Questions to Minister for Health: Early Supported Discharge programmes for stroke survivors

Questions to Minister for Health Leo Varadkar TD, Minister Lynch and HSE in advance of Health and Children Committee meeting 6 October 2015

Senator Jillian van Turnhout
To ask the Minister for Health if he will ensure that Early Supported Discharge programmes for stroke survivors are expanded by the HSE in 2016; what other actions he intends taking to develop community rehabilitation services for stroke survivors; whether he is concerned that the implementation plan for the National Neuro-Rehabilitation Policy and Strategy 2011-2015 has not yet been finalised with just four months left in its four-year lifespan; and if he will make a statement on these matters.

Currently there are 3 Early Supported Discharge (ESD) teams in Dublin North, Dublin South West and Galway respectively. These teams though small are functioning well.

The programme plans to increase the ESD teams over the coming years in larger urban areas first and then progress this expansion to less urban areas with a modified team to serve these areas, however resources are currently unavailable for this.

The National Policy & Strategy for Neuro-Rehabilitation 2011-2015 recognises the various possible challenges and the working group proposed an initial 3 year implementation plan.  Since the initial estimate of a 3 year implementation plan, the HSE has seen significant changes with the development of the Hospital Groups and the Community Healthcare Organisation configuration. This has changed the landscape within which services are to be configured to support implementation of this much needed strategy.

Currently, a steering group led by the HSE Social Care Division with representation from the National Clinical Programmes for Rehabilitation Medicine and Neurology, Department of Health, Primary Care, Therapy Professions & Neurological Alliance of Ireland has been assigned the task of developing an implementation framework for the National Strategy & Policy for Neuro-rehabilitation services. This group is working on finalising an implementation framework which will be released for consultation in Q4 2015.

The work of the steering group is overseen by an operational lead and a clinical lead with the group proposing a 2 phased approach to implementation which will begin at CHO level and expand to inpatient specialist rehabilitation services with connectivity across all service delivery sites.

The Model of Care of the National Clinical Programme for Rehabilitation Medicine (NCPRM) will be one of the primary reference points for the implementation of the Neuro-Rehabilitation strategy, given the importance in ensuring consistency and clarity in pathways to and across services.  The model of care of the NCPRM will provide a framework for the design and delivery of specialist rehabilitation services in the context of a strategy that addresses the broad continuum of services and supports required by those with neuro-rehabilitative needs.

The Model of Care for the NCPRM, which is currently being finalised post public consultation, details the role, function & benefits of these care teams, in line with the recommendations contained within the National Strategy & Policy for Neuro-rehabilitation Services in Ireland 2011-2015. This model of care proposes a 3 tiered model of specialist rehabilitation services namely complex specialist tertiary services, specialist in-patient rehabilitation units & community based specialist neuro-rehabilitation teams.

Both the National Clinical Programme for Rehabilitation Medicine and the National Policy & Strategy for Neuro-rehabilitation propose a needs-led service that meets the rehabilitative needs of people at acute, post-acute and community levels of people at all stages of the lifecycle who may benefit from medical, physical, cognitive, psychological and/or social Neuro-Rehabilitation service provision.

In this regard, it is not condition specific. While those who have suffered a stroke will be within the scope of this policy, services will not be exclusively for stroke survivors.


Questions to Minister for Health: School leavers with disabilities accessing services in North Dublin

Questions to Minister for Health Leo Varadkar TD, Minister Lynch and HSE in advance of Health and Children Committee meeting 6 October 2015

Senator Jillian Van Turnhout
To ask the Minister for Health if he is aware that 40 recent school leavers with disabilities in North Dublin, many in the highest category of support need, were informed on 30 June 2015, contrary to the HSE’s Social Care Operational Plan, that there was no service available for them moving forward. When will the situation be resolved for these young people whereby they are engaged in a service that meets their individual needs and will family members have a choice in the service that their family member attends.

Since the establishment of the Social Care Division in the HSE, significant progress has been made in improving on the planning and co-ordination on the annual allocation of places to school leavers and those young people exiting rehabilitative training (RT). This process has worked well and significant improvement has been made over the past number of years.

In line with these new arrangements and as set out in the Social Care Division Operational Plan 2015, the HSE undertook a mapping exercise to identify individuals who require a day service in 2015; the type of service that is required and the extent to which supports can be delivered within existing resources.

The data collected from each CHO Area indicated the following need:-

Client Status – RT / School Leaver
HSE CHO Area RT Leaver School Leaver Total
CHO Area 1 35 83 118
CHO Area 2 32 77 109
CHO Area 3 27 81 108
CHO Area 4 52 203 255
CHO Area 5 61 128 189
CHO Area 6 34 63 97
CHO Area 7 66 108 174
CHO Area 8 41 111 152
CHO Area 9 32 106 138
Total 380 960 1340

In summary:

  • 1,340 adults require a funded placement in 2015.
  • Capacity was identified to meet the needs of 508 of these individuals, from the existing services, resulting in a balance of 832 people that required a newly funded day service from the €12m allocation.

