Seanad E´Ireann

Vol. 189 Tuesday, No. 6 22 April 2008

DI´OSPO´ IREACHTAI´ PARLAIMINTE PARLIAMENTARY DEBATES

SEANAD E´ IREANN

TUAIRISC OIFIGIU´ IL—Neamhcheartaithe (OFFICIAL REPORT—Unrevised)

Tuesday, 22 April 2008.

Business of Seanad ………………………………205 Order of Business …………………………………206 Order of Business (resumed)……………………………221 Council Framework Decision: Referral to Joint Committee …………………224 National Skills Strategy: Statements …………………………225 Patient Safety: Statements ……………………………236 Business of Seanad ………………………………262 Patient Safety: Statements (resumed)…………………………263 Adjournment Matters: School Accommodation ……………………………265 Pharmacy Services ………………………………267 SEANAD E´ IREANN

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De´ Ma´irt, 22 Aibrea´n 2008. Tuesday, 22 April 2008.

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Chuaigh an Cathaoirleach i gceannas ar 2.30 p.m.

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Paidir. Prayer.

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Business of Seanad. An Cathaoirleach: I have received notice from Senator Alex White that, on the Adjournment of the House today, he proposes to raise the following matter:

The need for the Minister for Education and Science to outline the progress to date on the application for the redevelopment of St Colmcille’s senior national school and junior national school, Knocklyon, Dublin 16 and to allow the school to apply for planning permission without delay.

I have also received notice from Senator Joe O’Reilly of the following matter:

The need for the Minister for Education and Science to give final approval for the immediate construction of a new primary school at St. Mary’s Virginia, County Cavan as a necessary response to long-term chronic overcrowding of existing buildings and prefabs.

I have also received notice from Senator De´irdre de Bu´ rca of the following matter:

The need for the Minister for Health and Children to outline the contingency plans the HSE has in place if pharmacists withdraw from the community drug scheme from 1 May as they have publicly stated they will do.

I have also received notice from Senator Pearse Doherty of the following matter:

The need for the Minister for Health and Children to outline her plans to ensure that patients availing of the general medical card scheme and the drugs payment scheme will receive their medication from 1 May onwards in areas where pharmacies have indicated that they will no longer dispense medication under these schemes.

I have also received notice from Senator Cecilia Keaveney of the following matter:

The need for the Minister for Arts, Sports and Tourism to press for the launching and funding of the Report on the Sub-Committee on Arts in Education under the Arts Council, which relates to both the Departments of Arts, Sports and Tourism and Education and Science.

I have also received notice from Senator Maurice Cummins of the following matter: 205 Order of 22 April 2008. Business

[An Cathaoirleach.]

The need for the Minister for Enterprise, Trade and Employment to outline the current position regarding the request by Waterford Crystal for support aimed at saving 600 jobs in Waterford.

I regard the matters raised as suitable for discussion on the Adjournment. I have selected the matters raised by Senators Alex White, O’Reilly and de Bu´ rca and they will be taken at the conclusion of business. Senators Doherty, Keaveney and Cummins may give notice on another day of the matters they wish to raise.

Order of Business. Senator Donie Cassidy: The Order of Business is No.1, motion to approve framework decision re the exchange of information; No. 2, statements on the implementation of the national skills strategy; and No.3, statements on patient safety. It is proposed that No. 1 will be taken without debate at the conclusion of the Order of Business; that No.2 will be taken at the conclusion of No. 1, to conclude not later than 5 p.m. during which spokespersons may speak for seven minutes, all other Senators for five minutes and Senators may share time, with the Minister to be called upon ten minutes before the end of the debate for concluding comments and to answer questions from spokespersons; and that No.3 will be taken at the conclusion of No.2, to conclude not later than 7 p.m., during which spokespersons may speak for eight minutes, all other Senators for five minutes and Senators may share time, with the Mini- ster to be called upon ten minutes before the end of the debate for concluding comments and to answer questions from spokespersons.

Senator Frances Fitzgerald: Many people are extremely concerned about the very sad case in Our Lady’s Hospital for Sick Children in Crumlin, where the wrong kidney was removed from a child during an operation. The family wants privacy but given the enormous concern that a case like this raises among patients and families, whatever report is prepared should be made available as soon as possible. We must know the facts of the case. The pharmacy dispute continues to be of huge concern. I ask the Leader to raise the matter with the Minister for Health and Children and to reassure Members that steps are being taken behind the scenes — even if we are not being told about them — so that patients will not suffer if the dispute escalates. Clearly I would prefer it if the escalation of the dispute does not go ahead. I wish to refer to an issue raised in this House last week. I ask the Leader to apologise to Members on this side of the House for the comments he made regarding our approach to the Lisbon treaty.

