish Heart Foundation, looked at the extent of effects of stroke on people. It showed that almost half had a weakness on one side of their body, 22% were unable to walk, more than half needed assistance with activities in their daily life, 32% have depression and a further one third have cognitive impairment. That clearly shows that, more than any other disease, stroke can strip away people’s dignity and make them dependent on others, often to carry out basic personal tasks.

The improvements to acute services are saving lives but we cannot ignore the quality of life of survivors when their hospital stay has come to an end. In addition to the human implications, it does not make economic sense. That is what surprised me when I looked at this issue. This is not about increasing funding. This is about where we are placing the funding.

Those who have had a stroke and their carers need to be able to access a range of services after they have left hospital. Many stroke survivors will need further community based rehabilitation such as physiotherapy, speech and language therapy, occupational therapy, clinical psychology, and nutrition advice and input. Currently, few stroke survivors have access to this type of care and, therefore, their lives are dramatically affected.

My questions for the Minister are whether he accepts that there is a clear case for the provision of rehabilitation services for stroke survivors and others with neurological conditions and that the provision of such services would be cost effective. The Minister of State, Deputy Kathleen Lynch, announced that there will be shortly publication of a neuro-rehabilitation policy, but will funding be provided for the implementation of this policy to accompany it? If the funding is not provided, how will the policy be introduced and how will the suffering of stroke survivors and others in desperate need of rehabilitation be alleviated in the years to come? Does the Minister intend to support the carrying out of research into the cost benefit of rehabilitation to follow up on the Irish Heart Foundation’s Cost of Stroke in Ireland report?

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National Dementia Strategy: Motion (Private Members’ Business)

24th October 2012

I welcome the Minister. I thank my Labour Party colleagues for tabling the motion. It is great that there is harmony in the House as everyone welcomes the initiatives and strategies to deal with mental capacity legislation, dementia, Alzheimer’s and positive ageing. I would like to move beyond words and explore ways we can make the issues before us tangible. We can all say these words but we all know action speaks louder than words.

I would like two issues to be fed into the national dementia strategy before it is published. First, expert opinion is that earlier and accurate diagnosis is important, as colleagues have said, for the individual but also for family members because of what such a diagnosis will deliver for them and it is imperative that coming out of the implementation of the strategy, resources will be put in place or reconfigured that will result in a nationwide health service, which provides timely diagnosis and provision for early intervention supports and services. A crucial component of this will be access to a uniform assessment of needs for both the patient and their carer. My understanding is that the HSE is piloting a single assessment tool, which will need to be such that it provides the necessary early indication of the onset of a dementia and acts as an early detection mechanism which leads on to the necessary follow up of interventions and support services.

Currently, the first port of call for most patients who present themselves to our health service with possible symptoms of a dementia is at GP level. Making a diagnosis of dementia is not easy and Irish research, including anecdotal evidence from my local GP, has shown that many GPs, like their counterparts in other countries, are reluctant to get involved in the area because of lack of confidence and training, stigma, difficulties differentiating normal ageing from the signs and symptoms of dementia and resource issues. There is a requirement, therefore, to ensure all health care officials at GP, primary care or residential care levels are skilled in the detection and diagnosis of dementia and are suitably equipped with the necessary people skills to handle the delivery of the diagnosis to patients and their families.

The second issue relates to community-based services. Following on from the early diagnosis of dementia and consistent with the Department of Health’s stated policy to shift the emphasis of care back into community settings, there is a need to ensure these settings are age and dementia friendly. Access to clinical dementia experts at local community levels will form the basis of key community services for those with dementia and their carers. People who need and receive community care, whether through home help, respite, home care packages, hospice and palliative care services, value these supports enormously. However, access is discretionary, unequal and problematic. The root of this issue is the lack of legislation to underpin access to these services. There is no statutory entitlement to home care and community care services. Since access is discretionary, it is extremely difficult for individuals, families and carers to get information and reliable access at critical points for example at discharge from hospital, onset of disability, diagnosis of dementia, long-term or life-limiting illness. I agree with the Ombudsman who obverses that “people do not know where they stand in terms of their entitlements and in terms of the HSE’s obligations to provide services”. I also support the call made by Older and Bolder for the inclusion, as part of a national dementia strategy, of the development of long-promised legislation to establish a clear right to community care. Only this can provide the clarity and security to individuals and families.