As a comparison, in 2014 1,365 people were identified as requiring services.  Capacity was identified to meet the needs of 734 people from existing services and the balance of 631 required funding from the 2014 allocation. Therefore in 2015, an additional 201 people require a funded day service response over 2014.

The current position is that 1,305 young people have had their place confirmed.  A difficulty arose in respect of 35 young people – 23 of these related to a problem in securing services at Gheel Autism Services in North Dublin, with a further 12 whose placements remain to be finalised principally awaiting capital development of new locations which will be available shortly.

The difficulty which arose in respect of the 23 young people was that they were referred to Gheel Autism Services as their preferred provider.

This provider informed the HSE during the month of August that they were unable to provide the service within the funding allocated and without a significant additional resource to expand their organisational governance structure and staffing.

On receipt of this confirmation the HSE took immediate steps to engage with two other providers of services to people with ASD which have the required competence and expertise to deliver the appropriate specialist services (the two providers are Autism Initiative & Praxis). The HSE communicated with the 23 families and put them in contact with the newly identified providers.

These two providers have undertaken assessments for each individual and have committed to providing an appropriate service for each individual within the allocated resources.

The current position is that 21 of the 23 young people involved have agreed to take up the new services referred to above while 2 people remain to have an agreed service provided.  There is active engagement with the 2 families and the relevant providers and it is expected that a positive solution will be forthcoming very shortly.

It is regrettable that this difficulty has arisen in North Dublin.  However arrangements have now been put in place to resolve these challenges and overall 98% of the 1,340 young people requiring services have had their places confirmed.  The HSE will continue to work actively to ensure that the remaining young people have their places confirmed as soon as possible.

Children First, Committee Stage: Emotional Abuse

Children First Committee Stage with the Minister for Children and Youth Affairs, James Reilly TD, Wednesday 23 September 2015

In page 5, between lines 27 and 28, insert the following –
 ““Emotional abuse” means behaviour (including an omission to behave in a particular manner) that significantly and seriously deprives a child of his or her developmental need for affection, approval, consistency and security and, without prejudice to the generality of the foregoing, includes –
(i) the imposition of negative attributes on a child, expressed by persistent criticism, sarcasm, hostility or blaming;
(ii) conditional parenting in which the level of care shown to a child is made contingent on his or her behaviours or actions;
(iii) emotional unavailability of the child’s parent or carer;
(iv) unresponsiveness of the parent or carer or inconsistent or inappropriate expectations of the child;
(v) premature imposition of responsibility on the child;
(vi) unrealistic or inappropriate expectations of the child’s capacity to understand something or to behave and control himself or herself in a certain way;
(vii) under- or over-protection of the child;
(viii) failure to show interest in, or provide age-appropriate opportunities for, the child’s cognitive and emotional development;
(ix) use of unreasonable or over-harsh disciplinary measures;
(x) exposure to domestic violence; and
(xi) exposure to inappropriate or abusive material through new technology,
provided that such behaviour or omission to behave in a particular manner results in or is likely to result in significant and serious injury to the emotional, social or psychological welfare of the child.”

In page 6, delete lines 12 and 13 and replace with the following –
 “neglect” means, in relation to a child,
(i) to deprive the child of adequate food, warmth, clothing, hygiene, supervision, safety or medical care; or
(ii) to deprive the child of appropriate emotional and psychological support or to subject the child (or allow or cause the child to be subjected)
to emotional abuse to the extent that the child’s physical, social, intellectual, psychological or emotional development is significantly and seriously affected.”

Minister, I move Amendment 1

It is extremely important that we identify and name ‘emotional abuse’ as a stand-alone form of abuse which, where sustained and ongoing, has a devastating effect on children’s lives and through into adulthood.

Emotional abuse is often the first abuse to occur and then escalates into other forms of abuse. We talk at length about the importance of early intervention and should not underestimate the message we are sending by excluding emotional abuse. What message are we giving? Emotional abuse is about control and power.

Barring and Protection Order – cannot use abusive language – we are able to define this in law.  Why is an adult different to a child?

Case – parent telling child every day that they are “born angry” and then wonder why the child at 12 presents with an anger problem.

In the Bill, ‘harm’ includes ‘neglect’. This amendment (amendments 1 and 2 read together), alters the definition of neglect to include emotional abuse, though only where the emotional abuse significantly and seriously injures the emotional, social or psychological welfare of the child.

The definition of ‘emotional abuse’ is largely drawn from its definition in the Children First Guidance, subject to the caveat that behaviour or omission to behave will not be treated as emotional abuse for the purpose of this Act unless it has a significant and serious impact on the child.

This is a relatively high threshold, which is designed to ensure that minor infractions or subjective differences in relation to best practice in parenting do not become subject of investigation.

The amendment is clearly framed so that only behaviour or omissions to behave that have a significant and serious effect on the emotional, social or psychological welfare of the child are deemed to constitute emotional abuse.

