Category: Health and Children

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

Question 9: Registered Nurse Prescribers

Question 10: Cardiac Rehabilitation Services

Question 11: Neuro-Rehabilitation Services

Question 9: Registered Nurse Prescribers

To ask the Minister for Health the reason for the HSE policy that Registered Nurse Prescribers who work in private healthcare facilities including nursing homes are not issued with prescription pads; if he would agree that this discriminates against qualified registered nurse prescribers working in private facilities and may impact on patient care by preventing timely symptom relief for residents with medical cards living in private and voluntary nursing homes where access to a GP may not be immediately available; and if he has plans to ask the HSE to change this?

Professional guidance is already in place with regard to scope of nursing and practice and specifically in relation to nurse/midwife medicinal product prescribing. Nurse/midwife medicinal product prescribing has been in place in Ireland since 2007 underpinned by (a) legislation, and (b) the NMBI regulatory framework. There are currently 650 registered nurse prescribers.

The issue in question is the requirement for access for nurse prescribers in private nursing homes to primary care prescription pads for the purposes of GMS reimbursement for medical card holders. This is a matter primarily for the HSE to determine.
The Department supports, in principle, nurse prescribers in private nursing homes having access to primary care prescription pads, subject to robust governance and accountability structures being put in place. The provision of nurse prescribing services in nursing homes would greatly enhance continuity of care from the hospital sector through to the nursing home sector. Medicines legislation currently in place does not differentiate between prescribing by nurse prescribers in public or private setting. Nor does it deal with reimbursement under the Community Drugs Schemes of prescriptions by nurses.
The issue of reimbursement through the Primary Care Reimbursement Service (PCRS) is a matter that will be progressed through engagement with the HSE by the Primary Care Division in this Department.

Question 10: Cardiac Rehabilitation Services

In light of Irish Heart Foundation and Irish Association for Cardiac Rehabilitation survey showing serious staffing deficits in cardiac rehabilitation services in all hospitals providing this service nationally, is the Minister concerned that these services cannot therefore maximise their life-saving and quality of life-saving capability

Rehabilitation is the phase following acute medical intervention, during which structured approaches to halt or slow progression of the underlying health condition are undertaken and where the patient is enabled to return to an optimal level of physical, psychological and social well-being. Rehabilitation goals focus on recovering lost function and reconditioning, reducing the risk of a recurrent event (secondary prevention) and optimising quality of life. To be effective, rehabilitation must start as soon as the patient is stabilised in the acute medical setting. Rehabilitative care should be integrated across acute, out-patient and community services, to include access to both intensive acute rehabilitation and long-term follow-up.

The development of cardiac rehabilitation services were accelerated under the National Cardiovascular Strategy and the Building Healthier Hearts (BHH) initiative from 2000 onwards. The BHH identified ten recommendations and three implementation measures for cardiac rehabilitation. These recommendations identified the need for a cardiac rehabilitation service in all hospitals that treat patients with heart disease, which would be multi-disciplinary, exercise based and involve family members. During the years 2000 to 2005, €72 million was invested for the development of cardiovascular services in line with the recommendations of Building Healthier Hearts.
The HSE is aware of the findings of the study by the Irish Heart Foundation and the Irish Association for Cardiac Rehabilitation. Cardiac rehabilitation is an important and significant part of the recovery process for patients who have experienced an ischemic event. As the report acknowledges, the number of patients attending cardiac rehabilitation services has significantly increased whilst demand for services has also continued to increase.