I stress that I welcome this motion and I recognise the Government’s achievements in this area such as the publication of the national carers strategy in 2012, which was broadly welcomed by carers groups as an aspirational document that provides a solid basis for informing future policy decisions. However, I also note the reaction from some groups I work with in the areas in question that a motion such as this is nothing more than a series of platitudes unless accompanied by action such as the tangible recognition of the vital work carried out by family carers. While 50,000 carers are responsible for Alzheimer’s and dementia patients, 137,000 other carers look after other people with disabilities spanning all age groups from children to the elderly. Recognition of their work can be shown by the provision of adequate and ring-fenced resources, including payments to carers, which should not be seen as income supports but as direct supports for their caring duties.

We are all conscious that we are approaching budget 2013. The Minister for Social Protection recently gave us assurances that core benefits will be protected but we are still wondering what are core benefits? For example, is the half rate carers allowance a core benefit? I refer to the funding sources for carers, which include the Department of Social Protection, which covers benefits and allowance; the Department of the Environment, Community and Local Government, which administers the housing adaptation grant; and the Department of Health, which deals with hospital and respite care. When I consider this, I wonder whether the citizen or the Government is at the centre of policy, as he or she must constantly run around. He or she has to be assessed several times before a decision on his or her care and he or she must repeatedly go through his or her family history.

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Alcohol Consumption: Statements

17th October 2012

I will try to be succinct. I have five specific questions to ask the Minister of State but first I wish to comment briefly on the issue. I am speaking as a Senator, as a children’s rights activist and as a proud Irish citizen. My first concern relates to the social and cultural acceptability of our excessive alcohol usage. It disturbs me how frequently and casually excessive drinking and being hungover are spoken about on the national airwaves, in the media and in discourse following sports events and other everyday conversations. For example, we use such expressions as “How’s the head?” and “I’m dying” and “It is the Irish ‘flu”. This is acceptable discourse for us. We use these references and they are bandied about all the time. I am not trying to sound in any way pious and it is not that I have not misused alcohol myself but it is about the way we use these terms in common parlance. They are acceptable and tolerated. This is where I have a difficulty. We are sending mixed messages in our discourse on drinking. On the one hand there are drink awareness campaigns, especially those targeting young people. During the debate today I imagine we will refer to the scourge of binge drinking among young people and we will highlight the dangers of excessive drinking. On the other hand as adults we laugh it off. We are sending mixed messages.

Our international reputation as a nation of drinkers is seriously undesirable and is becoming increasingly so.

It is something that we should be working hard to overcome. While on holiday in the United States over the summer, I was shocked to see a T-shirt being sold in a tourist shop, among a number of T-shirts of a similar vein, depicting Irish yoga as a series of images of an extremely intoxicated man. I have a fairly healthy sense of humour but I did not find it funny. In fact, I was extremely embarrassed that this is the depiction, on several different types of T-shirt, of Ireland. There was nothing positive about that message.

There is an intrinsic link between excessive alcohol consumption and alcohol-related harm in Ireland. The negative impact, as has been testified to by the Minister of State, Deputy Alex White, and by my colleagues before me, on individuals, on families and on the Exchequer and society at large can no longer be justified in terms of the revenue the alcohol sector generates in and for Ireland, or how our pub and craic culture attracts tourism. I grew up with a definition of the idea of craic culture being about music, friendship and great fun, but we seem to have redefined what it means and this is something that we must seriously question.

Alcohol has been identified as a contributory factor in 97% of public order offences and, according to international research, there is a link between increased alcohol consumption and increased levels of public order crime. Alcohol related crime will cost us €1.2 billion this year. All of us here could make a long list of what we would like to spend that €1.2 billion on, and that figure relates only to crime and not the associated health costs.

I had the honour to write two European reports as a rapporteur for the European Economic and Social Committee on the harmful effects of alcohol. Often the employers’ organisations would row in on the side of the drinks industry but, luckily, I was able to persuade many of my colleagues from the employers’ organisations to support me in my work. The figures, for example, for increased absenteeism, show it costs Ireland €1.5 billion a year, according to a recent survey by IBEC, the very organisation that supports the drinks manufacturing industry of Ireland. Employers need to wake up to the cost alcohol imposes. Alcohol is the primary reason for 4% of short-term absences from work by male employees and 1% by female employees. On the impact on health, every seven hours someone in Ireland dies from an alcohol-related disease and alcohol is a factor in up to one third of all deaths of unnatural causes. The figures are quite startling.

