Public Health (Alcohol) Bill 2015: Second Stage

I welcome the Minister to the House on this, our penultimate day of term. I heartily welcomed the initiation of the Public Health (Alcohol) Bill. As did Senator Burke, I participated in the hearings of Oireachtas Joint Committee on Health and Children on the scrutiny of the heads of the Bill. We covered the aspects of the Bill and I thank the Minister for taking on many of the committee’s recommendations in what we see today. It does show pre-legislative scrutiny works. The Bill is about reducing alcohol-related harm, improving people’s health and, ultimately, saving children’s lives. From my reading, a children’s rights focus is evident throughout the Bill.

I acknowledge and thank the Alcohol Health Alliance Ireland, which is spearheaded by the Royal College of Physicians of Ireland and Alcohol Action Ireland, for its work and advice to me in this area. In all of our debates on alcohol, even those on reducing the alcohol-related harm which we all agree is extensive and needs tackling, we feel we need to clarify that we are not anti-alcohol. This is because our relationship with alcohol is so twisted into our culture and psyche we do not wish to be portrayed as judgmental and anti-fun. I have been rapporteur for two EU reports on the issue of alcohol-related harm. I have seen the drinks industry in action first-hand so I have no doubt of the pressure it must have put on the Minister. At EU level, I was on the European Economic and Social Committee, which was small, and the industry tried to silence me and discredit me and undermine the work of the NGO for which I worked. Thankfully, the majority of my colleagues on the committee were willing to stand with me and face down the vested interests and defend the public good. This is what we are trying to do with the Bill.

My entry point to the issue is the impact of alcohol-related harm on children. Four in ten children in Ireland are at risk of being adversely affected by alcohol misuse. Four in ten child protection cases are associated with alcohol misuse. It is a significant contributor to the neglect and abuse of children, to domestic and sexual violence and family breakdown. I welcome the support for the Bill and its harm reduction measures from several sectors of the industry in Ireland, including the vintners’ associations, the majority of publicans, the National Off-Licence Association and the C&C Group.

I use the term “drinks industry” but I speak more about the giants who see Ireland as a small pawn in the global drinks industry. The drinks industry speaks about responsible drinking, but the way we drink in Ireland is only responsible for the huge profits the industry makes here every year. As soon as the Minister launched the Bill I could almost hear the smoke machine of the drinks industry spluttering into action and, through its puppet drinkaware.ie, a soon to be launched rebranding of MEAS, talk about the importance of education. We see drinks industry initiatives all the time and the involvement of the drinks industry in public health campaigns despite clear and definitive statements from the World Health Organization that it should have no role in public health initiatives.

Drinkaware.ie is funded by Diageo, Heineken and Irish Distillers. Earlier this year we saw it advertise for an education programme manager to head up an education programme targeting young people, parents and teachers. This is completely inappropriate. If I put it this way, who would entertain the idea of an education programme about the dangers of smoking being designed and delivered by an organisation that is funded by tobacco companies? We cannot let the drinks industry in whatever guise it manifests itself to go into schools and purport to educate our children about the usage of a substance on which its entire profit is made. I hope the Department of Education and Skills takes a firm stance. I have tried to raise this issue several times in the Seanad. There is no safe level of alcohol consumption for children and this is the clear message we must send. We know education informs our behaviour, but it does not influence our behaviour. It is the actions contained in the Bill which will change and reduce alcohol consumption.

I have no doubt that, as has happened in Scotland, the industry will go to court if it feels it can delay or frustrate the implementation of the Bill. In my opinion, this tells us the Minister is on the right track. With regard to sponsorship and sport, the drinks industry spends £800 million a year in the UK on advertising, and research has shown that children there as young as ten are familiar with, and can readily identify, alcohol brands, logos and characters from television. In many instances, recognition was greater for alcohol brands than for non-alcoholic products targeted at children. This tells me a lot. The study also provided new evidence that many children are familiar with the link between alcohol brands and the sports teams and tournaments they sponsor. This is why I welcomed the initiatives the Minister is taking. He knows my position, which is I would love to see a full ban, but I welcome what he is doing in this area to try to reduce the impact on children.