The examples given at 1 through 11 of Amendment 1 are not exhaustive. They are without prejudice to the generality of the substantive definition and are drawn directly from Children First.

It is important to note that a single or isolated instance of any of these examples may not be enough in itself to constitute emotional abuse in the sense in which it is defined in the amendment.

These examples may nonetheless be useful in helping to identify emotional abuse though, again, they are subject to the caveat that the effects of the behaviour or omission to behave must be serious.


Children First Bill, Committee Stage: Corporal Punishment of Children

Children First Committee Stage with the Minister for Children and Youth Affairs, James Reilly TD, Wednesday 23 Sept 2015

Video of my speech:

Proposed Amendment to ban the corporal punishment of children.

“28. The Non-Fatal Offences Against the Person Act 1997 is amended by the substitution for section 24 of the following – 

“Abolition of common law rules in respect of immunity from criminal liability for punishing a child.

  1. Any rule of law under which any person is immune from criminal liability in respect of physical chastisement of a child, whether the person is a parent or guardian of the child, a person with custody of the child either temporarily or indefinitely, a teacher, or a person in loco parentis in respect of the child either temporarily or indefinitely, is hereby abolished.””

I would like to begin by acknowledging and thanking Peter Newell of Global Initiative to End All Corporal Punishment of Children, which promotes the universal prohibition and elimination of corporal punishment.

In November 2012, the people of Ireland voted to enshrine the protection of children as individual rights holders into the Irish Constitution.  Following a defeated Supreme Court appeal, it was signed into law on 28 April 2015.  Article 42A.1 states: The State recognises and affirms the natural and imprescriptible rights of all children and shall, as far as practicable, by its laws protect and vindicate those rights.

What I am proposing in this amendment is to ensure that all citizens are equal in the eyes of the law.

Why do we still believe it is acceptable for corporal punishment to be in our laws?

What is corporal punishment? The Committee on the Rights of the Child defines “corporal” or “physical” punishment as any punishment in which physical force is used and intended to cause some degree of pain or discomfort, however light. Most involves hitting (“smacking”, “slapping”, “spanking”) children, with the hand or with an implement – a whip, stick, belt, shoe, wooden spoon, etc. But it can also involve, for example, kicking, shaking or throwing children, scratching, pinching, biting, pulling hair or boxing ears, forcing children to stay in uncomfortable positions, burning, scalding or forced ingestion (for example, washing children’s mouths out with soap or forcing them to swallow hot spices). In the view of the Committee, corporal punishment is invariably degrading.

Adults have a talent for inventing euphemisms to make them feel more comfortable while they inflict pain and humiliation, such as spanking or smacking. The truth is that, for a child, all of this is violence, and if it were directed at an adult it would constitute criminal assault.

Minister, I am very conscious that often people believe this issue is a judgement on how they were raised.  I would like to take this opportunity to welcome my mother Jenny to the gallery and she will concur that I was raised with the “you’re not too old for the wooden spoon” ringing in my ears.  Thankfully she never used it – indeed only in Ireland is the wooden spoon not seen solely as a kitchen utensil but as a weapon.   Times have moved on and our understanding of the effects of corporal punishment on children has increased.

There are many other good reasons to ban corporal punishment:

  1. It can cause serious harm to children;
  2. It teaches children that violence is an acceptable way of solving conflicts;
  3. It is ineffective as a means of discipline and there are positive ways to teach, correct or discipline children which are better for the child’s development and health;
  4. It is more difficult to protect children from severe abuse if some forms of violence are legitimate.

In tandem Minister, we must provide parents with sufficient support in bringing up their children, including through educating parents about good parenting skills.

Minister, 46 states, including 28 in the wider Europe, have prohibited all corporal punishment including in the family and another 51 states have clearly and publicly committed to achieve a full ban.

Ireland has been found to be in violation of the European Social Charter (by the Council of Europe’s European Committee of Social Rights) by failing to ban all corporal punishment against children. However, I hope the Government will find itself in a position to accept this amendment because it is the right thing to do.  We must uphold and protect Children’s Rights.

Mr. Janusz Korczak, a Polish-Jewish paediatrician, educationalist and children’s author, wrote in his 1925 book The Child’s Right to Respect: “In what extraordinary circumstances would one dare to push, hit or tug an adult? And yet it is considered so routine and harmless to give a child a tap or stinging smack or to grab it by the arm. The feeling of powerlessness creates respect for power. Not only adults but anyone who is older and stronger can cruelly demonstrate their displeasure, back up their words with force, demand obedience and abuse the child without being punished. We set an example that fosters contempt for the weak. This is bad parenting and sets a bad precedent.”

Sweden brought in their laws in 1979 – now 36 years ago. In a publication to mark the 30 years since Sweden’s abolition of corporal punishment their then Minister Maria Larsson wrote: “When violence is used against children, their confidence in the adult world is damaged. And there is good reason to believe that if this violence is exercised by the child’s own parent, or by someone else close to them, the damage is greater.”

