HEALTH, DISABILITY and SPORT
Each speech listed here is an edited speech. If you'd like to see the speech or debate in full, please go to the Oireachtas website and click on "Seanad Eireann" and then "Seanad Debates" and click on the relevant date as listed with each speech on this page.
ALCOHOL – Drink Driving Limit (24/04/08)
Portlaoise Hospital Report (06/03/08)
Emergency Contraception (27/02/08)
HSE (26/02/08)
Health (Miscellaneous Provisions) Bill 2007 (19/12/07)
Motion of No Confidence in Minister for Health (28/11/07)
Pharmacist Negotiations and Pricing (22/11/07)
Cancer Services - HSE (20/11/07)
GAA and GPA - Players' Grants (14/11/07)
Hospital Hygiene (13/11/07)
Health Services and the HSE (08/11/07)
Health Services and the HSE (07/11/07)
Haemochromotosis (30/06/06)
Stem Cell Research (29/06/06)
National Sports Campus Development Authority Bill (27/06/06)
OECD Report on Health Services (27/06/06)
Public Hospital Lands and Consultants (31/05/06)
Accident and Emergency Services (09/05/06)
Recommendations of Lourdes Hospital Report (04/05/06)
Screening for Hearing Disabilities in Newborn Babies (06/04/06)
Cancer Services (23/03/06)
Cancer Services (22/03/06)
Lourdes Hospital Enquiry (09/03/06)
Medical Council (23/02/06)
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ALCOHOL – Drink Driving Limit
24/04/08 - We need to discuss the matter of the report on alcohol sales. I would like to hear more about two issues related to it. One is the proposal to reduce the duty on drinks containing lower levels of alcohol, such as beers with an alcohol content of 3%. The other issue on which we need to hear more is the impact of reducing the drink driving limit from a blood-alcohol level of 80 milligrams to 50 milligrams. Are there statistics to prove that reducing the limit from 80 milligrams to 50 milligrams would make a significant impact on reducing the number of road deaths or injuries suffered in road traffic accidents? I have not seen those figures. I have asked for them previously.
I understand this is a political issue. I do not want us to rush into a political decision that will cause further chaos in rural Ireland unless we have to. If we have to do it, then we should, but we should have the figures. Usually when figures are produced on the number of people involved in accidents involving drink driving, the blood-alcohol level of those involved is much higher than 80 milligrams. The effort, money and time being put into reducing the level from 80 milligrams to 50 milligrams might result in the saving of many more lives if it was put into BreastCheck or increasing the availability of other cancer diagnostic elements throughout the country.
I would like to have a full, honest and balanced debate on this issue. If we have to reduce the drink driving limit, I will support it, but I want to see the figures to back up the case for doing so.
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Portlaoise Hospital Report
06/03/08 - Looking at it (the Portlaoise report) from a disinterested point of view in terms of trying to take the patient and emotion out of it, extraordinary questions must be asked on both sides of the House about the process. This is not a matter solely for the Opposition benches. I do not want to make this into a political issue. However, I want to know how the risk register was applied to Portlaoise hospital. What was supposed to be happening there and what was not? What were the key performance indicators required for that area? I want to know if people’s bonuses was tied into it. Were there mid-year reviews? How could it happen that people were using out-of-date equipment? Management must take responsibility for that. Someone in management was aware and decided to use out-of-date equipment. We need to know why and who these people are.
I am interested in the Portlaoise case not because it has been dealt with badly but because I want to know about the rest of the system and how it is run. Can we have a discussion on how the health system is run, without referring to any particular hospital, as if we were a board of directors getting a clear description of how it does its business?
In any small operation in the public service — I am involved in several semi-State bodies — at every board meeting there is an outline of which checks and balances were applied every quarter. An outside auditor is brought in to verify the system. Fail-safe measures in the system are tested to check if they are sufficiently robust and flexible.
These are expected in ordinary operations but it does not seem to be happening in the health service. I am not having a go at the Government or advisers. I just want to know what they are doing. The recent higher remuneration report assessed a particular management group in the Health Service Executive and admitted it did not know what they were doing. That cannot be in anyone’s interests. I want a debate on this to ensure moneys are spent properly.
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Emergency Contraception
27/02/08 - In the past 24 hours, there has been a certain amount of debate on the question of access to emergency contraception, also known as the morning after pill. We need to have a proper discussion on that issue to develop a clear understanding of what is available. As far back as 2001, the British Medical Association recommended that the morning after pill be made freely available in pharmacies. That is not the case in Ireland, where people have to get a doctor’s prescription. That requirement appears to be unnecessary and the only reason for it is to avoid encouraging too much sexual activity. Other jurisdictions have addressed the issue by requiring that people of a certain age have to go through, for example, a school nurse to access the pill. Research on the issue by Imperial College London concludes that access to the morning after pill does not impact in any way on sexual activity. It is progressive and safe to allow access and I would like an open debate on the issue with either the Minister for Justice, Equality and Law Reform or the Minister for Health and Children in the interest of making the pill available to people who need it.
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HSE
26/02/08 - I have not been in the habit of making complaints about the HSE because plenty of other people have been doing so. I am interested, however, in the way it does its business and two issues concerning the HSE that arose in the past week are of serious concern to me as a public representative.
In one case, the HSE has pulled its advertising from a radio station which had the cheek and audacity to follow it up on issues where the station felt the HSE was not giving a proper service. Rightly or wrongly, a radio station which has been following up on issues with the HSE, which is what the media is there to do, has had advertising pulled. I would like to hear someone explain that to me as there is something fundamentally undemocratic and wrong about it. I have very little sympathy for the HSE if it is not prepared to take punches and fight back.
Deputy Joe Costello has had a weekly demonstration outside the accident and emergency department of the Mater Hospital for the past four and half or five years to bring attention to certain aspects of the department he feels should be highlighted. He also takes the opportunity each week to speak to patients there. This is a praiseworthy action. It is praiseworthy for an elected public representative to see how the public service gives its service at a local level and is seen to do so. It is good for politics. He has now been told he is not wanted there anymore and that he should not be there. These two issues cause concern for me because of political accountability, what we intended the HSE to do and our relationship with the executive.
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Health (Miscellaneous Provisions) Bill 2007
19/12/07 - I do not know whether I should support or oppose this Bill, and when in doubt, “Vote No” quickly comes to mind.
There are two aspects of the Minister’s speech which seriously concern me. The first is her statement that there are technical drafting issues identified regarding the Medical Practitioners Act 2007. I would like to know how that came to be. ….. The Minister suggests we could be in breach of Article 15.2 of the Constitution, which gives the right to legislate to the Oireachtas. How did this happen? Senator Fitzgerald said that she would like to see the Attorney General’s advice. I would too, but I know there is not the remotest chance of seeing it.
Let me give the Minister the other side of the argument. I do not trust lawyers in this regard. I do not trust lawyers who tell me that we cannot do something by secondary legislation or by regulation. Neither do I trust them when they say we should not have done something by secondary legislation. I have been dealing with legislation for 20 years and like to put my hands in the wounds myself. It is right for the Minister to do what she is trying to do to ensure that matters are brought beyond doubt. She knows that and has the information to come to that conclusion, but I do not.
When I say I do not trust lawyers, I am not being dismissive of the profession. I feel they are used to taking one side or the other and are not much good in the middle. I would like to hear what the advice was, to hear the opposing argument and to come to a conclusion. We are entitled to that in this situation.
I know the hardest thing for a Minister for Health to do. I remember saying to one of the Minister’s predecessors, Deputy Michael Noonan, whom I defended in the House previously, that he should not have taken legal advice in the Mrs. McCole case. This situation is not parallel, but that was a good example of where a politician should strenuously overrule legal advice when not convinced it is necessary.
The Minister has spent as much of her life as I have of mine looking at legal advice and being prepared to throw it in the bin if it seemed incorrect or did not fit the need at the particular time. I am not sure this is not one of those cases. The distinction between secondary legislation such as regulation, statutory instrument, order or whatever is sometimes very fine. If it goes over the line, I like to know why. If it went over the line, somebody in the Department, it is probable that whoever drew up the statutory instrument, not the Attorney General, went beyond his or her authority.
I do not envy the Minister her job. My comments are heartfelt from the perspective of a legislator, but there are issues here that cause grave discomfort to anybody who worries about the process of legislation and regulation and their relationship with the Constitution.
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Motion of No Confidence in Minister for Health
28/11/07 - Perhaps it is the trade unionist in me but I tend to react strongly when I hear calls for people to be sacked. I examine matters such as due process and I regret that we cannot have another debate on it. I would not support a motion of no confidence in the Minister for Health and Children, Deputy Harney. It does not achieve anything and brings us back to what has happened in the House for 20 years. This does not deal with accountability, responsibility and the difference between the two. People do not know who should be held responsible. It is like saying there is a teacher in the west abusing children so we should sack the Minister for Education and Science. That is the level of logic prevailing.
