Sinn Féin’s work in the Dail this week on Health 0305-06.06-2008
Irish Politicians’ Blogs
Originally posted on ClondalkinSinnFein
A&E crisis has not gone away – Ó Caoláin
Published: 4 June, 2008
Sinn Féin Health & Children spokesperson Caoimhghín Ó Caoláin TD has said new figures show the failure of the Government and the HSE, one year on from the publication of the Emergency Department Task Force Report, to reduce the numbers of patients waiting on trolleys in A&E departments in some of the largest hospitals in the State.
Statistics provided to the Irish Medical News by the Irish Association for Emergency Medicine show numbers of patients on trolleys in A&E departments up to three times higher than this time last year.
Deputy Ó Caoláin said, “A year on from the publication of the Emergency Department Task Force Report pressure at some of the largest hospitals in the state is worse than ever. The Task Force was set up after Health Minister Harney said the A&E situation was a national emergency.
“Now we find that five major hospitals - Beaumont, Sligo General, the Mid-Western Regional, Limerick, Portiuncula in Ballinasloe and University College Hospital, Galway - are showing very significant increases in numbers on trolleys in the month of April 2008 as compared to the same month this time last year. Numbers trebled in Sligo and more than doubled in Beaumont and Galway.
“These figures expose again the glaring need to provide additional hospital beds to address this crisis. We also need to see the delivery of the promised network of primary care centres and step-down facilities to free up hospital beds at both ends of the hospital system.
“This Government wants to centralise virtually all hospital services to the very hospitals which are currently under most pressure. Such a disastrous policy must be reversed.” ENDS
To ask the Minister for Health and Children the number of Health Service Executive owned buildings in Donegal that are vacant; and the locations of same.
Responsibility for the management and delivery of health and personal social services including estate management was assigned to the Health Service Executive under the Health Act 2004. Therefore the Executive is the appropriate body to investigate the particular matter raised by the Deputy.
Accordingly, my Department has requested the Parliamentary Affairs Division of the Executive to arrange to have the matter investigated and to have a reply issued directly to the Deputy.
Deputy Caoimhghín Ó Caoláin: I seek the adjournment of the Dáil under Standing Order 32 to discuss a matter of urgent importance, namely, the failure of the Government and the HSE, one year on from the publication of the emergency department task force report, to reduce the numbers of patients waiting on trolleys in accident and emergency departments due to a lack of hospital beds, with five major hospitals - Beaumont, Sligo General, the Mid-Western Regional in Limerick, Portiuncula in Ballinasloe and University College Hospital Galway - showing significant increases in numbers on trolleys as compared to this time last year and the need to provide additional hospital beds to address this crisis, as well as the delivery of the promised network of primary care centres and the reversal of the disastrous policy of centralisation of virtually all hospital services to those centres which are currently under most pressure.
Deputy Caoimhghín Ó Caoláin: Regarding the limited time that remains between now and the summer recess, as has been alluded to, the Government should facilitate a debate within the House to address the deepening crisis within the health service. I speak specifically about the fact that this week we have seen the exposure of the ever-increasing number of patients waiting on trolleys in accident and emergency departments and at this time of the year—–
An Leas-Cheann Comhairle: We cannot have the debate now.
Deputy Caoimhghín Ó Caoláin: I ask if the Government will facilitate, over the period of the limited weeks ahead between now and the summer recess, an address of this crisis because if we do not address it now, what will the situation be like in the autumn and the winter period?
An Leas-Cheann Comhairle: The point is well made.
Deputy Caoimhghín Ó Caoláin: It is absolutely essential that that is done.
The Tánaiste: On the issue of health services and reform, that is a matter that has been discussed ad infinitum in this House, almost every day. If we wish to factor in debates, that can be done within the limited timeframe. We will have to prioritise and we will facilitate that prioritisation to the best of our ability.
Deputy Caoimhghín Ó Caoláin: Will the Chief Whip please take note of that?
An Leas-Cheann Comhairle: For the information of the House, Standing Orders require that a debate be promised before it is in order to be raised.