Since 2006, the EU has emphasised the promotion and protection of children’s rights as a priority issue. The European Parliament, in a 2009 resolution on the situation of fundamental rights across the EU 2004-2008, called for a total ban on corporal punishment in all Member States. Again in November 2014, the Parliament adopted a resolution calling on Member States to uphold their obligations and combat any form of violence against children  “including by formally prohibiting and sanctioning corporal punishment against children”.

Recently, our Permanent Representative to the United Nations in New York, David Donoghue, said that Ireland had a central role in achieving sustainable development as co-facilitators of the UN negotiations together with Kenya on “Transforming our world: the 2030 Agenda for Sustainable Development”.

I note SDG 16 to promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels and particularly SDG 16.2 therein to end abuse, exploitation, trafficking and all forms of violence against and torture of children.

Minister, colleagues, children’s rights experts and advocates in Ireland concur.

Tanya Ward, Chief Executive, Children’s Rights Alliance:

“The Children’s Rights Alliance unites over a 100 organisation working with children and their families across the country. Since our establishment in 1995 we have repeatedly called for the removal from Irish law of the defence of reasonable chastisement of children.

Research is clear that corporal punishment has no benefits and carries causes children physical and psychological harm and can lead to short and long-term effects on their safety, health and development. There is no justification for corporal punishment and it is clearly at odds with Article 42A of the Constitution which “recognises and affirms the […] rights of all children” and commits to protect and vindicate those rights by its laws. Children have an absolute right to be protected from harm and abuse under the UN Convention on the Rights of the Child which Ireland ratified in 1992, there are no exceptions.

This coming January, Ireland’s progress on children’s rights will be examined by the UN Committee on the Rights of the Child, the Committee has criticised Ireland’s position on corporal punishment in 1998 and 2006 and are likely to do so again in 2016. The Children’s Rights Alliance has been leading the civil society engagement with the UN Committee and has prioritised corporal punishment as a key concern. There is no reason to delay, Ireland has a moral and legal duty to protection children from corporal punishment.”

Grainia Long, Chief Executive, ISPCC:

“As the national child protection charity, the ISPCC has long supported a ban on physical punishment of children.  Through our national listening service, Childline, we hear on a daily basis the impact of violence towards children.  Last year we responded to nearly 37,000 contacts from children regarding abuse or welfare, and many were from children who were anxious, traumatised and scared in their own home, due to violence.

We strongly support the amendment to remove the defence of reasonable chastisement, and believes that it meets the spirit and intent of the Children First legislation.  Whatever the circumstance, there is no reason why the law should permit a defence of hurt or violence towards a child.  Far too often, the debate centres on the needs or preferences of parents, rather than the rights of the child.  The recent change to our constitution following the Children’s Referendum requires us to think very differently and put children at the heart of our considerations.  Seanad members therefore have a long overdue and timely opportunity to place in law the right of a child to be safe in their own home, and we hope this opportunity will be grasped, in the best interests of children.”

 Laura Haugh, mum-in-residence / spokesperson for :

“ is Ireland’s largest online parenting community, and our members wholeheartedly support the campaign to repeal the defence of reasonable chastisement by parents and childminders (up to 3 children) in Irish law.

Slapping another person, and especially a vulnerable child is wrong in all circumstances. Firstly, allowing slapping by a caregiver to a child under the term ‘reasonable chastisement’, is legalising physical violence to another person and a form of child abuse. It demonstrates that it’s ok for a person to hit another person and indeed that it’s ok for a bigger or stronger person to hit a smaller or weaker person. This kind of behaviour can lead to intense abuse in the home for the child that does not learn quickly from the ‘reasonable chastisement’ and it is at complete odds with what is acceptable in today’s adult society or indeed the school playground.

Initially the child is hurt by the physical action and emotional breakdown of trust between parent and child that they forget what they have done wrong. What you want in effective discipline is for the child to understand what they have done wrong, and the consequences of their actions to others. You want the child to feel remorse but ultimately to still believe that they are a person of value, slapping does not promote this.

The main principle in promoting desirable behaviour is for the child to feel good and therefore be good. This is why regular positive affirmations of good behaviour is a much more effective tool to maintain this type of behaviour than anything else.

It is now well researched that when responding to an incident with a child that requires discipline; tuning into the child to understand exactly why they misbehaved, helping them to realise how their behaviour might affect others, and consistent follow-through with age appropriate consequences is much more effective than physical chastisement, no matter how ‘reasonable’ it is perceived.”

Minister, I am conscious of the comments made in February this year by Pope Francis.

For me it was encouraging to see the response by both the Vatican and indeed at national level.

I wish to cite from the letter written by Mary McAleese to the Irish Times, which noted that the Vatican was a signatory to the UN Convention on the Rights of the Child and that the relevant Treaty Monitoring Body, the Committee on the Rights of the Child, wants all corporal punishment of children to be banned.

She added “In submissions to that Committee last year, the Vatican said it did not promote corporal punishment, citing “respect for the inviolability of physical life and the integrity of the person…”.