I believe in holding the Minister to account and disagree fundamentally with many of her views. I will continue to debate them. There must be proper due process and a clear understanding of accountability so that when there is a change of Government, the next Minister with responsibility for health, if he or she comes from this side of the House, will not have to put up with the same attitude from the Members who are then in Opposition. It happens all the time. There must be accountability and responsibility and the difference between the two should be understood.
If I could see the risk register for Portlaoise Hospital and the risk register at various levels of the health service I could find out who needs to be brought to book in 20 minutes. If the Minister has not set up structures it is her fault. If she has, and other people are not operating them correctly as seems to be the case, it is the fault of others. If it is not the person at the top, and it need not be, we must find out where are the problems and single this area out for action.
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Pharmacist Negotiations and Pricing
22/11/07 - I support the Minister for Health and Children on the pharmacists matter. While I understand and approve of what the Minister is attempting to achieve, I do not understand what the row is about. The Irish Pharmaceutical Union is not entitled to represent its members to discuss dispensing costs with the Health Service Executive because it would be in breach of competition laws. As I see it, the Competition Authority will sit down with the HSE and the Minister for Health and Children, both of whom have a consumer interest and are required to give fair value. This would protect the consumer. If a discussion among a Department, a State body and the pharmaceutical union about getting the best price for consumers is in breach of the competition legislation then the legislation is an ass and should be changed quickly. If that is the case, the consumer is losing out. I am not putting the case for the pharmacists, as I share the Minister’s point of view on this issue.
I have discovered that pharmaceuticals are placed at different wholesale prices from country to country. This continues almost 50 years after we began to establish the so-called common market. The EU Commissioner responsible for the Internal Market, Mr. Charlie McCreevy should examine this issue. We are being hammered at least in part because of the high wholesale cost of pharmaceuticals based on a price determined by the pharmaceutical companies. I believe it breaches European legislation and it is certainly in breach of the Treaty of Rome. I would like us to consider whether the competition authority legislation protects the consumer and examine the European competition legislation which seems to go against the principles of the common market.
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Cancer Services - HSE
20/11/07 - I support what the Minister is doing in terms of centres of excellence and the cancer strategy, but I have many codicils. I became a Member in 1987 and, during my first week, I lunched with Barry Desmond, who had just finished his tenure as Minister for Health. He expressed his rage when discussing his problems in closing hospitals. …. I remember the Minister for Enterprise, Trade and Employment, Deputy Martin, being in deep trouble for the appalling nursing homes mess. …. I remember Deputy Noonan ten years ago, who I refer to because these people were at the centre of media demonisation. When Minister for Health, Deputy Noonan made a mistake in terms of the advice he received in respect of the Mrs. McCole case, but that did not take from my admiration for him as a Minister and what he was trying to do against all sorts of odds.
I have heard it all when it comes to people having a go at Ministers and it is occurring in the case of the current Minister, Deputy Harney. I admire her work, but I disagree fundamentally with some of her issues, which I will put on the record as I proceed. Let us begin with the role of Professor Drumm. I do not know Professor Drumm’s policy, but we passed legislation that requires him to take on board the Government’s policies and objectives. We demand that Professor Drumm be available to give an account of the general administration of the health services to an Oireachtas joint committee. I disagreed with this set-up then and I disagree with it still. Chief executives should be allowed have a view, say what they believe and drive policy as well as implement it.
I was delighted Senator Fitzgerald raised the issue of governance, accountability and responsibility. It is the height of nonsense to blame the Minister or the chief executive of the HSE when a hospital cannot be kept clean. Senator Fitzgerald is correct that there should be risk audits in hospitals to ensure they are kept clean. If they are not, someone in the hospital must be accountable and action should be taken.
It is unacceptable for a consultant who found dirty equipment at Portlaoise Hospital to claim the answer was to write a letter to the Minister. What do they do about dirty hypodermic needles? Do they write a letter about that? My view on this case is simple. They should have stopped using the equipment there and then and made someone deal with it.
Last week on radio, the Minister said she hoped to conclude the contract with the consultants by the end of the year, only for that to be contradicted an hour later by the consultants claiming that under no circumstances would it be finished by then. I want to hear more about this development.
I disagree fundamentally with the Minister, in principle and in practical terms, on bilocation. In practical terms, it is duplication. I believe consultants do a fabulous job and I am a great admirer of them. They are entitled to every penny they earn and I do not begrudge them a shilling of it. However, I want the world to know they earn their money using, at no charge to them, our hospitals, our beds, our nurses and our equipment. This is where I disagree with the Minister — I would make them pay for these services. Instead of building a second hospital on the one site, I would put a value on existing hospital services and let the consultants pay for them. I accept the Minister’s plausible argument that bilocation releases more beds. However, it must be recognised that consultants are using State equipment paid for with taxpayers’ money.
The levels of administrative staff in the health services is an issue constantly raised in the House. Not one Member wants to see consultants answering the telephone or scheduling their diaries, and there must a certain level of administration. The comments made by it (review body on higher remuneration) on extra people in senior management in the HSE are troubling. If the HSE could not come to a conclusion as to what some of its senior management are doing, it must be reviewed. In the change from the health boards to the HSE, there was a need to accommodate many people. Like what happened elsewhere, they either had to be bought out, paid off or given jobs. There is some element of duplication but that does not mean people should not be working.
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GAA and GPA - Players' Grants
14/11/07 - The matter of the GPA and GAA has been raised on a number of occasions in the past two weeks. I have hesitated to become involved in the matter and should declare an interest, in that I am part of the negotiating team dealing with the GPA on behalf of the GAA. The GAA and the GPA reached an agreement, of which I was part, and signed off on it more than one year ago. That agreement was brought to the Minister for Arts, Sports and Tourism prior to the election but it was not acceptable to his Department. We went back to the drawing board with the GPA and Dessie Farrell, myself and a few others hammered out another agreement which was signed off on. There is complete agreement on both sides and once again the agreement was brought to the Department of Arts, Sport and Tourism. To some extent, it was not acceptable to the Department.
There is no disagreement between the GPA and the GAA. They are in full agreement that this should be administered by the Sports Council. The Sports Council is a creature of Government and, therefore, it depends on Government to make it work. Any difficulties are minor. This merely needs political will and a decision at a high level to make it work. I believe the Minister, Deputy Brennan, is supportive of the idea but somebody needs to call the shots which is all that is required at this stage. That is the official position.
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Hospital Hygiene
13/11/07 - I wish to raise the hygiene issue. I would like to see a debate on that. I have a very different view on this matter than that of the Opposition in general. I am too long in the House to get sucked into blaming Ministers for everything that goes wrong and do not want to call for the resignation of a Minister or chief executive because staff cannot keep their hospitals clean. We should be clear that there are different levels of accountability and responsibility. Over the weekend, in the belief that we would be discussing the health service this week, I re-examined the Health Act 2004. I would recommend to Members to read what we all supported when it was enacted.
I object to one line in the Act pertaining to the appointment of a chief executive: “In carrying out duties under this section, the chief executive officer shall not question or express an opinion on the merits of any policy of the Government or a Minister . . .” For ten years, I have been saying the inclusion of this line in legislation is a disgrace. There is no point in politicians from either side of the House criticising a chief executive who does the Minister’s bidding if that chief executive is not allowed to contradict the Minister. The role of the chief executive is outlined in the Act and we therefore require clear thinking. Where there is a requirement to be responsible, let us demand that it is met, and where there is a requirement for accountability, let us demand it. Where hospitals are not being kept clean and where consultants are using dirty equipment and appeasing their consciences by writing a letter to the chief executive, I would expect a bit more. Let us have accountability at every level in the hospitals.
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Health Services and the HSE
08/11/07 - The House should discuss the health service. We should start by examining the legislation which established the Health Service Executive … to examine the question of accountability. We should also examine the issue of responsibility. It would make for a more serious debate if Senators knew who is responsible and who is accountable and what is the difference between responsibility and accountability. Unfortunately, as I have observed over the past 20 years, attitudes quickly change depending on which side of the House Senators sit. We must be able to understand the structure in place and identify who is responsible for what. As I indicated yesterday, the Health Service Executive was established because we did not want political interference in the health service. However, once political interference is removed, we are inclined to demand political responsibility. We cannot have it every way. We must decide what we want in this regard. Let us re-examine the legislation.
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Health Services and the HSE
07/11/07 - I am loath to get involved in a blame game, but we must examine the matter seriously. Benchmarks should be put in place in terms of what we expect from the health service and objectives for waiting lists, accident and emergency queues and cancer care should be set out during the next two years. People should be given one year to do what is expected before they reappear before the House to determine whether they have delivered. We should support or criticise them depending on whether things get done.