Senator Maurice Cummins: Hear, hear.

Senator Frances Fitzgerald: Senator Cassidy was quite inaccurate in what he said. Fine Gael has taken a most proactive approach, as emphasised by the huge number of public meetings we have held, at which thousands of people attended. If there has been any delay in selling the merits of the Lisbon treaty, it has been on the Government side of the House. The Government has been very slow in circulating the kind of information people need. The level of ignorance about the Lisbon treaty and its merits is worrying. The treaty has not been sold by the Govern- ment at all. For the Leader of the House to say what he said last week to Fine Gael — the party that has done so much to promote the merits of the treaty — was very inappropriate and inaccurate. I ask the Leader to acknowledge the work that has been done throughout the country by Members on this side of the House. We are very aware of how important it is for 206 Order of 22 April 2008. Business

Ireland that this treaty is ratified. We are anxious that it be supported by the people and are very concerned about the lack of information. I look forward to the Leader’s response.

Senator Joe O’Toole: I agree with what Senator Fitzgerald has just said. Perhaps the Leader was not aware of the situation. I have been invited, along with a number of colleagues, to meetings organised by Fine Gael on the Lisbon treaty. All the activity in my area has been organised by Fine Gael. I am totally disinterested in this issue but Fine Gael has pulled out all the stops and deserves credit for it. A great deal of tosh has been uttered in the debate and people need to examine it. It is all fine and well for those who need a 150-page contract to buy a few acres of land to seek a simple document for us joining 27 countries in Europe. The notion that a simple document can be produced such as the Ten Commandments or the US Constitution is another way of inviting a million lawyers all over Europe to challenge us at every nip and turn. This must be a complex document and it is not drivel. Many pages are easily read but others are necessarily complex. The US Constitution only takes a few pages and it is very clear but it has given rise to court case, constitutional challenges and constant reinterpretation. It is not a correct comparison and that case needs to be made publicly. It is completely incorrect for commentators to say the treaty is drivel. It is easily read by anybody who takes the trouble to go through it but it is hard going. It must be a complex document. The document cannot be written so that it can be read by a third class child as it concerns the most difficult and complex set of arrangements ever put together. The new treaty encompasses the EU Charter of Fundamental Rights, which is also an easily read document and which is very like the US Constitution. Whichever people are right and wrong, we should make the case. The Minister for Agriculture, Fisheries and Food has done good work but she should ask the following simple question of every farmer in Ireland: Do they think a representative of one island off the western seaboard of Europe would have greater clout at the World Trade Organisation than a representative of all of Europe? That is the issue and, therefore, our focus should be on supporters of farmers throughout Europe. There are many to make it work that way. People in France and Holland voted against the draft constitution for reasons other than what was in it and we cannot allow that to happen with this treaty. Let us have a fair debate and people can make up their minds at the end of the day. It has nothing to do with the WTO or Commissioner Mandelson or anybody else. The treaty reduces the power and influence of people like Commissioner Mandelson, placing him on an equal footing with parliamentarians.

Senator Alex White: I support the comments of Senators O’Toole and Fitzgerald on the Lisbon treaty debate. I did not hear the Leader’s remarks last week and, therefore, I cannot comment on them. It does not serve us at all to engage in such cross-party slagging about who is doing more on the issue. We all have a responsibility to explain the terms of the treaty. Fine Gael is doing that where I live. In case colleagues miss any of the Fine Gael meetings, they will have an opportunity to attend a Labour Party meeting next Thursday night in Taney Parish Centre, Dundrum, where they will hear myself and others doing our bit to explain the treaty. Senator Mary White lives nearby and she might find a half an hour to come along. It is vitally important that information is disseminated on the treaty. There are complexities to it and Senator O’Toole is correct that in the lead up to the referendum people want information. They genuinely need information and guidance regarding what is in the treaty. We can have the more robust debate about voting “Yes” and “No” closer to the date of the referendum. We have a responsibility as public representatives to inform the public because there is a great deal of misinformation. 207 Order of 22 April 2008. Business

[Senator Alex White.]