The Minister of State mentioned the indirect effects on children. Between 61,000 and 104,000 children aged under 15 in Ireland were estimated to be living with parents who misuse alcohol, one in 11 children is impacted negatively by parental alcohol problems and one in six cases of child abuse is attributed to alcohol. We really must wake up. I am glad the Minister of State said that he will bring back the proposals as soon as possible but there really is need for greater urgency.

I have the following five concluding points. First, the Minister of State mentioned the national substance misuse strategy. I draw his attention to the report on the misuse of alcohol and other drugs, which Senator Colm Burke mentioned, published in January last by the Joint Committee on Health and Children. We came up with 13 recommendations. They were debated heavily at the committee but the meeting was one of those good days in the Houses where all members were on the same side in trying to work out the best recommendations. There is cross-party consensus on those recommendations and I would bring the report to the Minister of State’s attention.

Second, there have been significant delays in the publication of both the alcohol action plan and the sale of alcohol Bill. They were expected in September and before the end of 2012, respectively. Can the Minister of State clarify when these will be published?

Third, the Minister for Justice and Equality, Deputy Shatter, was due to bring forward the recommendations of the RRAI voluntary code of conduct but he was also supposed to come back, prior to the summer recess, on section 9 of the Intoxicating Liquor Act 2008, which the Minister of State mentioned, which deals with the structural separation of alcohol from other products. The legislation is in place. It is a bizarre piece of legislation because the Minister has a choice when it comes to implementing it. I have never seen legislation that gives the Minister the choice. I think the Minister of State will find this interesting. I had to reread the legislation several times. I raised it here in the House with the Minister for Justice and Equality under an Adjournment matter. It is something that could be put into place now. We all talk about alcohol products straying into other parts of the supermarket but there is legislation to which we can give effect.

Fourth, given the legal challenge against minimum pricing being put to the Scottish Government, can the Minister of State clarify what changes in alcohol pricing will be introduced in Ireland and if minimum pricing cannot be introduced, will consideration be given to introducing a ban on below-cost selling?

Finally, a significant amount of work has been undertaken in Northern Ireland on alcohol advertising and price promotion. By the end of 2012, Northern Ireland will introduce additional regulations to ban certain irresponsible drink promotions that encourage excessive drinking and specified pricing practices. Further restrictions have also been proposed in Northern Ireland and are included in Scotland’s licensing law which are intended to prevent supermarkets and off-sale premises advertising school offers anywhere other than within a licensed area of their premises. The restrictions would also apply to other advertising material, such as newspapers, in-store magazines and leaflets. Will the Minister of State give consideration to introduce similar measures? It is my understanding that the legislation currently exists in the form of section 16 of the Intoxicating Liquor Act 2008 and these changes could be brought forward fairly quickly.

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Adjournment Motion – Mental Health Services

11th July 2012

In December last, I praised the budget 2012 commitment to invest €35 million in mental health services, of which €23 million was dedicated to developing community mental health teams for adults and children.

Along with many others with an interest in mental health, I was alarmed to read in a newspaper report over the weekend in The Irish Times that part of the €35 million investment in mental health services could be used to offset overruns in the HSE. This report was swiftly countered by the Minister of State’s Cabinet colleague, the Minister for Public Expenditure and Reform, who gave assurances on the RTE Radio 1 programme “This Week” on Sunday that the promises of additional posts for mental health services would be delivered. My first request is that the Minister of State take this opportunity to give me the same assurances in this regard.

In budget 2012, a further commitment was made to recruit 414 staff for community mental health teams, of which 250 posts were to be in dedicated adult teams. I am extremely disappointed that not one position has been filled although it is now July 2012. The Minister of State is, more than most, acutely aware of the wide-ranging benefits of community-based mental health services. Among many other benefits, community-based mental health services enable people to be treated for mental distress in their communities, either at home or in a hospital, minimise inpatient and day-case hospital stays, liaise with local community services such as vocational training, education, housing and voluntary support services to provide integrated recovery support for the individual, and support primary care staff in providing mental health support. Furthermore, having accessible mental health services in the community can help normalise mental health and destigmatise mental health problems, reducing the prejudice and discrimination that people currently face. Community mental health teams are a vital part of the recovery ethos which is central to A Vision for Change. The community-based mental health services envisaged in A Vision for Change are specialist services with staff who have particular expertise in supporting people’s mental health.