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Haemochromotosis
30/06/06 - A former Member of the House, Maurice Manning, recently published a report on behalf of the Irish Haemochromotosis Association which contained a series of recommendations on screening people for this condition, which is quite debilitating. I would welcome an opportunity to discuss this report and to hear the views of the Tánaiste and Minister for Health and Children on the implementation of the report’s recommendations. The group that compiled the report was, in fact, set up by the Tánaiste.
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Stem Cell Research
29/06/06 - A reasonable argument has been put forward on an issue. ……This is a matter of extraordinarily serious consequence and I accept that people hold different views. I suspect that views differ on both sides of the House. …. people should discuss it seriously and should consider all the views.
Members have seen the suffering that has come to families which cope with Alzheimer’s disease, Parkinson’s disease and a range of other issues. While I neither know nor purport to put forward the answers in this regard, apparently such conditions may be alleviated to some extent by stem cell research. I also understand that people have different views …. in respect of the difference between embryonic stem cells and adult cells. I am not familiar with the various arguments for and against such research.
However, this is absolutely crucial. ….. This is a major issue and while it sits in the ether, ordinary people will be led down the garden path. Perhaps they will go to quacks who do not know anything about it and purport to provide treatment which will not be effective at all. This issue must be regulated and co-ordinated.
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National Sports Campus Development Authority Bill
27/6/2006 - I must congratulate the Minister and his officials on the legislation, which I very much welcome. It is most important that this is focused on professionals, amateurs and the general public. If we are to get value from involvement in sport this legislation should bring about better quality of life and a greater appreciation and love of living which comes from sport. In terms of a centre of excellence, one of the problems is that we do not encourage sport early enough. If I was to take an oppositional line on this and recall what has happened in the past ten years, we have gone backwards, in terms of international success, although we are starting to come back again.
The biggest single influence on Irish sporting activity and achievement is the weather. We need all-weather access to sports facilities and we are very slow to recognise that. Senator Mansergh mentioned horse racing, for which there is a great love throughout Ireland. However, we do not have an all-weather racing track, although one is being built in Dundalk; the sooner it is completed, the better. One is not enough, however, for an industry that is so central to many aspects of Irish life and agri-industry, and we should have been on the ball much earlier.
I raised with the Minister before my belief that Ireland should be the European home of sailing. If counties were equipped with marinas, particularly along the west coast, it would bode well for that particular sport. This is an area that should be examined, getting people into the water, including the inland waterways. Fishing is an area in which there is continuing development. It is one of the mass sports in Ireland at the moment. I saw the figures involved recently and they were very high.
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OECD Report on Health Services
27/06/2006 - The report on the health service is really agitating people around the country. The Tánaiste and Minister for Health and Children, Deputy Harney, stated that this report was based on out of date information and the author of the report stated that the Department refused access to information. Somebody must answer for that. It is quite appalling. To the disinterested observer looking at this calmly and unemotionally, we cannot just accept that decision and we should know who took it.
The other issue to be noted from the report, apart from Ireland’s appalling results, is that the authors stated quite clearly that in their view the position of public and private sectors working together was the wrong way to go. That supports what the Tánaiste is trying to achieve and she should just go ahead and do it. Second, direct access to consultants was dealt with quite clearly in the report. If we are to use this report, let us use it positively and also ask the questions, move matters forward and get the results we seek.
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Public Hospital Lands and Consultants
31/05/06 - My opposition had been on the basis that something was to be given away to the private sector. I shared the view …..that this was completely unacceptable. Where does this leave me? I accept the point she (Tánaiste) clearly made to the House to the effect that not a square inch of public land will be given away and that any land to be used for private purposes will be sold or leased at the going rate. I appreciate that and it changes matters significantly.
That said, I still do not like this development. Having listened carefully to the arguments put forward by the Tánaiste, her position is logical. Nevertheless, I do not see why it must be on land which is available at present in hospitals. ……… the private sector should look after its own business. However, I do not object to private investment in the health services, if that is what people want. I object to taxpayers’ money subsidising it in any way.
I have been infuriated by the idea that up to the present, certain public beds owned by the State in public hospitals were under the control of private consultants. If I was obliged to make a choice between that practice and the Tánaiste’s proposals, I would prefer the latter. The idea that there is an empty bed in a hospital which the hospital authorities cannot assign to anyone because it is under the control of a consultant is one of the reasons why I believe the consultants’ contracts should be changed completely.
This measure should be fitted together with the renegotiation of the consultants’ contracts. Enough money should be paid to new consultants to attract the best people possible into the public health service. If only one of these measures is adopted, Members will be supporting the introduction of a two-tier system.
However, I have seen such a system work in other countries where the consultants in public hospitals were being paid at a rate that attracted the very best people who wanted to stay in well-paid secure employment where they could give a good service. The amount of money offered is insufficient to allow this to happen. We should move all those on existing consultant contracts to the private sector, where they can grow old, doing that business. Let us attract new energetic enthusiastic and ambitious consultants into the public health service and give us back the beds we own.
If public lands are given away to private interests I strongly support the point made by Opposition parties. It is our duty to ensure this does not happen. However, the suggestion that this is a cost effective manner of releasing or producing an additional 1,000 beds in the public sector is an attractive proposition. It will only work if it is matched by consultants of quality.
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Accident and Emergency Services
09/05/06 - I listened to the debate since it began and it is like every other debate I have heard on this issue, in that it is a constant rehearsal of the problems with few solutions offered. I will probably do more of the same. In my view, the Tánaiste is as committed to this as anybody has ever been. Whatever the problems are, they certainly have not been resolved. Simply politicising them does not help our case.
We could and should do certain things which we have not done. The consultants’ contract has not been dealt with. My view is that the Tánaiste has not offered enough money. I stated before that I would offer them more than €300,000 to be available, to work the appropriate number of shifts and to make progress. I would tell the consultants we would protect their contract for as long as they wanted to keep it. I am certain we can afford to pay that amount of money to consultants. Even though it would be less than what they may earn in the private sector, by the time the cost of running an office is removed and the importance of a pension is added, it becomes an extremely attractive proposal.
I would resolve those issues by taking decisions and progressing in a way that protects the consultants. We must recognise they are under an agreed contract. The only way to deal with it in HR terms is to recognise, acknowledge and respect that contract and allow the consultants to have it for as long as they wish. We must negotiate a new contract for new people. Decisions must be made on that basis.
What discussion has taken place with the unions and the organisation representing all of the other groups working in those services? My understanding, and I may be wrong because it is based on anecdote rather than on official information, is that no real negotiations or discussions have taken place on how to do this. Until we can operate a system where all of our assets are operational and available for at least two shifts a day we will never deal with the issue. That must be done.
The Tánaiste is correct when she states it is not only about money. At the same time, she should qualify that by stating more funding is required. We must set about getting value for money and the service required.
On a number of occasions, the Tánaiste raised the issue of GP clinics. That is an important part of the issue. I have no doubt that people do not of their own volition go to an accident and emergency department to queue for six, seven or eight hours in some cases. They do not do so lightly. In many of these cases people need some sort of reassurance that they, or a child or parent, are not actually dying. If they are examined there will be a certain reassurance. There would also need to be an assurance that any additional treatment required will be received.
My home town of Dingle, located on the west Kerry Peninsula, is in a difficult area. Somebody from Dunquin would have to drive more than 40 miles to the regional hospital in Tralee. That is a long and difficult drive. The GPs in the area recently put forward a plan to the HSE where they would provide 24-hour cover every day of the week. It needed the support of one additional person, which has not been given to the group. There may be good reasons for this, but to a person listening to the discussion, it seemed like a local initiative. I know some of the GPs involved and they would have very good reputations. They would not lightly put forward a proposal they felt would not work, and they felt they could provide a service. There is no doubt that this would immediately take pressure off the accident and emergency department in Tralee hospital.
When people arrive at an accident and emergency department for an X-ray, for example, why do these people have to queue up in one place and cause a blockage at the beginning, before having to go to another queue at X-ray? Why do these people not simply go straight into the X-ray section? Apparently that is not allowed, and these people have to go through each step, creating clogs in each of them. Such issues are not being thought out at that level. I will not get involved in the political arguments of the drink issue, but as far as I understand, drunk tanks should be in police stations. They have nothing to do with hospitals.
Those are the kinds of issues we should examine. We must resolve the problems in order to ensure we get the support and structures required to make the services work. It is not a purely political issue. Money and change is required, as is direction and commitment.
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Recommendations of Lourdes Hospital Report
04/05/06 - We recently had a very moving debate on the report into the activities of Dr. Neary in Our Lady of Lourdes Hospital in Drogheda. We were appalled at the hardship, trauma and suffering imposed on those women who went to have their children in that hospital. We looked at the recommendations of the learned judge who produced the report and we asked for them to be implemented. It now transpires that the judge has made a return trip to the hospital to discover what kind of action has been taken on foot of the recommendations. We find, appallingly, that whereas the hospital has made a serious effort to implement what was required of it at hospital authority level and staff level within the hospital, the HSE has done nothing whatever to implement the recommendations of the report.