The report confirmed that following the expansion of cardiac rehabilitation services under the cardiovascular strategy, most services have many members of the clinical team in place. The report states:

• all services have a medical director in place
• all but two services have a designated rehab co-ordinator with 30 of the 34 services having a full time co-ordinator in place
• the majority of services have access to nursing and dietician services.
• requirement for further focus on integrating psychology services given the important and specialised role such professionals play in the rehabilitation process
• significant gaps in dedicated access to social work and occupational therapy services

It should be noted that where dedicated social work and occupational therapy services are not available to the cardiac rehab team, medical staff within hospitals have the ability to refer patients to the general social work and OT services of the hospital.
Although the report identifies staff cut backs as a significant service issue, the largest category of staff vacancies related to maternity and sick leave. In such cases, staffing returning from maternity or sick leave will resume providing services as part of the cardiac rehabilitation unit and therefore should not be considered a staff cutback. Similarly, the previously invested budget in cardiac rehabilitation services continues as part of the overall hospital budget. There have been no targeted reductions in cardiac rehabilitation budgets and hospitals will continue to manage this and all hospital services in line with their overall budget for 2014.

However, the report does highlight the need for further actions to ensure continuity of cardiac rehabilitation services where important clinical support services are not available for the reasons identified in the report (i.e. maternity leaves, retirements, transfer of staff, etc). Similarly, it is anticipated that demand for cardiac rehabilitation services will continue to grow requiring all units to be able to respond to increased levels of referrals in the future. The National Director of Acute Hospitals will further progress this area over 2014 utilising the findings from the report particularly focusing on required improvements in waiting lists, access to allied health professionals and levels of patient enrolment in programmes. The integration of pathways between cardiology services and referral to cardiac rehabilitation services is also another area which the HSE will focus on to ensure greater levels of access for patients requiring such service. As part of the reorganisation of services in the future, there will be opportunities to develop single site services into larger multi-site services which can share development opportunities and achieve greater economies of scale to the benefit of patients. As an example, the University of Limerick has its Clinical Operations Group currently working to develop a single clinically governed cardiac rehabilitation service that will be available and operate across the acute hospitals in its region.

In parallel, the HSE will also be expanding the range of services available to patients who experience ischemic events through initiatives implemented via the clinical programmes. For example, the National Clinical Programme for Heart Failure aims to reorganise the way heart failure (HF) patients are managed across the health service rolling out a co-ordinated, multi-disciplinary and patient focused disease management programme. The initial focus of this work has been on the creation of dedicated hospital centres where care and expertise in HF is concentrated. The programme also aims to develop appropriate support services for patients to be managed in the community and is currently working on a number of initiatives to advance this. To date structured heart failure services have been implemented in 11 sites under the HSE’s National Clinical Programme for Heart Failure.

Question 11: Neuro-Rehabilitation Services

What progress has been made on the development of the promised implementation plan in relation to the National Policy and Strategy for the provision of Neuro-Rehabilitation Services in Ireland 2011 – 2015?

The National Neuro-Rehabilitation Strategy made a number of recommendations for services for people with rehabilitation needs that covered a range of types of provision including: clinical, therapeutic, social , vocational and community supports.

Following development of the report, the HSE as part of it’s commitment to ensure the optimal care pathway for different Clinical needs, established the Rehabilitation Medicine Programme. The scope of the programme covers the whole of the patient journey from self management and prevention through to primary, secondary and tertiary care. These programmes provide a national, strategic, and coordinated approach to a wide range of clinical services and include the standardization of access to and delivery of, high quality, safe and efficient hospital services nationally as well as better linkages with primary care services. The RMP has almost completed the Model of Care for the provision of specialist rehabilitation services in Ireland which will be the basis for the delivery of services.
Outside of the Clinical Programme, the HSE Disability Services Division has a role in certain key aspects of Neuro-Rehabilitation Services, primarily the provision of community based therapy services, and personal social services, often funded through partner service providing agencies in the non statutory sector. The Disability Services Division is obliged to implement the recommendations of the Value for Money and Policy Review of Disability Services, and will use the recommendations of the VFM report, to focus on Disability funded rehabilitation services and enable reconfiguration of existing provision through the establishment of demonstration sites. Close links will be maintained with the Rehabilitation Medicine Clinical Programme to ensure that there is no duplication of effort and that all initiatives receive optimal support.

Demonstration sites have been identified by Disability Services and mapping has commenced.