It was very interesting that in the days after the Bill was launched we saw a headline stating it would undermine the rugby World Cup. I cannot see the evidence for this. We have seen the rugby World Cup successfully held in France, which has a ban, and it made a profit. It made me think of FIFA, because it has influenced legislation in Brazil. Brazil has a law whereby alcohol is not sold in stadia, but a change will be made to enshrine the right to sell beer. Surprise, surprise, Budweiser is a big sponsor of FIFA. When the ban on tobacco sponsorship of sport was introduced we were told it would be the end of golf championships, and we would never see again championships such as the Carrolls Irish open. This has been disproved. It can still happen.

With regard to minimum unit pricing, over the past several years the alcohol strength of drinks has increased greatly. The alcohol strength of beers and wine has increased. The pricing the Minister will introduce is within the power of the drinks industry. If it reduces the alcohol strength we will not see price increases. It is simple because it has the power. The introduction of minimum unit pricing will not have an impact on people who drink alcohol in pubs, clubs and restaurants. We are speaking about off sales. People who drink alcohol purchased in supermarkets and consume it within the safe limits will pay 30 cent a week more, which is €15.70 over a full year, with minimum unit pricing. The difficulty is that people drinking cheap high-strength alcohol purchased in supermarkets and other retailers will notice, but we know this is what causes the most deaths, injuries, accidents and incidents. I recommend as reading the University of Sheffield report, which the committee dealt with during its hearings. We know minimum unit pricing works because we have seen it work in Canada.

I welcome what the Minister is doing with labelling. We very much see the importance of people having information. After we discussed it at the committee, we started looking more at labelling on bottles and we can see the misinformation, deliberate or not. It is very difficult to make informed decisions. For the first time, labels on alcohol products will include information which will tell consumers what they are consuming and the impact on their health and weight. More than 90% of Irish adults do not know what is meant by a standard drink. I must look it up and I am involved in the area. A total of 95% of people have said they support the labelling initiatives. The Minister knows I have raised with him the issue of cancer, and we know that alcohol is associated with 900 new cancer cases every year and 500 cancer deaths.

There is an issue with regard to structural separation, which the committee considered and brought to the Minister. I have read the explanatory memorandum which comes with the Bill. The Minister is taking a very pragmatic and easily implemented approach and I commend him for it. We have seen seepage in supermarkets with meal deals which normalise drinking wine every day. I commend the Minister on the pragmatic approach being taken. We will get to tease out each aspect of the report on Committee Stage and I say “Well done” to the Minister in respect of the children’s clothing issue also. We see the seepage on that matter throughout department stores. The Minister has my full support.

Full debate https://www.kildarestreet.com/sendebates/?id=2015-12-17a.93&s=jillian+van+turnhout#g103

18 July 2013: Questions to the Department of Children and Youth Affairs, for answer before the meeting of the Committee on Health and Children.

Question 4: National Substance Misuse Strategy

Question 5: Implementation plan for the Child and Family Support Agency

Question 6: Oberstown campus development

Question 4: National Substance Misuse Strategy.

To ask Minister for Children and Youth Affairs to outline her position on the recommendations contained in the Steering Group Report on a National Substance Misuse Strategy on protecting children and young people from the impact of alcohol. Specifically, the recommendations relating to alcohol marketing and minimum pricing with a view to impacting on the age at which young people start drinking alcohol, as well as the consumption levels of under18s.

Children and Alcohol
Whilst there have been some indicators showing an improvement in the levels of alcohol consumption in children over the last decade, with the percentage of children aged 10-17 who report never having had an alcoholic drink increased from approximately 40% in 2002 to 54% in 2010, there are many more indicators that continue to give deep concern about the patterns of drinking that exist in children and young people.