Considering that the report galvanised this country and shocked all of us, it is absolutely incredible that nothing would be done. The Tánaiste and Minister for Health and Children, Deputy Harney, would be within her rights to demand an explanation from the HSE as to why nothing has been done. I would welcome an opportunity to discuss with the Tánaiste how the recommendations of the report will be implemented and what action she proposes to take, or can take, to ensure they will be implemented.
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Screening for Hearing Disabilities in Newborn Babies
06/04/06 - I wish to raise an issue which was in the news some weeks ago and which I have researched somewhat in the meantime, namely, the lack of screening for newborn babies for hearing disabilities. Currently we carry out what is called a distraction test to assess children’s hearing when they are about one year old. A nurse clicks his or her fingers and observes if a child reacts. All this identifies is children who are profoundly deaf.
There is a simple and cheap test that involves putting a probe in a day-old baby’s ear for a couple of seconds. This immediately picks up any difficulties which can be followed by a simple treatment of brain stimulation which ensures, for instance, that a child beginning school has almost full language capacity. This is a significant improvement and I ask that we would consider this option. This could avoid a significant amount of hardship on families. It is one of the few measures in the health area which is very inexpensive and it could be provided to every maternity hospital in the country for approximately €3 million or €4 million a year, which is peanuts in terms of the cost of the health budget. The returns would give new life to families and children to protect their children. It is not just a matter of the problem being identified but the treatment being provided to ensure that a child develops properly. The Tánaiste and Minister for Health and Children should come to the House to deal with this issue.
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Cancer Services
23/03/06 - We jump up and down here in outrage regularly on the basis of gun crime and people dying by the gun or as a result of road accidents, but there are more unnecessary deaths among women from cancer each year. There are twice, if not three times, as many deaths among women from cancer as the cumulative number of deaths resulting from gun crime and road accidents. The lives of at least 1,000 women a year could be saved and they could be alive if we were to ensure the roll-out of the cancer screening programme to all parts of rural and provincial Ireland. The current position is disgraceful. We are more agitated about avian flu and the possibility of an outbreak of SARS in China than we are about burying many of our own people unnecessarily year after year. We need to address that. The Minister for Health and Children should come to the House and it should be pointed out to her that this is an infrastructural issue which is hugely important. This issue is only one aspect of health care — there are many more. However, this is one aspect which, if addressed, could have an immediate impact and bring about positive results. I ask that we discuss this matter.
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Cancer Services
22/03/06 - We have spent considerable time in this Chamber discussing gun crimes and deaths, driving behaviour and road deaths, but if we take the example of any female cancer, such as breast cancer, more people die from this each year than from gun crimes and road traffic accidents combined. Why is there no outcry? Why is this happening when we have the answer? We have the knowledge and everything that is needed. All that must be done is to roll out the facilities to every county in the country, but this is not being done. It is extraordinary.
The facts contained in the latest report, Women and Cancer in Ireland 1994-2001 are startling. We are the country with the greatest economic story in the last ten or 15 years, that has made the most progress and been set up as a role model, but we still cannot care for our people in a simple and straightforward way. It is inexcusable.
We have easily moved from referring to dying of cancer to living with cancer. Anyone who knows someone with cancer knows that this change is real. People can have good quality of life seven or eight years after being diagnosed.
The introduction of mammogram screening is a measure we can afford. Why is this not a priority? It would have full support and immediate results. Politicians are blamed for not accomplishing things because important measures take a long time to make a difference. However, this measure would make an immediate difference. Inviting each woman in Ireland for breast, cervical and other cancer screening would immediately save lives, make an impact on the quality of life in the community and benefit families. There are no negative consequences to this. The worst cancers might be diagnosed too late to cure the person but the measure would extend the life of everybody diagnosed in that period.
Politicians may like to talk about matters where there is no clear solution but in this case the solution is absolutely clear. This is a cash investment with immediate returns, welcomed by everyone and supported by the community. I urge the Minister of State to apply pressure to make this happen. If it does not happen, we will face a revolution and we will never be thanked.
People become angry with frustration when they realise an early diagnosis could have allowed a loved one to live longer. The Minister of State must have met such people, as I have. Breast and cervical cancer screening must be made available to women in every county in Ireland. An information programme is of equal importance so that people know the diagnosis of cancer is not a death sentence. If the disease is diagnosed early it is not a death sentence in the majority of cases. The campaign should show the success rate that can be achieved if people are checked.
A breast and cervical screening programme must be fully implemented. We also need appropriate tests for those who are worried their genes may make them more susceptible to cancer. These tests are being done but it is too late in many cases. I also suggest we launch an education programme on diet, lifestyle, alcohol and smoking. This has been done to great effect with regard to smoking and the programme should show how these other aspects can also affect lives and how they can be controlled to save lives.
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Lourdes Hospital Enquiry
09/03/06 - I welcome the opportunity to contribute to the debate, although I am not sure I can add much to what has been said. I would like to consider the issues in a cold light because the women who suffered have been left behind by the system and we must take responsibility for that. While I can blame Dr. Neary, these women and the people of Ireland depend on public representatives to ensure regulations are in place and protocols, structures and processes are correct. However, they were not in this instance and that is the most shocking aspect.
This was not only a case of one guy getting it wrong. How did he ever come to be appointed to the Lourdes hospital, given that he did not meet the necessary criteria for the post? He should never have been employed by the hospital in the first place. I refer to the consultants who took him out to lunch before investigating him and who then came to a conclusion — surprise, surprise — that he had nothing to answer for. It is appalling that this should have been allowed to happen. I do not understand how people brought in to run the rule over the man would do so in this manner by creating a “palsy-walsy” ambience at lunch and conducting an examination afterwards. That should not have happened. No matter what conclusion they reached, one would have had to question the impartiality of the investigation. I do not know whether the investigating consultants are answerable. Has their work been checked?
The question of normality arises. What is the norm? This practice was the norm for the Drogheda hospital and, therefore, none of the staff knew the difference. The crudeness and insensitivity of this man’s language and approach to his patients was appalling. We often hear about the lack of manners on the part of consultants and their overbearing attitude and superiority when dealing with patients, but this man’s behaviour brought that to a new level.
There is a question as to whether religious philosophies or beliefs had a bearing on events. I believe they did, but I do not know why this man did what he did. Despite having read through the report and tried to come to a conclusion, I cannot. I know what happened and that is enough for me. I do not need to know his motivation. It might make it worse and certainly would not make it any better. I cannot think of any benign philosophical basis on which he might have done this that could make me feel it is not as bad as it looks. It is as bad as it looks.
Doctor Neary’s apology is not worth seeking. I do not want to hear it as it is worth nothing and would only give him some dignity. My rule is never to seek an apology. I would only feel an apology was worthwhile if I had come to a good judgment about the person offering it. If it was somebody about whose judgment I did not care, I would not care for his or her apology. That is the case in this situation.
The area of compensation is sensitive. I do not know how we can calculate compensation. I am the vice-chairman of the Personal Injuries Assessment Board where we examine this sort of issue on a regular basis. However, I would not know where to start in terms of the traumatic impact on these women, not just psychological and physical, but in terms of relationships, self confidence and assertiveness as I feel these women have to rebuild their lives. I hope our discussion in the Oireachtas and the media will help them see that people are trying to understand their trauma and to be supportive. If we can offer nothing else, we can offer that.
With regard to compensation, we need to make early assessments and to deliver on them. I know this is not a payment and that “compensation” is probably the wrong word to use. It is an offering we need to make to these women. I would be appalled if along the way we come to a point where we have to ask could we not have done better by them. We should do what we think is right and do it in spades. An approach should then be made to the insurance companies. However, let us not wait.
If we look into the issue and see where people find themselves, we see that this has been an appalling, embarrassing chapter in Irish medical history and political life. We should bow our heads in shame and give our apology to these women.
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Medical Council
23/02/06 - For a number of years we have dealt with the issue of the mutual recognition of qualifications in European countries. The Medical Council is experiencing extraordinary difficulty with regard to doctors who are struck off the register and not allowed to practice in other jurisdictions but who must be accepted and recognised by the Medical Council if they come to Ireland. That seems to turn the whole idea of the mutual recognition of qualifications on its head. At a time when foreign teachers, pharmacists and veterinary practitioners cannot be recognised here due to qualification problems, the idea that a doctor from another European jurisdiction who had been struck off cannot be rejected by the Medical Council is appalling, in particular given that the Medical Council is doing all it can to expand its role as a supervisory authority of the medical profession in terms of visiting GPs and so on. We should discuss this issue, show support for the Medical Council and ask the Minister to introduce the appropriate legislation.