The Rehabilitation Medicine Clinical Programme and the HSE Disability Services Division will jointly agree an implementation plan for the Neuro-rehabilitation Strategy, the first draft of which has been completed and is undergoing a process of refinement before finalisation.

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

Question 9: U.N Committee on the rights of the Child report.

Question 10: Special Rapporteur on Child Protection Reports

Question 11 Youth work budget.

Question 9: U.N Committee on the rights of the Child report.

On 16 July 2013, Minister Fitzgerald advised that her Department had finalised and submitted to Government for approval Ireland’s consolidated Third and Fourth State Report to the UN Committee on the Rights of the Child. The submission of this Report, which is already considerably overdue (April 2009), are essential components of Ireland’s international obligation in relation to the review and monitoring process of the UN Convention on the Rights of the Child (UNCRC). Can the Minister provide a definitive answer as to when Government approval will be secured and when the consolidated Reports will be furnished to the UN Committee?

The Government approved a consolidated 3rd and 4th Report in July 2013 and the report was submitted to the on the United Nations Committee on the Rights of the Child, in August 2013.  The report is available on www.dcya.ie and outlines the most significant developments for children and how Ireland has been implementing the main aims of the UN Convention during the period 2006 to 2011 inclusive.

Ireland ratified the UN Convention on the Rights of the Child in 1992. Ireland submitted our second progress report to the UN Committee on the Rights of the Child in 2005. Following the establishment of the Department of Children and Youth Affairs in June 2011, I directed that a substantial progress report, combining the 3rd and 4th reports, to cover the period 2006 to 2011 inclusive should be submitted to the UN Committee on the Rights of the Child.  An Inter-Departmental Liaison Group was established to prepare the report and a draft of the report was completed in December 2012.  This draft report formed the basis of consultations with the NGO sector and subsequently the Children’s Rights Alliance, on behalf of the NGO sector, submitted its observations on the draft to the Department of Children and Youth Affairs.  These observations were considered by my Department in conjunction with other Departments and a draft report prepared for consideration by Government.

With the Report’s submission now complete I look forward to attending a hearing of the United Nations Committee on the Rights of the Child on the report, although the timing of the hearing will be a matter for the UN Committee.  I understand there is currently a backlog of hearings to be dealt with by the Committee.  The hearing when it takes place will provide an opportunity to further bring the Committee up to date on what we have achieved as part of the programme of this Government since 2011.

Question 10: Special Rapporteur on Child Protection Reports

There have been a number of important Reports concerning children over the last number of years. Significant amongst them are the Fifth and Sixth Reports of the Special Rapporteur on Child Protection, Dr Geoffrey Shannon. In each of these Reports, recommendations are outlined to Government to improve the experiences and lives of children in Ireland. In the interests of transparency and accountability, and indeed to facilitate the tracking of said recommendations, will the Minister consider adopting a formal response to the recommendations similar to Ireland’s response to the Working Group Report on the Universal Periodic Review, whereby indication is given to each recommendation as follows: examined and supported; to be examined and responded to in due time; not supported? And, will the Minister ensure that implementation mechanisms and timelines are developed and published as part of the formal response to each Report’s recommendations?

There have been a number of important reports concerning children published over the last number of years, among them are the reports of the Special Rapporteur on Child Protection and, significantly, the report of the Commission to Inquire into Child Abuse (referred to as the Ryan Report) published in May 2009. Currently the monitoring mechanisms vary between no formal mechanism, once off responses or annual monitoring.

The Special Rapporteur on Child Protection is appointed by the Government and his recommendations are relevant to a number of Government Departments and Agencies. The reports of the Child Protection Rapporteur are circulated to all relevant Departments and it is a matter for individual Departments to take the appropriate action on any recommendation relevant to its work. Where recommendations are proper to the DCYA they form part of the process of policy development and, if appropriate, are incorporated within the Department’s business planning process.