Drunkenness amongst Irish Young people
There exists a consistent trend for drunkenness when drinking among Irish young people, a trend that sets them apart from the majority of their European counterparts.
In the latest report on drinking among 15 and 16-year-olds across Europe, Irish students reported drinking a third more on their latest drinking day than the European average. In addition, there also exists a trend whereby Irish girls drink as much as boys, and sometimes drink more. Irish students reported that, in the 30 days prior to the survey
• Half (48% boys and 52% girls) had drunk alcohol
• 40% had 5+ drinks on a single drinking occasion
• 23% had one or more episodes of drunkenness
• In 2010, 18.3% of children aged 10-17 reported that they had been drunk at least once in the last 30 days.
Unfortunately, the impact of the trend in drunkenness has already surfaced as chronic alcohol-related conditions among young people become increasingly common.
Between 2005 and 2008, 4,129 people aged under 30 were discharged from hospital with chronic diseases or conditions of the type normally seen in older people.There has also been a considerable increase in alcoholic liver disease (ALD) among younger age groups. Among 15 to 34-years-olds, the rate of ALD discharges increased by 275% between 1995 and 2009
The accompanying trend of increased ease of access to alcohol is also a source of concern. In 2011, 84% Irish 15 and 16-year-olds reported that alcohol was “very easy” or “fairly easy” to get compared to 75% in 2007. Just over a quarter (26%) said they had bought drink for their own consumption from the off-trade in the 30 days prior to the survey; 37% said they had bought their drink from an on-trade outlet.
This trend has been accompanied by an explosion in the number of outlets selling alcohol at ‘pocket money’ prices with a bottle of beer often cheaper than a bottle of water. Discounts on multiple packs of alcohol have created a culture where young people buy slabs of beer instead of six-packs.
Unsocial and Public Order Offences by Children and Young People‘Public Order and other Social Code Offences’ were the single highest cause of referrals to the Garda Juvenile Diversion Programme, representing 28.9% of all referrals. Many of these are associated with alcohol consumption and binge drinking amongst young people.
The effects of Alcohol Abuse by Adults on Children
There are serious consequences also to children living in families where one of the parents or carers has an alcohol misuse problem. Adult alcohol problems are directly responsible for a significant percentage of child abuse and neglect cases; was identified as a risk factor in three-quarters of Irish teenagers for whom social workers applied for special care; is associated with a range of disorders known as foetal alcohol spectrum disorders are caused by mothers drinking alcohol in pregnancy
In Conclusion

The Department of Children and Youth Affairs works closely with the Department of Health to identify and support actions supported by emerging international evidence on what is effective in helping reduce the current levels of alcohol misuse in Ireland. Actions on pricing, advertising, sponsorship, labelling and others will move us further down the road of achieving safer levels of alcohol consumption in adults and minimising or preventing consumption by children.

Question 5: Implementation plan for the Child and Family Support Agency

To ask the Minister for Children and Youth Affairs to share with the Joint Committee on Health and Children the Implementation Plan for the new Child and Family [Support] Agency including: the anticipated commencement date for the Agency; details of the exact number and disciplines of the staff who will be transferred from the NEWB, Family Resource Centres and HSE; and a clear explanation of the referral pathways for children and families to the new Agency.

As I stated in response to the Deputy’s questions on this subject in advance of the April meeting, the establishment of the Child and Family Agency is at the heart of the Government’s reform of child and family services.

Extensive work is ongoing in the Departments of Children and Youth Affairs and Health, and in the HSE to prepare for the establishment of the Child and Family Agency. The preparations are designed to allow for the Agency to assume full statutory responsibility for specific services for children and families upon establishment.

The Child and Family Agency Bill was published on 12th July last and it is the intention to introduce it to the Houses of the Oireachtas in the current session. A precise target date for establishment of the Agency will be set when consideration of the legislation is advanced.

The Bill focuses on the task of bringing together the functions of the three “source” agencies (the HSE, the Family Support Agency and the National Educational Welfare Board). Particular care is required in respect of the disaggregation of the functions from the HSE to ensure that there are no unintended consequences (for either the Agency or the Directorates remaining within the HSE framework) in the separation of functions, either in legal terms, or in terms of the practical operation of day-do-day services for children and their families or HSE clients across the life cycle.