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Seanad debates are available in full on the Oireachtas Website
Each speech listed here is an edited speech. If you'd like to see the speech or debate in full, please go to the Oireachtas website and click on "Seanad Eireann" and then "Seanad Debates" and click on the relevant date as listed with each speech on this page.
ALCOHOL – Drink Driving Limit (24/04/08)
Portlaoise Hospital Report (06/03/08)
Emergency Contraception (27/02/08)
HSE (26/02/08)
Health (Miscellaneous Provisions) Bill 2007 (19/12/07)
Motion of No Confidence in Minister for Health (28/11/07)
Pharmacist Negotiations and Pricing (22/11/07)
Cancer Services - HSE (20/11/07)
GAA and GPA - Players' Grants (14/11/07)
Hospital Hygiene (13/11/07)
Health Services and the HSE (08/11/07)
Health Services and the HSE (07/11/07)
Haemochromotosis (30/06/06)
Stem Cell Research (29/06/06)
National Sports Campus Development Authority Bill (27/06/06)
OECD Report on Health Services (27/06/06)
Public Hospital Lands and Consultants (31/05/06)
Accident and Emergency Services (09/05/06)
Recommendations of Lourdes Hospital Report (04/05/06)
Screening for Hearing Disabilities in Newborn Babies (06/04/06)
Cancer Services (23/03/06)
Cancer Services (22/03/06)
Lourdes Hospital Enquiry (09/03/06)
Medical Council (23/02/06)
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ALCOHOL – Drink Driving Limit
24/04/08 - We need to discuss the matter of the report on alcohol sales. I would like to hear more about two issues related to it. One is the proposal to reduce the duty on drinks containing lower levels of alcohol, such as beers with an alcohol content of 3%. The other issue on which we need to hear more is the impact of reducing the drink driving limit from a blood-alcohol level of 80 milligrams to 50 milligrams. Are there statistics to prove that reducing the limit from 80 milligrams to 50 milligrams would make a significant impact on reducing the number of road deaths or injuries suffered in road traffic accidents? I have not seen those figures. I have asked for them previously.
I understand this is a political issue. I do not want us to rush into a political decision that will cause further chaos in rural Ireland unless we have to. If we have to do it, then we should, but we should have the figures. Usually when figures are produced on the number of people involved in accidents involving drink driving, the blood-alcohol level of those involved is much higher than 80 milligrams. The effort, money and time being put into reducing the level from 80 milligrams to 50 milligrams might result in the saving of many more lives if it was put into BreastCheck or increasing the availability of other cancer diagnostic elements throughout the country.
I would like to have a full, honest and balanced debate on this issue. If we have to reduce the drink driving limit, I will support it, but I want to see the figures to back up the case for doing so.
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Portlaoise Hospital Report
06/03/08 - Looking at it (the Portlaoise report) from a disinterested point of view in terms of trying to take the patient and emotion out of it, extraordinary questions must be asked on both sides of the House about the process. This is not a matter solely for the Opposition benches. I do not want to make this into a political issue. However, I want to know how the risk register was applied to Portlaoise hospital. What was supposed to be happening there and what was not? What were the key performance indicators required for that area? I want to know if people’s bonuses was tied into it. Were there mid-year reviews? How could it happen that people were using out-of-date equipment? Management must take responsibility for that. Someone in management was aware and decided to use out-of-date equipment. We need to know why and who these people are.
I am interested in the Portlaoise case not because it has been dealt with badly but because I want to know about the rest of the system and how it is run. Can we have a discussion on how the health system is run, without referring to any particular hospital, as if we were a board of directors getting a clear description of how it does its business?
In any small operation in the public service — I am involved in several semi-State bodies — at every board meeting there is an outline of which checks and balances were applied every quarter. An outside auditor is brought in to verify the system. Fail-safe measures in the system are tested to check if they are sufficiently robust and flexible.
These are expected in ordinary operations but it does not seem to be happening in the health service. I am not having a go at the Government or advisers. I just want to know what they are doing. The recent higher remuneration report assessed a particular management group in the Health Service Executive and admitted it did not know what they were doing. That cannot be in anyone’s interests. I want a debate on this to ensure moneys are spent properly.
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Emergency Contraception
27/02/08 - In the past 24 hours, there has been a certain amount of debate on the question of access to emergency contraception, also known as the morning after pill. We need to have a proper discussion on that issue to develop a clear understanding of what is available. As far back as 2001, the British Medical Association recommended that the morning after pill be made freely available in pharmacies. That is not the case in Ireland, where people have to get a doctor’s prescription. That requirement appears to be unnecessary and the only reason for it is to avoid encouraging too much sexual activity. Other jurisdictions have addressed the issue by requiring that people of a certain age have to go through, for example, a school nurse to access the pill. Research on the issue by Imperial College London concludes that access to the morning after pill does not impact in any way on sexual activity. It is progressive and safe to allow access and I would like an open debate on the issue with either the Minister for Justice, Equality and Law Reform or the Minister for Health and Children in the interest of making the pill available to people who need it.
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HSE
26/02/08 - I have not been in the habit of making complaints about the HSE because plenty of other people have been doing so. I am interested, however, in the way it does its business and two issues concerning the HSE that arose in the past week are of serious concern to me as a public representative.
In one case, the HSE has pulled its advertising from a radio station which had the cheek and audacity to follow it up on issues where the station felt the HSE was not giving a proper service. Rightly or wrongly, a radio station which has been following up on issues with the HSE, which is what the media is there to do, has had advertising pulled. I would like to hear someone explain that to me as there is something fundamentally undemocratic and wrong about it. I have very little sympathy for the HSE if it is not prepared to take punches and fight back.
Deputy Joe Costello has had a weekly demonstration outside the accident and emergency department of the Mater Hospital for the past four and half or five years to bring attention to certain aspects of the department he feels should be highlighted. He also takes the opportunity each week to speak to patients there. This is a praiseworthy action. It is praiseworthy for an elected public representative to see how the public service gives its service at a local level and is seen to do so. It is good for politics. He has now been told he is not wanted there anymore and that he should not be there. These two issues cause concern for me because of political accountability, what we intended the HSE to do and our relationship with the executive.
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Health (Miscellaneous Provisions) Bill 2007
19/12/07 - I do not know whether I should support or oppose this Bill, and when in doubt, “Vote No” quickly comes to mind.
There are two aspects of the Minister’s speech which seriously concern me. The first is her statement that there are technical drafting issues identified regarding the Medical Practitioners Act 2007. I would like to know how that came to be. ….. The Minister suggests we could be in breach of Article 15.2 of the Constitution, which gives the right to legislate to the Oireachtas. How did this happen? Senator Fitzgerald said that she would like to see the Attorney General’s advice. I would too, but I know there is not the remotest chance of seeing it.
Let me give the Minister the other side of the argument. I do not trust lawyers in this regard. I do not trust lawyers who tell me that we cannot do something by secondary legislation or by regulation. Neither do I trust them when they say we should not have done something by secondary legislation. I have been dealing with legislation for 20 years and like to put my hands in the wounds myself. It is right for the Minister to do what she is trying to do to ensure that matters are brought beyond doubt. She knows that and has the information to come to that conclusion, but I do not.
When I say I do not trust lawyers, I am not being dismissive of the profession. I feel they are used to taking one side or the other and are not much good in the middle. I would like to hear what the advice was, to hear the opposing argument and to come to a conclusion. We are entitled to that in this situation.
I know the hardest thing for a Minister for Health to do. I remember saying to one of the Minister’s predecessors, Deputy Michael Noonan, whom I defended in the House previously, that he should not have taken legal advice in the Mrs. McCole case. This situation is not parallel, but that was a good example of where a politician should strenuously overrule legal advice when not convinced it is necessary.
The Minister has spent as much of her life as I have of mine looking at legal advice and being prepared to throw it in the bin if it seemed incorrect or did not fit the need at the particular time. I am not sure this is not one of those cases. The distinction between secondary legislation such as regulation, statutory instrument, order or whatever is sometimes very fine. If it goes over the line, I like to know why. If it went over the line, somebody in the Department, it is probable that whoever drew up the statutory instrument, not the Attorney General, went beyond his or her authority.
I do not envy the Minister her job. My comments are heartfelt from the perspective of a legislator, but there are issues here that cause grave discomfort to anybody who worries about the process of legislation and regulation and their relationship with the Constitution.
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Motion of No Confidence in Minister for Health
28/11/07 - Perhaps it is the trade unionist in me but I tend to react strongly when I hear calls for people to be sacked. I examine matters such as due process and I regret that we cannot have another debate on it. I would not support a motion of no confidence in the Minister for Health and Children, Deputy Harney. It does not achieve anything and brings us back to what has happened in the House for 20 years. This does not deal with accountability, responsibility and the difference between the two. People do not know who should be held responsible. It is like saying there is a teacher in the west abusing children so we should sack the Minister for Education and Science. That is the level of logic prevailing.