The most formal response to a report is that of the Implementation Plan in response to the Ryan Commission Report, which was published in July 2009. The Plan sets out a series of 99 actions to address the recommendations in the Ryan Report, and includes additional proposals considered essential to further improve services to children in care, in detention and at risk. The Government committed to implementation of the Plan. The 99 actions identified in the Implementation Plan are the responsibility of a number of Government Departments and Agencies.  I, as Minister for Children and Youth Affairs, have had the responsibility for overseeing the implementation of the actions set out in the plan.  I chair a high level monitoring group with representation from the Department of Education and Skills, the Irish Youth Justice Service, the HSE, the Gardaí, the Children’s Rights Alliance and my Department. Three Progress Reports have been published so far and the final Progress Report is due at the end of this year.

My Department is currently preparing a monitoring framework for higher level oversight of recommendations from all significant child care reports, which is intended to be put in place following the completion of the formal monitoring process for the Ryan Commission Implementation Plan. In this regard the intention is to review current monitoring and reporting mechanisms, with a view to capturing all relevant recommendations and streamlining progress reporting, to provide effective and sustained implementation of recommendations.

My Department has also commissioned independent research on the extent to which previous reports have influenced policy and practice.  This research also identifies learning as to how to improve the influence and usefulness of recommendations made in such reports.  It is my intention to publish this research as I believe it will be of general interest and particularly useful to anyone engaged in conducting reviews or investigations in the future.

Question 11 Youth work budget.

 To ask the Minister for Children and Youth Affairs to share with the Committee the discussions her Department had with the Department of Public Expenditure and Reform concerning the budget for youth work in the next round of the Comprehensive Review of Expenditure from 2015-2017. Did the Minster emphasise the disproportionate cuts to youth work in the overall budget adjustments for her Department in the last round from 2012-2014, and also will the Minister give details of when youth work organisations will receive details of funding for 2014 following the budget on October 15th?

 Officials of my Department have met with representatives of all the national organisations that are funded under the Youth Service Grant Scheme to share information and to hear from the organisations about the impact of the reductions in funding on the services that they provide. I have met with and continue to meet with, many youth projects and groups to try and see how we can work together to minimise the impact of these necessary savings in order to ensure that the provision of quality youth services to young people is sustained in these challenging times.

 Funding requirements and how resources should be prioritised and allocated across each area of Government spending are generally considered as part of the annual estimates cycle and budgetary process.  I am sure the Senator will appreciate that it would be inappropriate for me to comment at this time on any decisions that may be taken by Government in the context of Budget 2014.  The Committee can be assured that the benefits of youth work have been fully considered as part of my Department’s input to Budget 2014.  As soon as Budgetary figures are available my Department will assess the implications for youth funding and engage with the sector in planning the approach to 2014.  It would be my hope that the earlier timing of the Budget will allow for the notification of allocations to be brought forward so that they can take place prior to the commencement of the year.

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

Question 9: Registered Nurse Prescribers
Question 10: Cardiac Rehabilitation Services
Question 11: Neuro-Rehabilitation Services 

Question 9: Registered Nurse Prescribers

To ask the Minister for Health the reason for the HSE policy that Registered Nurse Prescribers who work in private healthcare facilities including nursing homes are not issued with prescription pads; if he would agree that this discriminates against qualified registered nurse prescribers working in private facilities and may impact on patient care by preventing timely symptom relief for residents with medical cards living in private and voluntary nursing homes where access to a GP may not be immediately available; and if he has plans to ask the HSE to change this? 

Professional guidance is already in place with regard to scope of nursing and practice and specifically in relation to nurse/midwife medicinal product prescribing.  Nurse/midwife medicinal product prescribing has been in place in Ireland since 2007 underpinned by (a) legislation, and (b) the NMBI regulatory framework. There are currently 650 registered nurse prescribers.