A key task in drafting the legislation has been to ensure that the Agency operates within a strong framework of public accountability. Other important features of the legislation relate to the need to create the correct platform for interagency arrangements, shared service arrangements and a robust process for the commissioning of services from a range of providers.

In addition to creating a framework for the future, the Bill also has to take account of the transitional arrangements which inevitably have to be prescribed. These are potentially complex against the backdrop of changing governance and structural arrangements in the context of the wider Health Reform programme.

While the legislative process is under way, all necessary organisational preparations are continuing in parallel. It is important not to underestimate the scale of change involved and the absolute necessity for a carefully planned approach to be adopted while embarking upon such large-scale change within this crucial area of the public service.

The establishment of the Agency is being directed by a project team (led by the CEO Designate) which is driving the overall project plan. Its responsibilities include the full range of activities required to bring the project to completion – from the high level legislative programme elements through to the more practical day-to-day issues regarding the transfers of staff, systems and various undertakings relevant to the operation of the new Agency. Representatives of the Family Support Agency and the National Educational Welfare Board are also members of the team and are actively involved in leading the requisite change management programmes within those agencies.

The project team reports to an Oversight Group which is chaired by the Secretary General of the Department of Children and Youth Affairs and relevant matters are escalated to the Oversight Group if necessary. Its membership includes officials of the Departments of Children and Youth Affairs, Health and Public Expenditure and Reform; the HSE – both sides of the organisation; and the CEO Designate of the Child and Family Agency.

In order to prepare for the establishment of the new Agency, a due diligence exercise has been commissioned regarding the level of resources to transfer from the HSE to the CFA on establishment. The objective of the exercise is to establish that the level of resources to be divested from the HSE to the new Agency is fair and reasonable.

Following intensive work on the part of HSE and CFA-designated staff, individual letters of notification issued earlier this year to some 4000 staff that have been confirmed as transferring to the new Agency. This includes staff employed by the HSE (the majority currently working in Children and Family Services), the Family Support Agency (FSA) and the National Educational Welfare Board (NEWB). It should be noted that the staff of the Family Resource Centres are not employed by the Family Support Agency directly.

I am confident that the establishment of the Agency will bring a dedicated focus to child protection, family support and other key children’s services for the first time in the history of the State and will in time contribute to the transformation of what are essential services for families and communities. As can be seen from the above, following publication of the Report of the Task Force on the Child and Family Support Agency, intensive work has been underway to prepare for establishment of the Agency. There are strong project governance and project planning methodologies in place, with revisions on an ongoing basis as tasks are accomplished or issues escalated. Further details of the tasks undertaken or underway were set out in my April reply.

In addition, since April my Department has sought expressions of interest for the Family Support Agency board which will form a shadow board pending the legal establishment under the Child and Family Agency Bill which has now been published.

In respect of referral pathways, HSE Children and Family Services are piloting programmes in selected geographical areas to ensure the most effective response to all referrals. Currently, all child welfare and protection referrals are channelled through social work departments, where child protection is prioritised. The revised referral pathways are intended to ensure a service is provided for all referrals at a level that is most appropriate to the problem presented. The intention is that the lessons learned from the early roll-out of this method of dealing with referrals will be applied across the country.

Question 6: Oberstown campus development

To ask the Minister for Children and Youth Affairs when a single management structure will be in situ in Oberstown to oversee the development of the campus including the integration of the three existing schools, and to outline, including the timeframe, the remaining steps in the process to ending the practice of detention of children in St Patrick’s Institution by mid-2014.

As previously stated in response to various Parliamentary Questions, we are the first Government to:

• have ended the detention of 16 year olds in St Patrick’s Institution.
• provide capital funding, of €50 million, for the development of National Child Detention Facilities in Oberstown.
• have extended the remit of the Ombudsman for Children to include St Patrick’s Institution.
• have established a dedicated multidisciplinary assessment and therapeutic care team for children in detention and special care.
• revised campus rosters and management structures at Oberstown.
• moved to close St Patrick’s Institution.