I believe in holding the Minister to account and disagree fundamentally with many of her views. I will continue to debate them. There must be proper due process and a clear understanding of accountability so that when there is a change of Government, the next Minister with responsibility for health, if he or she comes from this side of the House, will not have to put up with the same attitude from the Members who are then in Opposition. It happens all the time. There must be accountability and responsibility and the difference between the two should be understood.
If I could see the risk register for Portlaoise Hospital and the risk register at various levels of the health service I could find out who needs to be brought to book in 20 minutes. If the Minister has not set up structures it is her fault. If she has, and other people are not operating them correctly as seems to be the case, it is the fault of others. If it is not the person at the top, and it need not be, we must find out where are the problems and single this area out for action.
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Pharmacist Negotiations and Pricing
22/11/07 - I support the Minister for Health and Children on the pharmacists matter. While I understand and approve of what the Minister is attempting to achieve, I do not understand what the row is about. The Irish Pharmaceutical Union is not entitled to represent its members to discuss dispensing costs with the Health Service Executive because it would be in breach of competition laws. As I see it, the Competition Authority will sit down with the HSE and the Minister for Health and Children, both of whom have a consumer interest and are required to give fair value. This would protect the consumer. If a discussion among a Department, a State body and the pharmaceutical union about getting the best price for consumers is in breach of the competition legislation then the legislation is an ass and should be changed quickly. If that is the case, the consumer is losing out. I am not putting the case for the pharmacists, as I share the Minister’s point of view on this issue.
I have discovered that pharmaceuticals are placed at different wholesale prices from country to country. This continues almost 50 years after we began to establish the so-called common market. The EU Commissioner responsible for the Internal Market, Mr. Charlie McCreevy should examine this issue. We are being hammered at least in part because of the high wholesale cost of pharmaceuticals based on a price determined by the pharmaceutical companies. I believe it breaches European legislation and it is certainly in breach of the Treaty of Rome. I would like us to consider whether the competition authority legislation protects the consumer and examine the European competition legislation which seems to go against the principles of the common market.
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Cancer Services - HSE
20/11/07 - I support what the Minister is doing in terms of centres of excellence and the cancer strategy, but I have many codicils. I became a Member in 1987 and, during my first week, I lunched with Barry Desmond, who had just finished his tenure as Minister for Health. He expressed his rage when discussing his problems in closing hospitals. …. I remember the Minister for Enterprise, Trade and Employment, Deputy Martin, being in deep trouble for the appalling nursing homes mess. …. I remember Deputy Noonan ten years ago, who I refer to because these people were at the centre of media demonisation. When Minister for Health, Deputy Noonan made a mistake in terms of the advice he received in respect of the Mrs. McCole case, but that did not take from my admiration for him as a Minister and what he was trying to do against all sorts of odds.
I have heard it all when it comes to people having a go at Ministers and it is occurring in the case of the current Minister, Deputy Harney. I admire her work, but I disagree fundamentally with some of her issues, which I will put on the record as I proceed. Let us begin with the role of Professor Drumm. I do not know Professor Drumm’s policy, but we passed legislation that requires him to take on board the Government’s policies and objectives. We demand that Professor Drumm be available to give an account of the general administration of the health services to an Oireachtas joint committee. I disagreed with this set-up then and I disagree with it still. Chief executives should be allowed have a view, say what they believe and drive policy as well as implement it.
I was delighted Senator Fitzgerald raised the issue of governance, accountability and responsibility. It is the height of nonsense to blame the Minister or the chief executive of the HSE when a hospital cannot be kept clean. Senator Fitzgerald is correct that there should be risk audits in hospitals to ensure they are kept clean. If they are not, someone in the hospital must be accountable and action should be taken.
It is unacceptable for a consultant who found dirty equipment at Portlaoise Hospital to claim the answer was to write a letter to the Minister. What do they do about dirty hypodermic needles? Do they write a letter about that? My view on this case is simple. They should have stopped using the equipment there and then and made someone deal with it.
Last week on radio, the Minister said she hoped to conclude the contract with the consultants by the end of the year, only for that to be contradicted an hour later by the consultants claiming that under no circumstances would it be finished by then. I want to hear more about this development.
I disagree fundamentally with the Minister, in principle and in practical terms, on bilocation. In practical terms, it is duplication. I believe consultants do a fabulous job and I am a great admirer of them. They are entitled to every penny they earn and I do not begrudge them a shilling of it. However, I want the world to know they earn their money using, at no charge to them, our hospitals, our beds, our nurses and our equipment. This is where I disagree with the Minister — I would make them pay for these services. Instead of building a second hospital on the one site, I would put a value on existing hospital services and let the consultants pay for them. I accept the Minister’s plausible argument that bilocation releases more beds. However, it must be recognised that consultants are using State equipment paid for with taxpayers’ money.
The levels of administrative staff in the health services is an issue constantly raised in the House. Not one Member wants to see consultants answering the telephone or scheduling their diaries, and there must a certain level of administration. The comments made by it (review body on higher remuneration) on extra people in senior management in the HSE are troubling. If the HSE could not come to a conclusion as to what some of its senior management are doing, it must be reviewed. In the change from the health boards to the HSE, there was a need to accommodate many people. Like what happened elsewhere, they either had to be bought out, paid off or given jobs. There is some element of duplication but that does not mean people should not be working.
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GAA and GPA - Players' Grants
14/11/07 - The matter of the GPA and GAA has been raised on a number of occasions in the past two weeks. I have hesitated to become involved in the matter and should declare an interest, in that I am part of the negotiating team dealing with the GPA on behalf of the GAA. The GAA and the GPA reached an agreement, of which I was part, and signed off on it more than one year ago. That agreement was brought to the Minister for Arts, Sports and Tourism prior to the election but it was not acceptable to his Department. We went back to the drawing board with the GPA and Dessie Farrell, myself and a few others hammered out another agreement which was signed off on. There is complete agreement on both sides and once again the agreement was brought to the Department of Arts, Sport and Tourism. To some extent, it was not acceptable to the Department.
There is no disagreement between the GPA and the GAA. They are in full agreement that this should be administered by the Sports Council. The Sports Council is a creature of Government and, therefore, it depends on Government to make it work. Any difficulties are minor. This merely needs political will and a decision at a high level to make it work. I believe the Minister, Deputy Brennan, is supportive of the idea but somebody needs to call the shots which is all that is required at this stage. That is the official position.
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Hospital Hygiene
13/11/07 - I wish to raise the hygiene issue. I would like to see a debate on that. I have a very different view on this matter than that of the Opposition in general. I am too long in the House to get sucked into blaming Ministers for everything that goes wrong and do not want to call for the resignation of a Minister or chief executive because staff cannot keep their hospitals clean. We should be clear that there are different levels of accountability and responsibility. Over the weekend, in the belief that we would be discussing the health service this week, I re-examined the Health Act 2004. I would recommend to Members to read what we all supported when it was enacted.
I object to one line in the Act pertaining to the appointment of a chief executive: “In carrying out duties under this section, the chief executive officer shall not question or express an opinion on the merits of any policy of the Government or a Minister . . .” For ten years, I have been saying the inclusion of this line in legislation is a disgrace. There is no point in politicians from either side of the House criticising a chief executive who does the Minister’s bidding if that chief executive is not allowed to contradict the Minister. The role of the chief executive is outlined in the Act and we therefore require clear thinking. Where there is a requirement to be responsible, let us demand that it is met, and where there is a requirement for accountability, let us demand it. Where hospitals are not being kept clean and where consultants are using dirty equipment and appeasing their consciences by writing a letter to the chief executive, I would expect a bit more. Let us have accountability at every level in the hospitals.
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Health Services and the HSE
08/11/07 - The House should discuss the health service. We should start by examining the legislation which established the Health Service Executive … to examine the question of accountability. We should also examine the issue of responsibility. It would make for a more serious debate if Senators knew who is responsible and who is accountable and what is the difference between responsibility and accountability. Unfortunately, as I have observed over the past 20 years, attitudes quickly change depending on which side of the House Senators sit. We must be able to understand the structure in place and identify who is responsible for what. As I indicated yesterday, the Health Service Executive was established because we did not want political interference in the health service. However, once political interference is removed, we are inclined to demand political responsibility. We cannot have it every way. We must decide what we want in this regard. Let us re-examine the legislation.
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Health Services and the HSE
07/11/07 - I am loath to get involved in a blame game, but we must examine the matter seriously. Benchmarks should be put in place in terms of what we expect from the health service and objectives for waiting lists, accident and emergency queues and cancer care should be set out during the next two years. People should be given one year to do what is expected before they reappear before the House to determine whether they have delivered. We should support or criticise them depending on whether things get done.