The issue in question is the requirement for access for nurse prescribers in private nursing homes to primary care prescription pads for the purposes of GMS reimbursement for medical card holders. This is a matter primarily for the HSE to determine.
The Department supports, in principle, nurse prescribers in private nursing homes having access to primary care prescription pads, subject to robust governance and accountability structures being put in place. The provision of nurse prescribing services in nursing homes would greatly enhance continuity of care from the hospital sector through to the nursing home sector. Medicines legislation currently in place does not differentiate between prescribing by nurse prescribers in public or private setting. Nor does it deal with reimbursement under the Community Drugs Schemes of prescriptions by nurses.
The issue of reimbursement through the Primary Care Reimbursement Service (PCRS) is a matter that will be progressed through engagement with the HSE by the Primary Care Division in this Department.

QUESTION 10: CARDIAC REHABILITATION SERVICES

In light of Irish Heart Foundation and Irish Association for Cardiac Rehabilitation survey showing serious staffing deficits in cardiac rehabilitation services in all hospitals providing this service nationally, is the Minister concerned that these services cannot therefore maximise their life-saving and quality of life-saving capability 

Rehabilitation is the phase following acute medical intervention, during which structured approaches to halt or slow progression of the underlying health condition are undertaken and where the patient is enabled to return to an optimal level of physical, psychological and social well-being. Rehabilitation goals focus on recovering lost function and reconditioning, reducing the risk of a recurrent event (secondary prevention) and optimising quality of life. To be effective, rehabilitation must start as soon as the patient is stabilised in the acute medical setting. Rehabilitative care should be integrated across acute, out-patient and community services, to include access to both intensive acute rehabilitation and long-term follow-up.

The development of cardiac rehabilitation services were accelerated under the National Cardiovascular Strategy and the Building Healthier Hearts (BHH) initiative from 2000 onwards. The BHH identified ten recommendations and three implementation measures for cardiac rehabilitation. These recommendations identified the need for a cardiac rehabilitation service in all hospitals that treat patients with heart disease, which would be multi-disciplinary, exercise based and involve family members. During the years 2000 to 2005, €72 million was invested for the development of cardiovascular services in line with the recommendations of Building Healthier Hearts.
The HSE is aware of the findings of the study by the Irish Heart Foundation and the Irish Association for Cardiac Rehabilitation. Cardiac rehabilitation is an important and significant part of the recovery process for patients who have experienced an ischemic event. As the report acknowledges, the number of patients attending cardiac rehabilitation services has significantly increased whilst demand for services has also continued to increase.

The report confirmed that following the expansion of cardiac rehabilitation services under the cardiovascular strategy, most services have many members of the clinical team in place. The report states:

· all services have a medical director in place
· all but two services have a designated rehab co-ordinator with 30 of the 34 services having a full time co-ordinator in place
· the majority of services have access to nursing and dietician services.
· requirement for further focus on integrating psychology services given the important and specialised role such professionals play in the rehabilitation process
· significant gaps in dedicated access to social work and occupational therapy services

It should be noted that where dedicated social work and occupational therapy services are not available to the cardiac rehab team, medical staff within hospitals have the ability to refer patients to the general social work and OT services of the hospital.
Although the report identifies staff cut backs as a significant service issue, the largest category of staff vacancies related to maternity and sick leave. In such cases, staffing returning from maternity or sick leave will resume providing services as part of the cardiac rehabilitation unit and therefore should not be considered a staff cutback. Similarly, the previously invested budget in cardiac rehabilitation services continues as part of the overall hospital budget. There have been no targeted reductions in cardiac rehabilitation budgets and hospitals will continue to manage this and all hospital services in line with their overall budget for 2014.

However, the report does highlight the need for further actions to ensure continuity of cardiac rehabilitation services where important clinical support services are not available for the reasons identified in the report (i.e. maternity leaves, retirements, transfer of staff, etc). Similarly, it is anticipated that demand for cardiac rehabilitation services will continue to grow requiring all units to be able to respond to increased levels of referrals in the future. The National Director of Acute Hospitals will further progress this area over 2014 utilising the findings from the report particularly focusing on required improvements in waiting lists, access to allied health professionals and levels of patient enrolment in programmes. The integration of pathways between cardiology services and referral to cardiac rehabilitation services is also another area which the HSE will focus on to ensure greater levels of access for patients requiring such service. As part of the reorganisation of services in the future, there will be opportunities to develop single site services into larger multi-site services which can share development opportunities and achieve greater economies of scale to the benefit of patients. As an example, the University of Limerick has its Clinical Operations Group currently working to develop a single clinically governed cardiac rehabilitation service that will be available and operate across the acute hospitals in its region.