To ask the Minister for Health and Children if she has discussed with the Health Service Executive the decision to discontinue the post of specialist liaison nurse in Cavan-Monaghan for the care of patients who have self-harmed; and if she will make a statement on the matter.
I am advised by the Health Service Executive that there has been no cessation in the response to self harm presentations in Cavan/Monaghan.
Indeed, a range of liaison mental health services are provided by Cavan/Monaghan mental health services to the Cavan/Monaghan general hospital. Medical and nursing liaison is provided through home based treatment teams that provide a rapid response to presentations of acute psychiatric illness, including those involving self harm.
In addition, in February 2006, two clinical nurse specialists were appointed to the role of alcohol liaison between Cavan/Monaghan mental health services and Cavan/Monaghan general hospitals. This was in recognition of the established link between self harm and alcohol. These nurses have screened 1500 presentations to date and have engaged with more than 400 patients and their families.
The overall liaison services with Cavan/Monaghan general hospitals and therapeutic services are being reviewed and the role of deliberate self harm nurse will be examined in that context. The purpose of this review is to ensure that these services are consistent and needs-led. The National Office for Suicide Prevention (NOSP) will be consulted as part of the review process. In addition, the National Suicide Research Foundation in Cork is currently considering best practice in the area of deliberate self harm services in order to standardise the approach to service delivery.
To ask the Minister for Health and Children the number of persons with an intellectual disability and those with autism accommodated in psychiatric hospitals; the number of same accommodated in de-designated units which were formerly designated as psychiatric services; the numbers of same moved from psychiatric hospitals prior to 2002 to alternative accommodation which is now unsuitable for their needs; the names and locations of the hospital, units and other accommodation in each case; and if she will make a statement on the matter.
To ask the Minister for Health and Children the status of her Department’s programme to transfer persons with an intellectual disability or autism from psychiatric hospitals and other inappropriate placements; the progress made in implementing this programme since 2002; the number of persons moved from inappropriate placements to appropriate accommodation in each year since 2002; and if she will make a statement on the matter.
The National Intellectual Disability Database, (NIDD), report for 2007 identified 329 individuals with intellectual disability, all aged 20 years or over, as being accommodated in psychiatric hospitals. It should be noted that registration on the NIDD is voluntary.
An integral part of the National Disability Strategy is the Multi-Annual Investment Programme, (MAIP), announced in the 2005 Budget, which provides €900m for the provision of specific high priority disability services over the period 2006 to 2009. MAIP commitments include the development of new residential, respite and day places for persons with intellectual disability and autism in each of the years covered by the programme as well as the transfer of persons with intellectual disability/autism from psychiatric hospitals and other inappropriate placements.
The Deputy’s specific questions, in relation to the progress and details of the programme to move those individuals to more appropriate accommodation, relate to the management and delivery of health and personal social services, which are the responsibility of the Health Service Executive under the Health Act 2004. Accordingly, my Department has requested the Parliamentary Affairs Division of the Executive to arrange to have these matters investigated and to have a reply issued directly to the Deputy.
To ask the Minister for Health and Children the immediate action she will take to implement in full the recommendations of the Health Protection Surveillance Centre on the spread of C difficile and other hospital based infections.
I would like to assure the Deputies that tackling Healthcare Associated Infections (HCAIs), including Clostridium difficile (C. difficile), continues to be a priority for the Government and for the Health Service Executive (HSE).
The recommendations referred to by the Deputies are contained in the Guidelines for the Surveillance, Management and Control of C. difficile-associated disease which were published on 22nd May by the Health Protection Surveillance Centre. They give national guidance and deal with the isolation of C. difficile ribotype 027 for the first time in Irish hospitals. They will be a valuable resource in assisting in the prevention, management and control of this infectious disease. The HSE is considering the report at present to decide on its implementation and I have asked to be kept informed of progress on this matter.