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Haemochromotosis
30/06/06 - A former Member of the House, Maurice Manning, recently published a report on behalf of the Irish Haemochromotosis Association which contained a series of recommendations on screening people for this condition, which is quite debilitating. I would welcome an opportunity to discuss this report and to hear the views of the Tánaiste and Minister for Health and Children on the implementation of the report’s recommendations. The group that compiled the report was, in fact, set up by the Tánaiste.
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Stem Cell Research
29/06/06 - A reasonable argument has been put forward on an issue. ……This is a matter of extraordinarily serious consequence and I accept that people hold different views. I suspect that views differ on both sides of the House. …. people should discuss it seriously and should consider all the views.
Members have seen the suffering that has come to families which cope with Alzheimer’s disease, Parkinson’s disease and a range of other issues. While I neither know nor purport to put forward the answers in this regard, apparently such conditions may be alleviated to some extent by stem cell research. I also understand that people have different views …. in respect of the difference between embryonic stem cells and adult cells. I am not familiar with the various arguments for and against such research.
However, this is absolutely crucial. ….. This is a major issue and while it sits in the ether, ordinary people will be led down the garden path. Perhaps they will go to quacks who do not know anything about it and purport to provide treatment which will not be effective at all. This issue must be regulated and co-ordinated.
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National Sports Campus Development Authority Bill
27/6/2006 - I must congratulate the Minister and his officials on the legislation, which I very much welcome. It is most important that this is focused on professionals, amateurs and the general public. If we are to get value from involvement in sport this legislation should bring about better quality of life and a greater appreciation and love of living which comes from sport. In terms of a centre of excellence, one of the problems is that we do not encourage sport early enough. If I was to take an oppositional line on this and recall what has happened in the past ten years, we have gone backwards, in terms of international success, although we are starting to come back again.
The biggest single influence on Irish sporting activity and achievement is the weather. We need all-weather access to sports facilities and we are very slow to recognise that. Senator Mansergh mentioned horse racing, for which there is a great love throughout Ireland. However, we do not have an all-weather racing track, although one is being built in Dundalk; the sooner it is completed, the better. One is not enough, however, for an industry that is so central to many aspects of Irish life and agri-industry, and we should have been on the ball much earlier.
I raised with the Minister before my belief that Ireland should be the European home of sailing. If counties were equipped with marinas, particularly along the west coast, it would bode well for that particular sport. This is an area that should be examined, getting people into the water, including the inland waterways. Fishing is an area in which there is continuing development. It is one of the mass sports in Ireland at the moment. I saw the figures involved recently and they were very high.
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OECD Report on Health Services
27/06/2006 - The report on the health service is really agitating people around the country. The Tánaiste and Minister for Health and Children, Deputy Harney, stated that this report was based on out of date information and the author of the report stated that the Department refused access to information. Somebody must answer for that. It is quite appalling. To the disinterested observer looking at this calmly and unemotionally, we cannot just accept that decision and we should know who took it.
The other issue to be noted from the report, apart from Ireland’s appalling results, is that the authors stated quite clearly that in their view the position of public and private sectors working together was the wrong way to go. That supports what the Tánaiste is trying to achieve and she should just go ahead and do it. Second, direct access to consultants was dealt with quite clearly in the report. If we are to use this report, let us use it positively and also ask the questions, move matters forward and get the results we seek.
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Public Hospital Lands and Consultants
31/05/06 - My opposition had been on the basis that something was to be given away to the private sector. I shared the view …..that this was completely unacceptable. Where does this leave me? I accept the point she (Tánaiste) clearly made to the House to the effect that not a square inch of public land will be given away and that any land to be used for private purposes will be sold or leased at the going rate. I appreciate that and it changes matters significantly.
That said, I still do not like this development. Having listened carefully to the arguments put forward by the Tánaiste, her position is logical. Nevertheless, I do not see why it must be on land which is available at present in hospitals. ……… the private sector should look after its own business. However, I do not object to private investment in the health services, if that is what people want. I object to taxpayers’ money subsidising it in any way.
I have been infuriated by the idea that up to the present, certain public beds owned by the State in public hospitals were under the control of private consultants. If I was obliged to make a choice between that practice and the Tánaiste’s proposals, I would prefer the latter. The idea that there is an empty bed in a hospital which the hospital authorities cannot assign to anyone because it is under the control of a consultant is one of the reasons why I believe the consultants’ contracts should be changed completely.
This measure should be fitted together with the renegotiation of the consultants’ contracts. Enough money should be paid to new consultants to attract the best people possible into the public health service. If only one of these measures is adopted, Members will be supporting the introduction of a two-tier system.
However, I have seen such a system work in other countries where the consultants in public hospitals were being paid at a rate that attracted the very best people who wanted to stay in well-paid secure employment where they could give a good service. The amount of money offered is insufficient to allow this to happen. We should move all those on existing consultant contracts to the private sector, where they can grow old, doing that business. Let us attract new energetic enthusiastic and ambitious consultants into the public health service and give us back the beds we own.
If public lands are given away to private interests I strongly support the point made by Opposition parties. It is our duty to ensure this does not happen. However, the suggestion that this is a cost effective manner of releasing or producing an additional 1,000 beds in the public sector is an attractive proposition. It will only work if it is matched by consultants of quality.
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Accident and Emergency Services
09/05/06 - I listened to the debate since it began and it is like every other debate I have heard on this issue, in that it is a constant rehearsal of the problems with few solutions offered. I will probably do more of the same. In my view, the Tánaiste is as committed to this as anybody has ever been. Whatever the problems are, they certainly have not been resolved. Simply politicising them does not help our case.
We could and should do certain things which we have not done. The consultants’ contract has not been dealt with. My view is that the Tánaiste has not offered enough money. I stated before that I would offer them more than €300,000 to be available, to work the appropriate number of shifts and to make progress. I would tell the consultants we would protect their contract for as long as they wanted to keep it. I am certain we can afford to pay that amount of money to consultants. Even though it would be less than what they may earn in the private sector, by the time the cost of running an office is removed and the importance of a pension is added, it becomes an extremely attractive proposal.
I would resolve those issues by taking decisions and progressing in a way that protects the consultants. We must recognise they are under an agreed contract. The only way to deal with it in HR terms is to recognise, acknowledge and respect that contract and allow the consultants to have it for as long as they wish. We must negotiate a new contract for new people. Decisions must be made on that basis.
What discussion has taken place with the unions and the organisation representing all of the other groups working in those services? My understanding, and I may be wrong because it is based on anecdote rather than on official information, is that no real negotiations or discussions have taken place on how to do this. Until we can operate a system where all of our assets are operational and available for at least two shifts a day we will never deal with the issue. That must be done.
The Tánaiste is correct when she states it is not only about money. At the same time, she should qualify that by stating more funding is required. We must set about getting value for money and the service required.
On a number of occasions, the Tánaiste raised the issue of GP clinics. That is an important part of the issue. I have no doubt that people do not of their own volition go to an accident and emergency department to queue for six, seven or eight hours in some cases. They do not do so lightly. In many of these cases people need some sort of reassurance that they, or a child or parent, are not actually dying. If they are examined there will be a certain reassurance. There would also need to be an assurance that any additional treatment required will be received.
My home town of Dingle, located on the west Kerry Peninsula, is in a difficult area. Somebody from Dunquin would have to drive more than 40 miles to the regional hospital in Tralee. That is a long and difficult drive. The GPs in the area recently put forward a plan to the HSE where they would provide 24-hour cover every day of the week. It needed the support of one additional person, which has not been given to the group. There may be good reasons for this, but to a person listening to the discussion, it seemed like a local initiative. I know some of the GPs involved and they would have very good reputations. They would not lightly put forward a proposal they felt would not work, and they felt they could provide a service. There is no doubt that this would immediately take pressure off the accident and emergency department in Tralee hospital.
When people arrive at an accident and emergency department for an X-ray, for example, why do these people have to queue up in one place and cause a blockage at the beginning, before having to go to another queue at X-ray? Why do these people not simply go straight into the X-ray section? Apparently that is not allowed, and these people have to go through each step, creating clogs in each of them. Such issues are not being thought out at that level. I will not get involved in the political arguments of the drink issue, but as far as I understand, drunk tanks should be in police stations. They have nothing to do with hospitals.
Those are the kinds of issues we should examine. We must resolve the problems in order to ensure we get the support and structures required to make the services work. It is not a purely political issue. Money and change is required, as is direction and commitment.
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Recommendations of Lourdes Hospital Report
04/05/06 - We recently had a very moving debate on the report into the activities of Dr. Neary in Our Lady of Lourdes Hospital in Drogheda. We were appalled at the hardship, trauma and suffering imposed on those women who went to have their children in that hospital. We looked at the recommendations of the learned judge who produced the report and we asked for them to be implemented. It now transpires that the judge has made a return trip to the hospital to discover what kind of action has been taken on foot of the recommendations. We find, appallingly, that whereas the hospital has made a serious effort to implement what was required of it at hospital authority level and staff level within the hospital, the HSE has done nothing whatever to implement the recommendations of the report.