In parallel, the HSE will also be expanding the range of services available to patients who experience ischemic events through initiatives implemented via the clinical programmes. For example, the National Clinical Programme for Heart Failure aims to reorganise the way heart failure (HF) patients are managed across the health service rolling out a co-ordinated, multi-disciplinary and patient focused disease management programme. The initial focus of this work has been on the creation of dedicated hospital centres where care and expertise in HF is concentrated. The programme also aims to develop appropriate support services for patients to be managed in the community and is currently working on a number of initiatives to advance this. To date structured heart failure services have been implemented in 11 sites under the HSE’s National Clinical Programme for Heart Failure.

Question 11: Neuro-Rehabilitation Services 

What progress has been made on the development of the promised implementation plan in relation to the National Policy and Strategy for the provision of Neuro-Rehabilitation Services in Ireland 2011 – 2015? 

The National Neuro-Rehabilitation Strategy made a number of recommendations for services for people with rehabilitation needs that covered a range of types of provision including: clinical, therapeutic, social , vocational and community supports.

Following development of the report, the HSE as part of it’s commitment to ensure the optimal care pathway for different Clinical needs, established the Rehabilitation Medicine Programme. The scope of the programme covers the whole of the patient journey from self management and prevention through to primary, secondary and tertiary care. These programmes provide a national, strategic, and coordinated approach to a wide range of clinical services and include the standardization of access to and delivery of, high quality, safe and efficient hospital services nationally as well as better linkages with primary care services. The RMP has almost completed the Model of Care for the provision of specialist rehabilitation services in Ireland which will be the basis for the delivery of services.
Outside of the Clinical Programme, the HSE Disability Services Division has a role in certain key aspects of Neuro-Rehabilitation Services, primarily the provision of community based therapy services, and personal social services, often funded through partner service providing agencies in the non statutory sector. The Disability Services Division is obliged to implement the recommendations of the Value for Money and Policy Review of Disability Services, and will use the recommendations of the VFM report, to focus on Disability funded rehabilitation services and enable reconfiguration of existing provision through the establishment of demonstration sites. Close links will be maintained with the Rehabilitation Medicine Clinical Programme to ensure that there is no duplication of effort and that all initiatives receive optimal support.

Demonstration sites have been identified by Disability Services and mapping has commenced.

The Rehabilitation Medicine Clinical Programme and the HSE Disability Services Division will jointly agree an implementation plan for the Neuro-rehabilitation Strategy, the first draft of which has been completed and is undergoing a process of refinement before finalisation.

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ORDER OF BUSINESS, 15 JANUARY 2014

I, too, wish everyone a happy new year. 
 
I warmly welcome the establishment of the Child and Family Agency and was surprised to learn this morning that it was to be branded with the new name Tusla, which apparently is a completely new word reflecting a shared desire for a new beginning and forging a new identity.  I wonder why we cannot call things what they are.  Why must we make up a word in order to brand the agency? 
 
On the Child and Family Agency, the good news is that at the Joint Committee on Health and Children I established with the Minister for Health that no historic deficit will be transferred to the new agency.  However, that is where the good news ends.  The agency has a budget of €545 million.  We established yesterday that the budget does not meet the anticipated costs for 2014 and we are not giving the agency a fighting chance.  It has not even got off the starting line.  There is an agency that is to herald a new start with a €545 million budget and we are not giving it a fighting chance.  In parallel, there is Irish Water where several Ministers and officials have defended, and even supported, the establishment costs which, according to the briefing document of September 2012, are €180 million.  Establishment costs are important.  The Child and Family Agency got zero for establishment costs.  It has no start-up budget.  Its funding is not sufficient.  No doubt it will have a deficit this year.  Are we throwing out the baby with the bath water?  I would ask that the Minister for Children and Youth Affairs clarify what is the budget, where are our priorities and will we wait until January next year when we will have a furore over what happened in the Child and Family Agency.