The Vatican responded by appointing Peter Saunders, Founder of the National Association for People Abused in Childhood, UK, to the The Papal Commission for the protection of minors and was asked to lead on the Commission’s non-violence against children working group.

I contacted Peter Saunders earlier today and he advised me that the members of the working group are unanimous in their position that violence or reasonable chastisement of children is never justifiable.

Irish abuse survivor Marie Collins is also a member The Papal Commission for the protection of minors.   In discussions with both Marie Collins and Peter Saunders they are extremely supportive of Ireland updating its laws to bring into effect a ban on corporal punishment in Ireland.

Marta Santos Pais, Special Representative of the Secretary General on Violence against Children, advocates that corporal punishment can be prevented “[b]y supporting caregivers in the use of non-violent child rearing practices; by promoting advocacy and social mobilisation to safeguard children’s dignity and physical integrity; by reforming laws to introduce a clear ban of all forms of violence including corporal punishment, we can make a real difference in the life of children, all children, everywhere and at all times,”

Irish law is now out of step with parents, children’s rights advocates and international best practice.  With this amendment we have a way to unite and agree that all citizens are equal.


Gender Recognition Bill 2014: Report and Final Stages 15 July 2015

As always, the Minister of State is welcome to the House. I thank the Tánaiste for her commitment to the issue of gender recognition and thank the Minister of State for the energetic and robust debates we have had here in the Chamber and outside. I join other Members in welcoming the distinguished guests who have joined us here today, in particular Dr Lydia Foy and Michael Farrell. As I look at each face in the Visitors’ Gallery and think of the journey I have been on, I note that I did not know the majority of these people a few years ago, but now I feel I know them as friends. They have had to share their life stories with me for me to understand what we are debating here today and see the importance of today. That says a great deal. I have met some really amazing and brilliant people.

As the Minister of State knows, I have met many parents and children directly affected by this issue. While I am really happy today and recognise that is a great day, it is a bittersweet moment for me. It brings me back to my childhood when teams were being picked. There is a team getting on the human rights bus that is going. They are the adults and they are going to get it but the children did not get picked. That feeling of children being left out in the cold…yet again… makes it very difficult for me again today that we did not do anything for children, even though we had that opportunity. As we meet today, young people organised by TENI are meeting on the issue. BelongTo has a group of children meeting on this very issue. It is not that these children do not exist; they do. The Minister of State and I have met the parents and we know the real issues they face.

I will not go back over and rehearse every issue, but there have been developments since we debated the issue in the House in February. The calls I have made were informed and very much supported by organisations such as TENI and BeLonG To but also by the ISPCC, Children’s Rights Alliance, NYCI, SpunOut, Epic, Amnesty and the USI, just to name a few. Indeed, at its parliamentary assembly, the Council of Europe issued a resolution on discrimination against transgender people in Europe and said we needed to ensure that the best interests of the child are a primary consideration in all decisions concerning children. This is on transgender people; I am not picking something out of place. Indeed, since we have been debating the matter, Malta has passed gender identity, gender expression and sex characteristics legislation which ensures that children are free to live as they wish and are only required at the age of 14 to provide a gender for their birth certificate. In Norway, the Government has proposed legislation for pre-legislative scrutiny, not some independent Senator, to look at gender recognition from age seven. I welcome the commitment the Minister of State made in February to have the roundtable among education partners and I welcome the fact that one meeting has happened, but it is only one meeting. No education partners have been contacted on the issue of transgender children. We will face September again and there will be children who cannot live as they wish and go to the schools they wish to attend because they are being actively blocked.

Much has been made of the marriage equality referendum, which was a joyous and tremendous day, but there was also the children’s referendum which took two years for the Supreme Court to clear. That is the lens we also need to be looking at. We need to ensure that our legislation is also looking at that lens. The Government’s national policy framework for children and young people, Better Outcomes, Brighter Futures, is a whole-of-government document, not just one relating to the Department of Children and Youth Affairs. It very clearly sets out that the development of laws, policies and services should take into account the needs, rights and best interests of children and young people. It says that efforts should be made to involve children and young people in policy and decision-making processes. While that is Government policy, we saw in this process that children were excluded from the debate at the pre-legislative scrutiny stage. I have gone over my notes to confirm that. There was no good reason for it. I have gone back over the e-mails and the Acting Clerk of the Dáil has confirmed that they should have been allowed to give testimony at those committee hearings, but were not. We did not allow their voices to be heard, and we should not have done that. Other committees allow children to appear before them.
As I said, the best interests of the child should be our paramount consideration, taking account of the views of the child and the evolving capacity of the child. I proposed an interim gender recognition certificate where everybody is ad idem, that is, the parents, the child and an independent person, be that the Minister, a general practitioner or a court. Obviously, that was not successful. It was brought forward again in the Dáil. That led me to read the debates in the Dáil on Second and Report Stages, in particular. It was noticeable that Members of all parties and none raised the issue of children and the importance of including children in the Gender Recognition Bill. There was one exception, the Labour Party. Its Members did not, so perhaps it is Labour Party policy. I do not understand. I have read through all of the transcripts and no Member from the Labour Party raised this issue. I am still at a loss. The European Region of the International Lesbian and Gay Association gave really compelling testimony before the 29th Human Rights Council. Obviously, it welcomed what we are doing in Ireland but also noted that there was no process for legal recognition of minors under 16 years of age. These children exist and they deserve protection. A parent of a six year old trans girl said: “I just want to keep this child alive. I have a happy child now, why end up with a dead child? It’s important that she gets documents that reflect her gender.”