As the Deputies will be aware, the HSE launched a National Infection Control Action Plan in March 2007. An Infection Control Steering Group, chaired by Dr. Pat Doorley, National Director (Population Health) is responsible for overseeing the implementation of the plan. Over the next five years, the HSE aims to reduce HCAIs by 20%, MRSA infections by 30% and antibiotic consumption by 20%. Achievement of these targets will benefit all patients who are at risk. These targets will be achieved through the development of national and local level action plans to reduce the potential for spread of infections between persons in healthcare settings, and, in addition, will focus on reducing antibiotic use in Ireland. The Steering Group is supported by eight Local Implementation Teams which will ensure that all local facilities are focused on achieving the national targets.
C. difficile was not, up to now, a notifiable disease and, as a result, it was difficult to quantify the extent of infection in the health care system. However, it was examined in the Third Prevalence Survey of Health Care Associated Infections (HCAIs) in acute hospitals in 2006. The survey found that thirty-six patients had C. difficile representing 0.5% of patients studied. In March 2008, the Chief Medical Officer of my Department instructed the HSE to make C. difficile a notifiable disease and since May 4th all cases are required to be notified to the relevant Department of Public Health. The number of cases reported to date is within the range identified in the 2006 Survey. The HSE will continue to monitor the data closely.
While accepting that not all HCAIs are preventable, I am satisfied that significant steps are being taken to reduce the rates of HCAIs generally and to treat them promptly when they occur.
Deputy Caoimhghín Ó Caoláin: What I am offering is not the definitive position of Sinn Féin. We are here to participate, to be convinced and to persuade. All these actions are required in coming to what is, to all intents and purposes, a negotiation. On reading my letter, I will leave the text with the Chairman.
As promised and for the purpose of Committee deliberations, I detail below the Sinn Féin proposals on the principles that we believe should guide the drafting of new legislation that would incorporate offences of strict liability.
Sinn Féin has deliberated on the submissions to the Committee, both written and oral, and the various suggestions that were made by Committee members when formulating our proposals for consideration by the Committee.
Sinn Féin proposes that any new legislation regarding strict liability offences incorporate the following principles:
that the Bill to amend the Constitution should limit strict liability offences to specifically sexual offences involving persons in a position of authority over a child under the age of consent for example, persons in loco parentis, a teacher or other person involved in education or training, sports coach or child minder/babysitter, where there can be no issue of mistake of fact as to the age of their charge.
that provision for robust protections for all vulnerable child witnesses in court proceedings based on existing Scottish laws be implemented and allow the courts to appoint a special commissioner to take evidence from child witnesses.
that the Bill to amend the Constitution should have inserted a provision stating that it is a constitutional imperative to consider the child’s best interests as paramount in all actions affecting children.
that a defence of “reasonably held” and “genuinely believed” mistake of fact as to age should be available in respect of sexual offences except to those in positions of authority over a child, where both subjective and objective criteria must be met for this to be valid.
Strict Liability Offences
‘Strict Liability Offences’ are offences that are independent of wrongful intent or negligence. Generally under criminal law strict liability offences relate only to summary offences triable in the District Court. (i.e. certain road traffic offences or littering offences etc). Due to their nature they do not require the same procedures as more serious offences. Serious offences to which heavy penalties apply require proof of guilty intent or negligence (i.e. mens rea) on the part of the accused.
Proposition 5 of the Twenty Eighth Amendment to the Constitution Bill 2007 [I am not referring to the Lisbon treaty] allows the Oireachtas to introduce any strict liability offences relating to children up to the age of 18. As this provision is not limited to sexual offences it is problematic and risks resulting in serious miscarriages of Justice.
We understand that the purpose of the denial of the defence of genuine mistake of age is to spare children the ordeal of cross-examination which that defence might entail and we support this purpose.
However, we are concerned that due consideration has not been given to whether such a Constitutional change is proportionate and absolutely necessary, given the potential for grave injustice that it entails. For example, [and this is my major concern on which I have reflected previously] if the age of consent for sexual intercourse is set by the Oireachtas at 16, a situation may arise where a 15 year old and an 18 year old who may have met in a pub or night-club (where the legal minimum age for serving alcohol and subsequent entry to the venue is 18) have consensual sex where the 15 year old has claimed to be 18.