Considering that the report galvanised this country and shocked all of us, it is absolutely incredible that nothing would be done. The Tánaiste and Minister for Health and Children, Deputy Harney, would be within her rights to demand an explanation from the HSE as to why nothing has been done. I would welcome an opportunity to discuss with the Tánaiste how the recommendations of the report will be implemented and what action she proposes to take, or can take, to ensure they will be implemented.
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Screening for Hearing Disabilities in Newborn Babies
06/04/06 - I wish to raise an issue which was in the news some weeks ago and which I have researched somewhat in the meantime, namely, the lack of screening for newborn babies for hearing disabilities. Currently we carry out what is called a distraction test to assess children’s hearing when they are about one year old. A nurse clicks his or her fingers and observes if a child reacts. All this identifies is children who are profoundly deaf.
There is a simple and cheap test that involves putting a probe in a day-old baby’s ear for a couple of seconds. This immediately picks up any difficulties which can be followed by a simple treatment of brain stimulation which ensures, for instance, that a child beginning school has almost full language capacity. This is a significant improvement and I ask that we would consider this option. This could avoid a significant amount of hardship on families. It is one of the few measures in the health area which is very inexpensive and it could be provided to every maternity hospital in the country for approximately €3 million or €4 million a year, which is peanuts in terms of the cost of the health budget. The returns would give new life to families and children to protect their children. It is not just a matter of the problem being identified but the treatment being provided to ensure that a child develops properly. The Tánaiste and Minister for Health and Children should come to the House to deal with this issue.
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Cancer Services
23/03/06 - We jump up and down here in outrage regularly on the basis of gun crime and people dying by the gun or as a result of road accidents, but there are more unnecessary deaths among women from cancer each year. There are twice, if not three times, as many deaths among women from cancer as the cumulative number of deaths resulting from gun crime and road accidents. The lives of at least 1,000 women a year could be saved and they could be alive if we were to ensure the roll-out of the cancer screening programme to all parts of rural and provincial Ireland. The current position is disgraceful. We are more agitated about avian flu and the possibility of an outbreak of SARS in China than we are about burying many of our own people unnecessarily year after year. We need to address that. The Minister for Health and Children should come to the House and it should be pointed out to her that this is an infrastructural issue which is hugely important. This issue is only one aspect of health care — there are many more. However, this is one aspect which, if addressed, could have an immediate impact and bring about positive results. I ask that we discuss this matter.
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Cancer Services
22/03/06 - We have spent considerable time in this Chamber discussing gun crimes and deaths, driving behaviour and road deaths, but if we take the example of any female cancer, such as breast cancer, more people die from this each year than from gun crimes and road traffic accidents combined. Why is there no outcry? Why is this happening when we have the answer? We have the knowledge and everything that is needed. All that must be done is to roll out the facilities to every county in the country, but this is not being done. It is extraordinary.
The facts contained in the latest report, Women and Cancer in Ireland 1994-2001 are startling. We are the country with the greatest economic story in the last ten or 15 years, that has made the most progress and been set up as a role model, but we still cannot care for our people in a simple and straightforward way. It is inexcusable.
We have easily moved from referring to dying of cancer to living with cancer. Anyone who knows someone with cancer knows that this change is real. People can have good quality of life seven or eight years after being diagnosed.
The introduction of mammogram screening is a measure we can afford. Why is this not a priority? It would have full support and immediate results. Politicians are blamed for not accomplishing things because important measures take a long time to make a difference. However, this measure would make an immediate difference. Inviting each woman in Ireland for breast, cervical and other cancer screening would immediately save lives, make an impact on the quality of life in the community and benefit families. There are no negative consequences to this. The worst cancers might be diagnosed too late to cure the person but the measure would extend the life of everybody diagnosed in that period.
Politicians may like to talk about matters where there is no clear solution but in this case the solution is absolutely clear. This is a cash investment with immediate returns, welcomed by everyone and supported by the community. I urge the Minister of State to apply pressure to make this happen. If it does not happen, we will face a revolution and we will never be thanked.
People become angry with frustration when they realise an early diagnosis could have allowed a loved one to live longer. The Minister of State must have met such people, as I have. Breast and cervical cancer screening must be made available to women in every county in Ireland. An information programme is of equal importance so that people know the diagnosis of cancer is not a death sentence. If the disease is diagnosed early it is not a death sentence in the majority of cases. The campaign should show the success rate that can be achieved if people are checked.
A breast and cervical screening programme must be fully implemented. We also need appropriate tests for those who are worried their genes may make them more susceptible to cancer. These tests are being done but it is too late in many cases. I also suggest we launch an education programme on diet, lifestyle, alcohol and smoking. This has been done to great effect with regard to smoking and the programme should show how these other aspects can also affect lives and how they can be controlled to save lives.
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Lourdes Hospital Enquiry
09/03/06 - I welcome the opportunity to contribute to the debate, although I am not sure I can add much to what has been said. I would like to consider the issues in a cold light because the women who suffered have been left behind by the system and we must take responsibility for that. While I can blame Dr. Neary, these women and the people of Ireland depend on public representatives to ensure regulations are in place and protocols, structures and processes are correct. However, they were not in this instance and that is the most shocking aspect.
This was not only a case of one guy getting it wrong. How did he ever come to be appointed to the Lourdes hospital, given that he did not meet the necessary criteria for the post? He should never have been employed by the hospital in the first place. I refer to the consultants who took him out to lunch before investigating him and who then came to a conclusion — surprise, surprise — that he had nothing to answer for. It is appalling that this should have been allowed to happen. I do not understand how people brought in to run the rule over the man would do so in this manner by creating a “palsy-walsy” ambience at lunch and conducting an examination afterwards. That should not have happened. No matter what conclusion they reached, one would have had to question the impartiality of the investigation. I do not know whether the investigating consultants are answerable. Has their work been checked?
The question of normality arises. What is the norm? This practice was the norm for the Drogheda hospital and, therefore, none of the staff knew the difference. The crudeness and insensitivity of this man’s language and approach to his patients was appalling. We often hear about the lack of manners on the part of consultants and their overbearing attitude and superiority when dealing with patients, but this man’s behaviour brought that to a new level.
There is a question as to whether religious philosophies or beliefs had a bearing on events. I believe they did, but I do not know why this man did what he did. Despite having read through the report and tried to come to a conclusion, I cannot. I know what happened and that is enough for me. I do not need to know his motivation. It might make it worse and certainly would not make it any better. I cannot think of any benign philosophical basis on which he might have done this that could make me feel it is not as bad as it looks. It is as bad as it looks.
Doctor Neary’s apology is not worth seeking. I do not want to hear it as it is worth nothing and would only give him some dignity. My rule is never to seek an apology. I would only feel an apology was worthwhile if I had come to a good judgment about the person offering it. If it was somebody about whose judgment I did not care, I would not care for his or her apology. That is the case in this situation.
The area of compensation is sensitive. I do not know how we can calculate compensation. I am the vice-chairman of the Personal Injuries Assessment Board where we examine this sort of issue on a regular basis. However, I would not know where to start in terms of the traumatic impact on these women, not just psychological and physical, but in terms of relationships, self confidence and assertiveness as I feel these women have to rebuild their lives. I hope our discussion in the Oireachtas and the media will help them see that people are trying to understand their trauma and to be supportive. If we can offer nothing else, we can offer that.
With regard to compensation, we need to make early assessments and to deliver on them. I know this is not a payment and that “compensation” is probably the wrong word to use. It is an offering we need to make to these women. I would be appalled if along the way we come to a point where we have to ask could we not have done better by them. We should do what we think is right and do it in spades. An approach should then be made to the insurance companies. However, let us not wait.
If we look into the issue and see where people find themselves, we see that this has been an appalling, embarrassing chapter in Irish medical history and political life. We should bow our heads in shame and give our apology to these women.
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Medical Council
23/02/06 - For a number of years we have dealt with the issue of the mutual recognition of qualifications in European countries. The Medical Council is experiencing extraordinary difficulty with regard to doctors who are struck off the register and not allowed to practice in other jurisdictions but who must be accepted and recognised by the Medical Council if they come to Ireland. That seems to turn the whole idea of the mutual recognition of qualifications on its head. At a time when foreign teachers, pharmacists and veterinary practitioners cannot be recognised here due to qualification problems, the idea that a doctor from another European jurisdiction who had been struck off cannot be rejected by the Medical Council is appalling, in particular given that the Medical Council is doing all it can to expand its role as a supervisory authority of the medical profession in terms of visiting GPs and so on. We should discuss this issue, show support for the Medical Council and ask the Minister to introduce the appropriate legislation.
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