The difficulty for me, to which I have not received a satisfactory answer, is relevant to the court case S. v. An Bord Uchtála in 2009.  The case involved an intersex child born abroad, who had been registered as female at birth. The judge made an order to allow an amendment of the register of foreign adoptions so that the child’s paperwork would reflect his gender of rearing as a boy and enable him to be enrolled in the local boy’s school. The difficulty is that because this Bill excludes children, are we saying to the courts that we do not want them to interfere or do anything on children? We are closing the door on this. As a legislator, I believe we are sending a clear message to children that we will not talk about gender recognition. That is a problem for me. I am also worried about one of the amendments from the Dáil regarding passports. Again, I have dealt with some cases where children have got their gender changed, not on their birth certificate but on their passport. This amendment will not allow that to happen. Even more children have been squeezed out of this. There are four to five children a year who will not now be able to get a passport in the gender they wish because we have tightened the knot again and really made sure that children are firmly outside the room when it comes to gender recognition.

In conclusion, the Minister for Children and Youth Affairs wrote to the Tánaiste and Minister for Social Protection and proposed written amendments. I appreciate that she did not feel she was in a position to accept those amendments. Is the Minister saying that this is now under the remit of the Minister for Children and Youth Affairs? If it is, I will table amendments to the Children First Bill. This must be made clear because I do not wish to be told when we debate the Children First Bill that it should have been done in the Gender Recognition Bill or that it should be done by the Minister for Social Protection. Will the Minister clearly state whether this is in the remit of the Minister for Children and Youth Affairs? When will the meeting with the education partners take place? I am not asking for an exact date, but a timeframe for when it will take place.

One of the proposals sent by the Minister for Children and Youth Affairs was that we would explicitly state that children and young people would be included in the strategic review. Will the Minister give a firm commitment on that? I do not wish to be told two years hence: “Children are not in the Bill so how can one strategically review children if they are not in the Bill?” I wish to be told clearly that this issue will not be left behind. It is a joyous day for adults, but there are children whom I have met and to whom we have said: “Go sit in the corner; we are not ready to deal with this yet.” In fact, we have slammed the door.


Press Release: New cross-party group seeks greater efforts to counter childhood obesity and food poverty

New cross-party group seeks greater efforts to counter childhood obesity and food poverty

Children's Future Health Launch

A new cross party Oireachtas group set up to seek a more effective policy response to the twin problems of childhood obesity and food poverty was launched in Dublin today.

The Oireachtas Children’s Future Health Group, chaired by Independent Senator Jillian van Turnhout, was launched by RTE presenter Miriam O’Callaghan, along with Irish Heart Foundation spokesman and consultant endocrinologist, Professor Donal O’Shea.

The group is being established amid growing concern across the political spectrum over the health status of children in Ireland at a time when one in four children are overweight or obese and one in five children go to bed hungry at night. The Irish Heart Foundation is providing a secretariat, along with expertise to support the group, which is also being assisted by organisations, including the Children’s Rights Alliance, Healthy Food for All and Social Justice Ireland.

The members of the informal group include: Senator Ivana Bacik (Labour), Deputy Clare Daly (Technical Group), Deputy Billy Kelleher (Fianna Fail), Deputy Sandra McLellan (Sinn Fein) and Deputy Mary Mitchell O’Connor (Fine Gael).

“To date actions to tackle obesity have focused on individual behaviour change through education, awareness and media programmes. But these don’t take into account the key drivers of obesity – the increasing availability and intense marketing of unhealthy food and drinks that are becoming cheaper all the time compared to healthy produce,” said Senator van Turnhout.

“Meanwhile, as the numbers living in food poverty grow, health workers are seeing more and more children who are obese and undernourished at the same time – a phenomenon of modern malnutrition.”

Senator van Turnhout said the objective of the Oireachtas group was to develop proposals for actions which tackle the root causes of childhood obesity – particularly those recognising that childhood obesity and food poverty must be addressed in tandem and that solutions must be primarily targeted at disadvantaged communities.

“The disparity between social classes is demonstrated in the Growing Up in Ireland study which shows that among nine-year-olds, whilst 19% of boys and 18% of girls from professional households are overweight or obese, the rate soars to 29% of boys and 38% of girls from semi-skilled and unskilled households.

“For parents who cannot make ends meet, the worry isn’t feeding their children well, it’s feeding them at all. One recent study shows the cost of a healthy calorie is up to ten times higher than an unhealthy one and it’s high time we woke up to the fact that if we don’t help these families, we are condemning increasing numbers of children to lives dominated by ill-health, chronic disease and ultimately an early grave.”