Core services offer a holistic range of supports and include staff from a range of specialist disciplines such as clinical psychology, mental health nursing, occupational therapy, psychiatry and social work. However, the specialist disciplines mentioned remain significantly understaffed. Back in 2010, a report by the Inspector of Mental Health Services on an audit of community health staffing showed that only 50% of the required number of psychologists and only 60% of the required number of occupational therapists were in place.

In addition to my concern about the existing under-staffing, I am concerned by reports from the coalition group Mental Health Reform that the Irish Mental Health Commission is no longer collecting data on staffing levels in approved centres. This gap in data will make it extremely difficult to assess whether staffing levels are reaching the recommended level as set out in A Vision for Change. My second request is that the Minister of State tell us what information has she in this regard. Perhaps she can provide me with assurances that data will be collected.

The Minister of State recently confirmed that 31 of the promised 414 posts in community mental health teams under the HSE service plan 2012 will be converted to nursing posts for acute inpatient services in Dublin-mid-Leinster region. Mental health services in Ireland have for far too long been the Cinderella of the health services. The 414 staff promised in the HSE service plan should not be deployed in inpatient services and must remain in the community. Staffing needs to be ring-fenced. The continuing uncertainty over the future of the mental health budget does nothing to allay fears about the Government’s commitment to invest the dedicated €35 million I mentioned at the start. My third and final request is that the Minister of State confirm that the badly needed posts in community mental health teams will be in place by September, and that the posts will be ring-fenced to ensure they are not diverted to inpatient services.

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Symphysiotomy: Statements

16th May 2012

I welcome the Minister of State to the House. I also thank my Labour Party colleagues for providing the opportunity to Members of Seanad Éireann to make statements on the scandalous medical malpractice of symphysiotomy, which was performed in Ireland at least 1,500 times between 1944 and 1992. I also extend the warmest of welcomes to the survivors of symphysiotomy who are present today in the Visitors Gallery and elsewhere in Leinster House. I commend the dignity, bravery and honesty they have shown in sharing their personal traumas with Members during a number of Oireachtas briefing and information sessions. I thank them for opening Members’ eyes to the at best utterly inappropriate and at worst barbaric treatment they suffered at the hands of trained medical professionals in Irish hospitals.

I followed the statements on symphysiotomy in the Dáil last March with great interest and I agree with the comment by the Minister, Deputy Reilly, which was echoed today by the Minister of State, that we should be proud that Ireland is recognised internationally as a leader in the field of obstetrics. We also should be proud that with only one maternal death per 100,000 live births, Ireland has one of the lowest maternal mortality ratios in the world. However, as is evident from the statements being made today, Ireland has a far from unblemished record in the area of maternal health care. Between 1920 and as recently as 1992, many women suffered serious maternal morbidities under the care of trained medical practitioners in Irish hospitals. Maternal morbidity is defined as an illness or disability in women caused directly or indirectly by factors relating to pregnancy, childbirth or the post delivery period. The vast majority of maternal morbidities are preventable and as such, their prevalence constitutes a serious violation of women’s fundamental rights to life, liberty and security, as well as to health, dignity and freedom from cruel, inhuman and degrading treatment.

In common with many others, I am extremely frustrated by the delay in the publication of the report into the practice of symphysiotomy in Ireland. Extremely serious concerns must be addressed for the survivors to receive the acknowledgement, truth and justice they deserve. Chief among them is the contention by the Institute of Obstetricians and Gynaecologists in Ireland, upon which it appears the Department of Health is content to rely, that the practice of symphysiotomy was carried out due to medical necessity and only until consensus regarding caesarean section changed and it was deemed safe. It is my hope that in carrying out a critical appraisal of international reviews of symphysiotomy practice and associated rates in comparable countries in the world, as well as an examination of the Irish experience relative to other countries, this report will refute this contention once and for all.