On 30 January I raised the issue of an EU directive the Minister for Justice, Equality and Law Reform proposes to introduce in respect of the retention of information about all e-mail and Internet activity by citizens of the State for a period of three years. The Leader kindly wrote to me the following day but the issue has come to light again today. I seek a debate in respect of the range of offences it is proposed the statutory instrument will encompass. Of course people have concerns about Bank of Ireland, loss of laptops and retention of data, but when it comes to the State, it is vital the Houses of the Oireachtas should have a supervisory role in determining the law in this area. It is not good enough for the issue to be dealt with by way of statutory instrument. I ask the Leader to arrange for the Minister to come to the House to debate the matter and explain why he proposes to deal with the matter by way of statutory instrument rather than by primary legislation, which is the correct way for it to be done. Will the Leader revisit the issue and call upon the Minister for Justice, Equality and Law Reform to come to the House and facilitate debate on this important issue?

Senator De´irdre de Bu´ rca: I draw the attention of the House to the fact that today, 22 April, is Earth Day, a day that is marked internationally. The purpose of the day is to promote greater awareness of some of the threats that face our earth, the greatest of which is climate change. I congratulate the Minister for the Environment, Heritage and Local Government, Deputy John Gormley, on the series of advertisements his Department has launched recently to promote public awareness of the importance of this issue. The advertisements put forward the issue as a challenge our generation must face up to, similar to challenges faced by previous generations. I raise the issue because, when legislation and measures to deal with the issue arise in the Houses of the Oireachtas, I hope there will be cross-party support for them. I also call for an urgent parliamentary debate on the issue of data retention. It is ironic and somewhat disturbing that on a day when the leading story in the media concerns the fact that customers of a particular bank discovered their confidential data had been stolen and only belatedly reported to the Data Protection Commissioner, we hear the State is considering broadening Garda powers of request for Internet data under a new draft statutory instrument implementing European directives in the area of data retention. Unfortunately, as Senator Alex White said, it appears the definition of criminal offence will be broadened to allow gardaı´ to request e-mail and Internet data retained by service providers relating to any offence which could receive a maximum custodial sentence of six months. This would include offences such as public order offences, for example, a minor assault or refusing to move on when being asked to do so by a garda. As in many other policy areas, we must get the balance right. In the area of data retention we must find the right balance between protecting our common security and recognising that the issue of data retention is bound up with human and consumer rights. Protecting individual privacy must be a priority. I ask that the Minister for Justice, Equality and Law Reform come to House to explain how the statutory instrument is being implemented and the reason the definition of serious offence has been changed. I suggest we also should have a broader debate on the issue in both Houses. If we do not have that, we will see measures such as this being implemented without much debate, which is not in our interests.

Senator Joe O’Reilly: I missed the opportunity last week to be associated with the congratulations to Senator Cannon on his elevation and offer my congratulations to him today. I also congratulate Senator Terry Leyden on his elevation to the vice presidency of his political grouping within the Council of Europe last week.

208 Order of 22 April 2008. Business

I wish to raise an issue I raised at the beginning of the year, namely, the serious gridlock around the city that impinges on us all. It takes me approximately two and a half to three hours to get here and approximately one and a half hours to come through the last stretch into Dublin. This has serious economic and social consequences for the country. I propose that we have a debate on the re-introduction of a railway network. One of the arguments used against the introduction of a railway is that it would not be used sufficiently to justify the cost economi- cally. However, that it is not available means it will not be used. The same reasoning could have applied to a swimming pool constructed in my local area recently. The argument then was there would not be a throughput to use it, but it is being used when it is available and the same principle applies to railway. If people could have boarded a railway today in Navan and not stayed in the two and a half hours gridlock from Navan to Dublin, they would have happily boarded the railway. We should have a railway from Navan to Dublin with park-and-ride facilities at Navan and this should be linked up to Kingswood in my constituency. This should be replicated throughout the country. We should do a feasibility study as a matter of urgency on the introduction of railways and the costings. There is a compelling case to introduce a railway network immediately and, at a minimum, to do a study to establish the reason we are not doing this. If the railway was available it would be used. I ask the Leader for a debate on the introduction, costings and the prioritisation of railway. The quality of life of the people and the future of the economy and so many other issues depend on this. I ask that this be made a priority issue.