Specific areas the Oireachtas group will be examining include taxation to fund programmes such as fruit and vegetable subsidies and community food initiatives, school food provision, no fry zones around schools, addressing the impact of low incomes on health eating, food labelling and marketing of unhealthy food and drinks to children. Later this year the group will launch the first ever study on food marketing to children via the Internet and social media, which is currently being carried out for the Irish Heart Foundation.

Professor Donal O’Shea, consultant endocrinologist and member of the Irish Heart Foundation Nutrition Council said: “I see this group as strong cross party support for the full implementation of the Healthy Ireland Framework – ensuring that Healthy Ireland will continue beyond the life of this Government. It is really hard to understand why there has been so little sustained action to tackle obesity to date. It is the number one public health issue facing the developed world in terms of driving diabetes, heart disease, cancer and depression. Doctors are seeing confirmation of this daily even in children with boys and girls in primary school suffering from high blood pressure, high cholesterol, painful joint conditions and rapidly increasing incidence of type 2 diabetes.”

Speaking before the launch of the group, Miriam O’Callaghan added: “Children and their parents are constantly being bombarded by strategies to encourage them to consume more: Product placement in stores, attractive packaging, toys with fast food meals, promotions to buy one-get-one-free, prizes, discounts, supersizing. As a mother I know well how hard it is to resist such marketing and it’s clear that solutions to childhood obesity must address the fact that treat food and drinks are increasingly being consumed as if they were a staple part of children’s diets.”


Media queries to: Caroline Cullen, Communications Manager, Irish Heart Foundation, Main switch: 01-6685001 or Mob: 086-6049282.

Photos taken by Photocall Ireland

Children's Future Health Launch  Children's Future Health Launch

Quarterly Meeting of the Joint Committee on Health and Children and the Minister for Children and Youth Affairs, Dr James Reilly TD

Question submitted in advance by Senator Jillian van Turnhout:

Can the Minister provide an exact timetable for the progress of the  Government’s Adoption (Tracing and Information) Bill and advise what is hampering the progression of the Adoption (Identity and Information) Bill 2014 into the Dáil, following the completion of all stages in the Seanad on 18 February 2015 with support from all parties.

My Department is developing the Heads of the Adoption (Information and Tracing) Bill, and work on the Heads of that Bill is nearing completion. It will set out the information to be provided and circumstances in which it can be provided for past and future adoptions.

Officials in my Department are exploring all options with a view to balancing the needs of all stakeholders in this sensitive and complex and very personal matter. While I want to provide adopted people with as much information as possible about their identity, birth parents’ constitutional right to privacy must also be protected in this legislation.

The Heads will provide access to records for birth parents and adopted persons in so far as is possible in line with legal advices. I am proposing as progressive an approach as is possible within the significant legal and operational complexities which arise in giving effect to this objective.

The proposed legislation will provide for, inter alia,

  • Placing the National Adoption Contact Preference Register on a statutory basis
  • Arranging for the management of Adoption Records
  • Setting out the information to be provided and circumstances in which it can be provided both for retrospective and prospective adoptions.

I know that there are many people affected by adoption who are keen to see this legislation progress at the earliest opportunity, and I share that view. However, I am also concerned that we get it right. This is a complex piece of legislation, which must strike the right balance in respecting the rights of all of those involved. Regular and ongoing contact is maintained between my Department and the Office of the Attorney General in that regard.

It is my intention to have the General Scheme and Heads of Bill finalised as soon as possible and submitted for the consideration of Government, in advance of referral to the Oireachtas Committee on Health and Children.

In parallel, I have requested officials to commence an examination of operational arrangements for the preservation of, and access to, adoption records both to secure existing service provision and to make ready for any proposed new legislation.

The Adoption (Identity and Information) Bill 2014, introduced by Senators Power, van Turnhout, and Healy Eames, was passed by the Seanad on 19th November 2014 and that the draft Bill is at second stage in Dáil Éireann.

My Department has considered the draft Bill and notes that there is much to be commended in the draft Bill and, in relation to the areas of concern that it addresses, it is very much in line with the tenor of the draft Bill being prepared in my Department. On this basis I did not oppose the Bill.  However the Private Members Bill differs from that being prepared by my Department in that it does not differentiate between prospective and retrospective adoptions. In that respect, it does not fully address the complex constitutional issues that arise in relation to the provision of identifying information to those, and about those who were adopted in the past.

The Bill has been fully reviewed as part of the ongoing work of the drafting of the proposed Bill on Adoption (Information and Tracing).


2 July 2015: Quarterly Meeting of the Joint Committee on Health and Children and the Minister for Children and Youth Affairs, James Reilly TD

Question submitted in advance by Senator Jillian van Turnhout:

Given the new Article 42A of the Constitution of Ireland, will the Minister now conduct a law audit relevant to children to determine where gaps exist in full implementation of the United Nations Convention on the Rights of the Child and bring in a comprehensive Children’s Rights Bill.