The Minister, Deputy Reilly, himself acknowledged last March that symphysiotomy continued to be used in Ireland for some time after it had been all but discontinued in other developed countries and continued to be used for a longer period in particular hospitals, most notably in Our Lady of Lourdes Hospital, Drogheda. Rather than a procedure arising out of medical necessity, the evidence suggests symphysiotomy was the preference of some senior doctors in keeping with their conservative Catholic belief systems, whereby caesarean section had a safe birth limit of up to four children, while symphysiotomy would allow women have an unlimited number of children despite the horrendous cost to their health and well-being.

While the last thing anyone wants is another institutional abuse scandal, if there is one, and I believe there is, it must be met head on. The culture of secrecy, collusion and cover-up that surrounded institutional and clerical child sex abuse cannot be allowed to flourish again now as, otherwise, what has been learned? I cannot help but discern a parallel between the recent calls for Cardinal Brady’s resignation and this issue. Something that was not illegal at a particular time or indeed which was accepted practice within an institution or discipline but which in hindsight is found to be utterly inappropriate and morally wrong, cannot and should not be immune to a contemporary and robust response.

I was disappointed by the limited terms used by the Minister, Deputy Reilly, during the Dáil statements in March in referring to the experience of the survivors. He spoke of pain and distress but it is clear to me, having listened to the women’s personal testimonies, that such descriptions are totally inadequate in the face of the devastating impact symphysiotomy had on their lives and those of their families. In addition to the horrendous physical injuries they suffered as a direct result of the procedure, which sustained and worsened in the absence of appropriate aftercare, the serious emotional and psychological suffering they endure must be acknowledged. The birth of a child — for many of the women affected this was the birth of their first child — should be the most joyful time in a woman’s life. Instead, for the survivors, of whom there are currently a little over 150, the birth of their child was the beginning of a nightmare. This was a nightmare as a result of a medical procedure to which they did not consent, of which they were not informed of after they had it, in respect of which they did not receive medical treatment and aftercare, and the evidence of which suggests was not medically necessary. Shockingly, there are women who, despite having presented to doctors for treatment for various medical ailments over the years, only realised following the RTE “Prime Time” investigation into symphysiotomy in February 2010 that they were survivors. These women still present as survivors in 2011. Sadly, as time passes survivors are dying. We know that at least four survivors have passed away since the Walsh report was commissioned.

The women are the primary victims here. We have heard testimonies from women who could not lift or attend to the needs of their newborn babies due to the pain they were in and of the helplessness, guilt and shame they felt as a result. We heard from those who could no longer play beloved sports, to those who could no longer walk, of how their quality of life was irrevocably altered. We also know that there are secondary victims. They, too, must be acknowledged. One in ten babies died during symphysiotomy births. Children lost the love and nurture of mothers so traumatised by their experiences that they could not bond with their baby and subsequent babies. Likewise, husbands suffered as a result of the effects on their wives.

I note the Minister of State’s comments today and those of the Minister, Deputy Reilly, in March in relation to the provision of medical care to the survivors, which I welcome. However, having also heard from the women, I am concerned that they are having difficulty accessing services. I am particularly concerned about the difficulty some are facing accessing their medical records. Some women have been told there records no longer exist and others have simply been denied access to them. I presume this is the same “unforeseen difficulty” which the Minister of State, Deputy Lynch, mentioned Dr Walsh was experiencing in explaining the delay in the submission of her report? I accept that records get lost over the passage of time, in isolated instances but when it seems to be systemic my antenna goes up.

I heard from one woman that her doctor had requested a hospital in Dublin to carry out an X-ray to establish whether symphysiotomy had been performed on her. To establish or indeed rule out symphysiotomy the doctor had referred the woman to the hospital for a stand-up X-ray, specifically. The hospital refused to carry out the X-ray in this manner. The Minister of State, Deputy Lynch, spoke about addressing the legacy of the past. What I have just outlined happened last week, not in the past, which makes me question whether the system is trying to protect itself.

Will the Minister of State send out a clear message today that it is totally and utterly unacceptable for the medical profession to frustrate in any way the right of these women to redress and remedy?

I would like to put on the record my full support for the setting aside of the statute bar to allow these women seek judicial redress. There is solid precedent in terms of this having been done in respect of clerical sex abuse.