Senator Ned O’Sullivan: I ask the Leader if possible to arrange for the Minister for Communications, Energy and Natural Resources, Deputy Eamon Ryan, to come to the House and to initiative a debate on the question of energy security. This is an issue which is becoming more critical every day both nationally and globally. I ask that the Minister outline the Govern- ment’s position in the growing debate on the pros and cons of bio-fuels. This is in the context of increasing world hunger, whether the emphasis on the production of bio-fuels is positive or negative, and that it may be a crime against humanity as described in one of the leading newspapers yesterday. I ask the Minister to outline the Government’s position on the liquified national gas project which is planned for north County Kerry. It has now passed all stages of the planning process, including an oral hearing at An Bord Pleana´la. I ask that the Minister indicate his support for this project and that he would be prepared to get involved as a facilitator. The project is very much in line with his party’s policy. It is hoped to remove any outstanding concerns that may linger among a small group of the community. This project has the support of the entire business community and the support of the population of an area which is witnessing increasing unemployment.

Senator Dominic Hannigan: I wish to address the comments made at the end of last week by the Leader of the House where he implied that some of us were not doing our bit for the Lisbon treaty. He must have been asleep last week. One of our MEP’s was assaulted for trying to explain the treaty to people. I have attended three meetings on the Lisbon treaty in the last week, most recently this morning sharing a platform with the Minister of State at the Depart- ment of Foreign Affairs, Deputy Dick Roche, at the Irish Countrywomen’s Association day in Termonfekin.

Senator Jerry Buttimer: The Senator is lucky.

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Senator Dominic Hannigan: They were more civil than the crowd last week and I got out alive. I agree it is vital that we do our part and I can assure the Leader that he will not find us wanting on this side of the House. I wish to raise the issue of broadband. I read a report some days ago stating that Eircom has offered to upgrade the speeds of broadband in such gateway towns as Dundalk and Letter- kenny. There is no proposal to do anything in the commuter belt. Unemployment rates in the commuter belt are rising all the time especially in such places as Naas, Drogheda and Ash- bourne. We need to start investing in faster broadband speeds in such places. Broadband speeds in Japan are 100 times faster than speeds in Ireland. We need to do something about this. We cannot only work on the gateway cities. We need to look at the rest of the commuter belt.

Senator Eoghan Harris: In light of all the Taoiseach has done to promote pluralism in Northern Ireland, it would be a pity if he did not distance himself from the uses put by some SDLP councillors to the money made at a recent breakfast lunch fundraiser in the Carrigdale Hotel in County Louth. The Taoiseach may not be aware that some of the proceeds of that breakfast were being used to pay the fines of a group of five delinquent SDLP councillors who followed 12 Sinn Feín councillors in a tribal action to deprive Willie Frazer’s group, Families Acting for Innocent Relatives, the use of a community-owned hall in Armagh in 2002. It may well be that the SDLP did not advise the Taoiseach that some of the funds raised at that breakfast were going to be used to pay off these fines but in light of the fact he has done nothing but advance the pluralist cause and represent the progressive tradition, the Lynch tradition, in Fianna Faíl, it would be a tragedy if any construction could be put on this that Fianna Faíl was any way condoning the actions of these five SDLP councillors and the 12 Sinn Feín councillors who conspired to ban Protestants from the use of that public hall. Although I would not in principle be against Fianna Faíl having relations with the SDLP, as there are many things to commend it, it would be a pity if Fianna Faíl were to be led by local groups of SDLP councillors with local tribal agendas and be carried on their coat tails in these matters when it has broad national aims to carry out which may be contrary to the local aims of tribal SDLP and Sinn Feín councillors.

Senator Liam Twomey: They could have been led by worse.

Senator Eoghan Harris: This also illustrates another point: the danger of being carried on the coat tails of Sinn Feín policies in any matter. The SDLP allowed itself to be carried in that local area on the coat tails of Sinn Feín, much as some of the people who opposed the Lisbon treaty are allowing themselves to be carried by Sinn Feín fronts in the campaign and which led to the attack, which I deplore strongly, on Proinsias De Rossa, MEP, by elements within the anti-Lisbon campaign who are first cousins of the Shell to Sea gangsters who have been pollut- ing that campaign. I call on the anti-Lisbon people, as well as Fianna Faíl, to distance themselves from these Sinn Feín tribal elements with regard to both the Armagh issue and the anti- Lisbon campaign.