Likewise, teenagers under the legal age of consent may engage in consensual sexual activity and be criminalised as a result. In particular we hold that the current situation whereby, for example, a 16 year old boy who has consensual sexual relations with a 16 year old girl is guilty of a crime is untenable. Sexual assault and exploitation involve an abuse of power. The relevant criminal law must be amended to distinguish between that and the consensual sexual activity between young people where no such abuse of power occurs. Unnecessarily criminalising children flies in the face of the most basic guiding child protection principles.
Persons in positions of authority
We believe the Bill should be amended to limit strict liability offences to specifically sexual offences involving persons in a position of authority only. A person in a position of authority over a child e.g. a teacher, sports coach or baby sitter can be under no illusions as to the real age of their charge - hence the defence of mistake of fact as to age will not be applicable.
In addition to this, provisions for robust protection of all vulnerable child witnesses in court proceedings based on existing Scottish laws must be introduced. Introduction of such protections would allow the courts to appoint a special commissioner to take evidence from child witnesses.
It is preferable to protect children through the insertion of a constitutional imperative to consider the child’s best interests as being paramount in all actions affecting children. This would allow the courts to prevent the cross-examination of a child except where they consider it absolutely necessary. This would also ensure that the office of the Director of Public Prosecutions is constitutionally obliged to consider the best interests of children when taking proceedings.
The Irish Council of Civil Liberties and the Irish Family Planning Association have recommended that the provision be restricted to persons in a position of authority over a child. [I cite two examples]. In the Supreme Court decision in Re: Employment Equality Bill Hardiman J. said:
“I cannot regard a provision which criminalises and exposes to a maximum sentence of life imprisonment a person without mental guilt as respecting the liberty or the dignity of the individual or as meeting the obligation imposed on the State by Article 40.3.1o of the Constitution: The State guarantees in its laws to respect, and as far as practicable, by its laws to defend and vindicate the personal rights of the citizen.”
In 1990 the Law Reform Commission recommended that the defence of a “reasonably held” and “genuinely believed” mistake of age should be available in respect of sexual offences except to persons in a position of authority over a child. In our view both the subjective (genuinely believed) and the objective (reasonably held) criteria must be met for this defence to be valid.
Sinn Féin is currently examining other issues related to the work of the committee, and I speak specifically about the age of consent, where there is a fairly intense debate. I hope colleagues will appreciate that I represent a party organised throughout the island of Ireland. It is not a question of just bringing on board my small cadre of colleagues in the Dáil and in the Seanad. It is a much wider engagement and there are many other competing issues for the time of all concerned. We will bring forward proposals on the other issues to which I referred in due course. It is a work in progress. I look forward to discussing the proposals of the Government and the other parties during the course of this committee’s ongoing deliberations, of which I will be a happy participant.
Deputy Michael Noonan: I was interested in Deputy Ó Caoláin’s contribution. His submission was interesting and well thought out. As I understand it, he did not offer a definitive recommendation for the age of consent. I understand why. He is of the view that the absolute zone of protection should be confined to persons in responsibility who transgress. This is not absolutely in line with the Law Reform Commission but it seems to draw on its recommendation.
Deputy Caoimhghín Ó Caoláin: It is close to it.
Deputy Michael Noonan: According to Deputy Ó Caoláin’s proposal, the defence of reasonable mistake would be available in all other cases.
However, I am not clear as to the Deputy’s view on sexual activity between a boy and girl of proximate age, where the boy is over the age of consent and the girl is under the age. I assume the participants would know each other’s age and that there would be no validity in offering the boy a defence of reasonable mistake. Has Deputy Ó Caoláin thought that through?
Deputy Caoimhghín Ó Caoláin: I am not sure one can make that assumption. It is one set of circumstances where the persons involved know each other—–
Deputy Michael Noonan: I refer to a long-standing relationship between a boy and girl, where the boy is over the age of consent and the girl is under the age.
Chairman: Deputy Noonan refers to a case where the persons involved are very close in age.
Deputy Michael Noonan: Yes, and each would know the other’s age.