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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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Oireachtas Health and Children Committee – Cystic Fibrosis Unit

13th December 2012

Part 1

One of my reasons for requesting the meeting today was because we are all very aware of the stress and distress of the patients from the media reports. I understood that the purpose of today’s meeting was to restore confidence. I do not have that confidence. I am reading the statement signed by the witnesses and the Cystic Fibrosis Association that states clearly: “1-2 in-patient rooms in the Nutley Wing will be kept available at all times for emergency admissions. In circumstances where the emergency admission rooms have already been utilised and all the other in patient rooms in the Nutley Wing are occupied, patients with Cystic Fibrosis will be accommodated elsewhere in clinically appropriate single rooms until such time as a room becomes available in the Nutley Wing and then the patient will be transferred there as a priority.” I am not hearing that today. In his Budget Statement last week the Minister for Health, Deputy James Reilly, said 34 beds is 34 beds. That is not what we are hearing.

Part 2

Professor Gallagher made a very clear statement that the 14 beds should be allocated in the same place. I do not have all the clinical terms. This is my understanding of reading an agreement about 20 beds being flexed up to 34. Everybody would know where these 14 are. I would like a commitment to work towards allocating the 14 beds and to examine structurally how to allocate them. I know the witnesses cannot state they exist now, but can we get a commitment this is what will be worked towards so the statement issued will live up to what it states?

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Joint Committee on Health and Children – World Prematurity Day 2012: Discussion with Irish Premature Babies Organisation

22nd November 2012

The report, Too Little, Too Late?, states that we do not have a national neonatal health policy and criticises the fragmented implementation of policy and the significant disparities across the country. I ask the witnesses to elaborate on this geographical lottery. This brings me to the issue of the transport service. I am trying to understand the precise nature of the obstacles. I see that the service is available on a nine to five basis, seven days per week but logic tells us that babies do not always arrive during office hours. What are the obstacles to a 24 hour service?

I ask for more information on the other supports available to families. I have been working on the issue of pre and post-natal depression, which affects between 10% and 20% of women. They are being told that they have to wait nine months before they can get the appropriate services but this is a critical time for bonding with their children.

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Joint Committee on Health and Children – Youth Issues: Discussion with Comhairle na nÓg

22nd November 2012

Part 1

I thank the delegates for packing so much into their presentation. I refer to the issue of sexual health. I think the presentation emphasised sexual health over sexual relationships. My husband is Dutch and in the Netherlands much time is devoted to relationship education and awareness. Is it the case in schools that the word “sexual” makes everybody wary of dealing with this matter? Should the emphasis not be more on young people developing relationships of which sex is one aspect? I note the point about access to STI clinics. Are there issues with regard to parental consent for children and young people to access information? Is there a role for youth cafés or other spaces to allow services to be provided in a more informal setting?

I was privileged to attend the showcase organised by Comhairle na nÓg and I applaud the work of the comhairlí on the issue of mental health. I refer to the various media campaigns about youth mental health issues. I ask how awareness can be increased, because we are all agreed this is necessary.

Part 2

My point is to build on that. There is also a role for adults. We are giving one message to children about Facebook and Twitter. When adults do not act appropriately on these sites, however, we deal with it differently. We have to take on our responsibility as role models in how different social networking sites are used.

While I agree on the point of the importance of education, there is also a huge power in young people telling their peers how they deal with being trolled and that it is okay to ignore it. It can give young people solidarity that they are not alone in being trolled. When one is in a difficult situation in life and realises one is not on one’s own, it makes it easier to get through it.