Senator Ivana Bacik: I support Senator Alex White’s call for a debate with the Minister for Justice, Equality and Law Reform on the issue of Internet and e-mail data retention which is being reported on in today’s edition of The Irish Times. I am delighted that Senator de Bu´ rca also has called for this and I ask her to use her influence within Government to ensure this statutory instrument does not see the light of day because it seems to me to encroach seriously on the constitutional rights of accused people and on the rights of us all in that it appears to enable the Garda Sı´ocha´na to request access to Internet and e-mail data for the investigation of any sort of offence which carries of maximum penalty of six months or more. This would 210 Order of 22 April 2008. Business undermine all the legal understanding of what constitutes a serious offence. In all other legislation, including the Bail Act, it is defined as an offence carrying a five-year maximum penalty or more. This is also of concern to business because the proposed statutory instrument would impose onerous obligations on business to retain such data for a period 12 months. We need to have this debated urgently. I also ask for a debate on another issue relating to pharmacies. There has been much discussion in both Houses about pharmacists and the Health Service Executive. I wish to raise an issue which has been brought to my attention by final year pharmacy students in Trinity College. They are very concerned about the lack of placements available to them for professional training. These are students coming to the end of their undergraduate course who need to have professional placements. Usually about 80% of the class would have obtained placements by now but this year only about 40% so far have obtained placements. They have contacted the Department of Health and Children about this issue and requested that more training placements be made available within hospitals, which is within the remit of the Minister for Health and Children to do, or that additional funding be made available to secure placements for them. This is a serious issue which will impinge on the future qualification of sufficient pharmacists in this country. I ask for a debate on this issue.

Senator Terry Leyden: I am grateful for the generous comments of my colleague, Senator Joe O’Reilly. I was delighted to accept the position of vice president of the Alliance of Liberals and Democrats for Europe as the member of the Fianna Fa´il party in the Council of Europe.

Senator Joe O’Toole: The word “liberal” is a bit of a misnomer.

Senator Terry Leyden: I also wish to congratulate Senator Ciaran Cannon on his election as leader of the Progressive Democrats. As someone from the west, it is a great honour for him and his family. I hope his deputy leader will also be another Member of this House, Senator Fiona O’Malley, who was runner-up in the contest. Will the Leader arrange a debate on the accession of the European Union to the European Convention on Human Rights? At last week’s April session of the parliamentary assembly of the Council of Europe in Strasbourg, a resolution recommending that the Committee of Mini- sters open negotiations immediately with the European Union on the arrange- 3 o’clock ments for and procedural implications of accession was accepted by 33 votes to three, with two abstentions. The main implication of the accession of the EU to the convention is that European citizens will be entitled to take the institutions of the EU to the European Court of Human Rights in Strasbourg, thus enhancing the transparency and accountability of the Union. While all member states are already parties to the convention, this important further step is required by the amended Article 6 of the Treaty on European Union. It is an aspect of the Lisbon treaty that has received little attention in this House or in the media. Statements on the Lisbon treaty will resume in this House tomorrow and this important but somewhat ignored aspect of the treaty merits a full debate. I heard callers to RTE Radio 1 this morning express dissatisfaction at the unavailability of copies of the Lisbon reform treaty. I agree with Senator O’Toole that a text of its size and complexity cannot be explained easily in a short document. The referendum on the Lisbon treaty is the most important issue facing the Irish people. The more debates we have in this House and the greater our efforts to ensure voters are informed, the more likely we are to increase support for the treaty. Ireland, with a population of 4.2 million, has a tremendous responsibility in deciding the fate of the 500 million citizens of the EU. It is a great honour and it is up to all of us to do our best. I acknowledge that all parties are playing their part in this regard. 211 Order of 22 April 2008. Business

Senator Liam Twomey: While it is a nice idea for Fianna Fa´il and the Green Party to celebrate Earth Day 2008, it is pathetic that we are allowed only ten minutes of questions and answers with the Minister for Health and Children, Deputy Harney, on the issue of patient safety.

Senator John Paul Phelan: Hear, hear.

Senator Liam Twomey: I do not wish to pre-empt the report into events at Our Lady’s Hospital for Sick Children in Crumlin. There have been numerous incidents in recent years that gave similar cause for concern, including events at Leas Cross and Barringtons Hospital and the cases of PJ Walsh in County Monaghan and Rebecca O’Malley in County Tipperary. There is no transparency and accountability in regard to patient safety. It is degrading to the status of this House that the Minister will give Members only ten minutes for questions and answers. Some weeks ago, a debate on littering and rubbish took place over several days. If we are serious about patient safety and making the Health Service Executive work for patients, there should be a much wider and lengthier debate on patient safety issues. I call on the Leader to make that happen.