Deputy Caoimhghín Ó Caoláin: Yes, the Deputy refers to cases where the young people concerned are of relative age compatibility. As I have said at previous meetings, I am concerned that in expressing this in a black and white way and in drawing definitive lines, we will create serious consequences for young people. Such young persons are not predatory and are not the type of person whose activities we seek to address substantively out of this process. There is a danger that we may end up criminalising young people who have no criminal intent and are not predatory. I am conscious, given my many years’ experience of local government and my exposure to a variety of people within the professions in my own community, that many people’s notion of the nature of a predator is not always accurate. A predator may be as young as 13 years. It is difficult to cater to every situation.
I am concerned that we are putting in place rigid directions whereby the courts will have no option but to apply the bleakest consequences for certain individuals who, in my mind and in the minds of many others, are simply other innocent young persons. As I stated in my submission, these concerns must be evaluated by the Director of Public Prosecutions. I do not claim to have all the answers. However, in participating in this committee, I seek to ensure that we do not facilitate the destruction of the lives of innocent young people - invariably young males. I claim no monopoly of wisdom in terms of how to avoid such a scenario, but I am very much of a mind that we must, as best we can, take account of all the eventualities that may present. We could never hope to forecast all of these with certainty. Even in the period since this committee was established, circumstances have arisen that one could never have second guessed and decisions have had to be made. We are trying to avoid a situation where innocent young people are criminalised. I cannot be any clearer or more prescriptive than I have been.
Deputy Michael Noonan: Has the Deputy considered a type of pre-trial situation in the absence of a jury, as referred to by the Minister?
Deputy Caoimhghín Ó Caoláin: Yes. There is merit in all these proposals. We have examined the Scottish approach and deliberated with colleagues north of the Border, where developments have recently taken place in the area of child protection and the criminal law. It is important that we seek ways to protect children from the potential ravages of cross-examination and the difficulties that presents. There are international examples of approach which we can point to and commend as worthy of consideration. I make direct reference to that in this three-page missive. I will leave it with the Chairman at the end of the meeting for circulation to members.
Chairman: The secretariat will distribute it.
Deputy Caoimhghín Ó Caoláin: Members will not be reading it in The Irish Times.
To ask the Minister for Health and Children if she will establish a national working group comprising children with specific speech and language impairments and their parents and key agencies involved in service provision including her Department, the Department of Education and Science and the Health Service Executive, with a view to reviewing and establishing agreed terminology and diagnostic criteria for specific speech and language impairments and addressing policy and service development.
Deputy John Moloney: Recognising the cross-cutting nature of the national disability strategy, the Government established the Office for Disability and Mental Health in January 2008. This office helps me in exercising my functions as Minister of State with responsibility for disability and mental health across the Departments of Health and Children, Education and Science, Enterprise, Trade and Employment and Justice, Equality and Law Reform. The office brings together responsibility for a range of different policy areas and State services which directly impact on the lives of people with disabilities and mental health issues. The office will aim to bring about improvements in the manner by which services respond to the needs of people with disabilities and mental health issues by working to develop person centred services, focusing on the holistic needs of clients and service users and actively involving them in their own care.
A key priority for the office is to support the implementation of the health sectoral plan under the Disability Act 2005 and the planned implementation of the Education for Persons with Special Educational Needs Act 2004. The office will focus in particular on facilitating the delivery of integrated health and education support services for children with special needs by further developing existing mechanisms for co-operation and co-ordination between the health and education sectors at national and local levels.
A cross-sectoral team consisting of senior officials from the Office for Disability and Mental Health, the Departments of Health and Children and Education and Science, the Health Service Executive and the National Council for Special Education meets on a regular basis to address issues arising in respect of the implementation of both Acts, as well as issues of cross-sectoral responsibility. The focus of the team is on the interaction required between the education and health sectors in order to advance and enhance services to people with disabilities. The matter raised by the Deputy regarding the provision of appropriate services to children with specific speech and language impairment must be considered within the overall context of preparations within the health and education sectors for the implementation of the Education for Persons with Special Educational Needs Act. I have asked the cross-sectoral team to consider the matter in this context and to report back to me in due course.