 Article 42A provides an enhanced general visibility for the rights of children under the Constitution.  More generally, the new standard has the capacity to influence the approach to legislation beyond what is required by the letter of the new constitutional provision. The interpretation of the existing statute law is now subject to the new constitutional requirements and this will, no doubt, be reflected in jurisprudence in both public and private law in the years to come.

At the time the wording of the then proposed thirty-first amendment of the Constitution was published by the Government, there was a commitment to bring forward important amendments in adoption law. In order to fully inform consideration by the people of the constitutional change being put forward for their decision, the Government published the General Scheme of a proposed Adoption (Amendment) Bill 2012 which would flow from implementation of the change. With the thirty-first amendment now standing as part of the Constitution, in the form of the new Article 42A, my Department will proceed with arrangements to submit the promised Adoption (Amendment) Bill for consideration by the Oireachtas.

Specifically the amendment sets certain standards relating to determining the views and best interests of children in specified proceedings which both comprehend existing provisions and require that all future legislation must comply in the areas concerned.  The Government has also provided potent examples of this in the inclusion of provisions relating to the views and best interests of the child in the Child and Family Agency Act 2013 and the Children and Family Relationships Act 2015.

My Department has a number of other proposed legislative initiatives in train that aim to promote the rights and welfare of children.  These include the Children First Bill, 2014 to strengthen fundamental aspects of the child protection system which is currently before the Oireachtas; the Child Care Act (Amendment) Bill, to strengthen the legislative provisions for aftercare which is currently being drafted; and   work is continuing on the Heads of Bill for the Adoption (Information and Tracing) Bill.  I also mention in a separate reply to Senator Van Turnhout, that my Department is working on policy proposals for significant statutory reform of provisions relating to Guardians ad litem under the Child Care Act 1991.

I note that there is a major and wide-ranging initiative underway to advance the rights of children on a cross-government basis.  I refer to the on-going implementation of Better Outcomes, Brighter Futures: the National Policy Framework for Children and Young People 2014-2020, which is demonstrably rooted in the values and principles of the United Nations Convention on the Rights of the Child.  These values and principles will continue to guide the implementation and monitoring of Better Outcomes, Brighter Futures.

This universal strategy, covering all aspects of children’s lives, is a challenging and highly-focused whole-of-government undertaking.  Delivery of the 163 commitments set out in the strategy will result in better outcomes for children right across the spectrum of State inter-actions with the child and his or her parents and family. Along with the legislative programme, these are the mechanisms by which the implementation of the UN Convention on the Rights of the Child is being advanced.

A further important underlying process relevant to the question raised concerns the examination of Ireland by the United Nations Committee on the Rights of the Child which is scheduled to take place next January.  This provides a basis for engagement between my Department and other Departments of Government, preparatory to the meeting with the Committee, on issues it will raise regarding the State’s discharge of Ireland’s obligations as a party to the Convention.

2 July 2015: Quarterly Meeting of the Joint Committee on Health and Children and the Minister for Children and Youth Affairs, James Reilly TD

Question submitted in advance by Senator Jillian van Turnhout:

Can the Minister confirm whether the blueprint set out in the 2009 Children Acts Advisory Board Report “Giving a voice to children’s wishes, feelings and interests” for a properly funded Guardian Ad Litem agency in Ireland forms part of the reform promised for the Guardian Ad Litem services in proceedings under the Child Care Act 1991? And can the Minister outline his plans in this area and a timeline for implementation?

 Guardian ad litem services, under the provisions of the Child Care Act 1991, are currently organised and provided on an unregulated and ad hoc basis and, in the absence of extensive and fundamental reform, the service will not be sustainable into the future. The service now incurs an annual spend of over €16 million, and needs to be grounded as a consistent, accountable and sustainable national service. My Department is currently preparing policy proposals to achieve this objective.

A ‘root-and-branch’ reform is envisaged. Work on the policy proposals is being informed by a number of considerations and sources of information, including work done by the former Children Acts Advisory Board. The objective is to put in place a comprehensive legislative basis for the delivery of a high quality and sustainable service, on a national basis.

The reforms must ensure the best interests of the child, the centrality of the courts and the independence of guardians ad litem, but must also put in place a nationally managed service that is cohesive, accountable and sustainable. In Ireland, as in other jurisdictions, the service is subject to increasing demand and finite resources. I am determined to achieve best possible use of the substantial level of funding that has already been allocated to this area.

Reflecting elements identified by the Children Acts Advisory Board, proposed statutory arrangements will aim to address such matters as guidance as to circumstances for appointment, the qualifications that will be required for appointment, a well-defined role and responsibilities for the guardian ad litem, their legal status in proceedings, and legal representation. The reforms will take full account of the importance of listening to the views of children in relation to their own future.

My Department is well advanced in its examination of all aspects of reform of the guardian ad litem service. It aims to have the necessary policy proposals completed as soon as possible and, subject to Government approval for same, to proceed immediately to the preparation of Heads of legislation.



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.