With respect to the development of National Child Detention Facilities in Oberstown, this project is required in order to give effect to the Programme for Government commitment to end the practice of detaining children in adult prison facilities. My officials have, in conjunction with the Office of Public Works, completed the design process and secured planning permission for the capital development. The tender process is being managed by the Office of Public Works at present and an announcement on the outcome of this process will be made shortly. The project will result in an increase in the overall detention capacity on the campus from 52 places at present to 90 places in total, along with associated education, visiting and other facilities. The required capacity to enable the assignment of responsibility for all children under the age of 18 years to the Oberstown campus is to be delivered in the first phase of the project, by mid 2014.

There is legal provision under the Children Act 2001 for 24 male bed spaces in Trinity House School, 8 female bed spaces in Oberstown Girls School, and 20 male bed spaces in Oberstown Boys School. However, only 16 of the certified 24 male bed spaces in Trinity House School are currently available for use due to staffing issues. The Irish Youth Justice Service, which is based in my Department, is currently in discussions with management and staff on the Oberstown campus to reconfigure staffing and accommodation in order to meet the increased demand for male bed places from the courts. I have also noted a substantial increase in demand for male bed spaces on the Oberstown campus in 2013 compared to 2012. This has been primarily but not exclusively driven by an increase in the number of boys aged 16 years old on admission detained in Oberstown. The Irish Youth Justice Service has identified a trend since late 2012 of a higher number of such children being detained in Oberstown compared to the situation which applied when this age group was the responsibility of St Patrick’s Institution. This increase in demand from the courts merits further consideration, particularly since the Central Statistics Office has recently recorded a general reduction in crime trends overall in the community.

The first-ever campus-wide staffing roster, with a set of harmonised conditions for hours worked, was implemented on 25th February 2013 following protracted negotiation and agreement between staff and management at the Labour Relations Commission. I wish to acknowledge the cooperation of staff with the implementation of the LRC agreement to date. A number of outstanding issues are the subject of ongoing discussions in conjunction with implementation of the campus wide roster, the ongoing industrial relations process on the campus and the Haddington Road Agreement.

I have obtained Government approval for an amendment to the Children Act, 2001. The Bill includes an enabling provision which will allow for the merging of the three current children detention schools into one single cohesive organisation. The Bill is at drafting stage at present with Parliamentary Counsel and it is my aim to bring it to the House later in 2013. This will ensure that a single unified management structure is in place and fully operational when the proposed new development on the campus is completed. In the interim my Officials are making arrangements for the appointment of a campus manager to drive the change management programme in Oberstown. The arrangements for the recruitment and appointment of this manager will be made in the coming weeks, in conjunction with the Public Appointments Service (PAS). It should be noted that the existing Board of Management has responsibilities in relation to each of the three schools.

Since taking over responsibility for the children detention schools, I have also engaged fully with the HSE on the implementation of a new mental health service for children in detention and in the special care / high support system. This is known as the Assessment, Consultation and Therapy Service (ACTS). Good progress has been made and the posts for addiction counsellor and speech and language therapist have been filled with the psychology post due to be filled in September, 2013. Representatives from the children detention schools, HSE and IYJS have been working together over the last two months to identify an appropriate mental health screening system that can be used in the children detention schools and to develop training for staff. Training is due to take place in September 2013 with a view to implementing mental health screening for all young people in the detention system before the end of December 2013. I welcome the ongoing development of this important service on the Oberstown campus, which was a key recommendation of the Ryan Commission on child abuse of 2009.

In conclusion, a very substantial change programme is underway on the Oberstown campus. Oberstown’s expanded remit will see it accommodate all children detained in the State in a child specific environment from the middle of next year. The Government has provided dedicated capital funds for this purpose. I recognise that significant operational change is also required. Major change has already been achieved and my Department continues to work with the Board of Management, the staff and their representatives to expand the range and quality of services on the campus.

The Lancet

In July 2021, Jillian co-authored an article in the world-renowned medical journal “The Lancet”