Deputy Caoimhghín Ó Caoláin: I tabled this question last week for a written response and I received almost exactly the same reply. I do not wish to begin on a feisty note but nowhere in the reply is reference made to speech and language therapy, even though this is the critical focus of my question. I ask the Minister of State to pass that on to those who assist in the preparation of these responses.
The Minister of State might take this opportunity to correct the remarks made by the Taoiseach on 14 May. He caused concern within the sector by suggesting that the shortage of speech and language therapists was caused by the requirement on new graduate therapists to undergo a one year period of supervised clinical practice. Does the Minister of State agree with the statement of the Irish Association of Speech and Language Therapists that the Taoiseach’s comment was ill informed and does he accept that one year of supervised clinical practice is an internationally recognised best practice approach for all health professionals? Does he agree that the problem is not caused by the requirement on new graduates but by inadequate resourcing, insufficient posts to meet the demand for speech and language therapy and poor management by the HSE?
Does he acknowledge that the services are not properly co-ordinated? Implementation is required of the recommendation by the Irish Association of Speech and Language Therapists on a national working party. The Minister of State referred to the cross-sectoral team but the critical difference between that and the proposed working party is that the latter would directly involve service users, including children and their parents, and the Department of Education and Science and the HSE. That is clearly absent from the formula used in the replies given to the questions tabled today and last week.
I acknowledge and welcome the 300% increase that has been made to the number of training places for speech and language therapists. However, that will not work on its own if it is not matched by the development of critical posts. With the recent HSE cuts, we face the prospect of increasing numbers of trained therapists leaving the country while children are deprived of the therapy they desperately need. I ask the Minister of State and his departmental colleagues to ensure that the increased numbers of trained therapists are retained within the system and that posts are opened up. They are clearly required given that children need intervention as early in their lives as possible.
Deputy John Moloney: I am not in the business of correcting the Taoiseach because he is usually right. I will not speak on his behalf until I consult him directly. The former Taoiseach, Deputy Bertie Ahern, established the new office with responsibility for disabilities and mental health, which has only been up and running since January last. Prior to that issues had always arisen in respect of the HSE and the Departments of Health and Children and Education and Science. The establishment of the new office represents an attempt to deal with these issues in one place. All of the issues to which the Deputy refers come within the remit of the office. As reports are received in the coming months, it will be our responsibility to decide how to proceed, particularly in the context of learning and special educational needs.
From the figures, one might obtain the impression that we are downgrading services. I do not wish to use the time available to rattle off details of what has been achieved. However, it is worth placing on record the fact that the number of physiotherapists has risen by 230, or 20%, that the number of occupational therapists has risen by 320, or 45%, and that the number of speech and language therapists has risen by 140, or 28%.
Deputy James Reilly: From impossibly low bases.
Deputy John Moloney: I accept that we are coming from a low base. However, I ask the Deputy to bear in mind that the office was only recently established. The Government recognises the importance of the work of the office. It also accepts that we need to catch up quickly and that is what we are doing.
The first priority on the agenda of the cross-sectoral teams is how the issues should be resolved and how the required professional staff should be put in place. I ask the Deputy to give the office a 12-month settling down period. When we return with a proposal in September or October, we will clearly show how we intend to deal with the matter of recruitment. It must be remembered that there are industrial relations issues with which we must deal. The awful reality is that when the jobs in question were advertised three to four years ago, we could not get people to even apply for them. The establishment of the office underlines the commitment on the part of the Government to ensure that the issues raised by the Deputies will be dealt with. We will communicate further with them in October or November when the process has been properly evaluated and when the position regarding need and demand has been established.
Deputy Caoimhghín Ó Caoláin: In a previous reply, the Minister for Health and Children, Deputy Harney, referred to the National Treatment Purchase Fund. Will the Minister of State, in the context of question I posed, indicate where stands the commitment in the programme for Government to ensure that any child under five waiting more than three months for occupational or speech and language therapy will be allowed to access these services automatically through the National Treatment Purchase Fund? How many children have been given such access?
Deputy John Moloney: I am evaluating the commitment to which Deputy Ó Caoláin referred. That evaluation will not be completed for at least six weeks.
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