Senator Cecilia Keaveney: At the plenary session of last week’s Council of Europe, an important report on adolescent suicide in Europe was presented. This report highlighted that in Ireland, as in many other European countries, many more people die by suicide than in road accidents. We have had many debates in this House on road safety but there has been insuf- ficient debate on suicide. I put forward an amendment calling for mechanisms to be put in place to equip and encourage teenagers to communicate with a supportive person when they feel under pressure or fearful or perceive themselves to have failed in some way. This amendment was passed unanimously. Discussion on this issue can be based on the recent report from the Council of Europe or on the extensive work done in this State. I ask the Leader to communicate with the Minister of State at the Department of Health and Children, Deputy Devins, who has responsibility for mental health, to ensure this issue is brought to the fore. We must discuss how we will enable students to be equipped and encouraged to communicate their fears, whether perceived or real. Either the Department of Education and Science or the Department of Health and Children must take the lead role in this endeavour. As usual, last week’s plenary session was attended by representatives of the 47 member states. I was surprised by the number of people who made a point of approaching the Irish delegation to wish us success in the campaign on the Lisbon treaty. This included the German Chancellor, Angela Merkel, and the Ukrainian Prime Minister. Warm wishes were conveyed that we should achieve a positive result. A strong report that was published last week showed that half of students have experienced some degree of bullying in school. I have raised on a number of occasions the need for a debate on bullying in the workplace. Perhaps both matters can be discussed in the context of a single debate on bullying which is something that can lead to suicide. Perhaps the issues I have mentioned could be tied together as part of a debate that is pertinent at this point.

Senator David Norris: Will the Leader contact the Minister for Foreign Affairs to wish him success with the forthcoming international diplomatic conference on cluster munitions, to be held in Croke Park? I hope a treaty can be produced on foot of that meeting. In light of the resolutions which were passed unanimously on an all-party basis by the Joint Committee on Foreign Affairs and this House, it is important for the Minister, Deputy Dermot Ahern, to hold the line in the interests of everyone. European countries that persist in manufacturing 212 Order of 22 April 2008. Business these appalling instruments of misery and death will be represented at the conference. They will seek to weaken what is already on the table. I hope we will hold the line in that regard. In that context, I welcome the announcement made a week ago or so by the Minister that the process of disinvestment of this State’s pension funds, etc. in companies that are associated with the munitions trade has commenced. We had been looking for such an announcement for some time. Can the Leader arrange a debate on the extraordinary disappearance of hundreds of children who had been placed in care by the Health Service Executive? We have no record of them. We do not know where they are or what has happened them. Some of them appear to have ended up in the sex trade, which is not something this country should support. I welcome the opportunity to speak on the Lisbon treaty tomorrow. There seems to be an automatic assumption that the only positive outcome is a “Yes” vote. It is not democratic to suggest that one has the right to vote as long as one votes “Yes”. Similarly, we should not patronise voters by telling them they cannot access a document that is amenable to “a third class child”, whatever that is.

Senator Joe O’Toole: I was referring to a child in third class in school.

Senator David Norris: Fine.

An Cathaoirleach: On the Order of Business——

Senator David Norris: To be fair, a Chathaoirligh, I gave Senator O’Toole advance warning of that little one. He made some arcane whispers to me about the need for a treaty that could be turned over two pages at a time, like the Book of Kells.

Senator Joe O’Toole: We can read one page a day.

Senator David Norris: I have attempted to look at this treaty.

An Cathaoirleach: Other speakers are waiting.

Senator David Norris: The closer I look at it, the less I like it. We know that 96% of it is the failed European constitution. If we are so democratic, why are we the only one of the 27 member states to give voters an opportunity to vote on the treaty? If it is such a wonderful thing and everyone knows it is right, why are we afraid to let people vote? Why do we have a new blossoming of European megalocrats, so to speak, who know better than their own popu- lations? Why are we getting so many conflicting messages? We are being told that our tax advantage, of which many European countries are jealous, will be guarded, even though the leaders of at least two or three major European countries which are in competition with us have convinced themselves they will be able to get rid of it. I do not like the insidious way in which, for example, a European Commissioner who commenced action against the provisions which permitted the churches in this country to get exemption from our equality legislation——

An Cathaoirleach: We are on the Order of Business.

Senator David Norris: It is an extraordinary thing that the Christian religions should want not to be covered by that legislation.

An Cathaoirleach: The Senator should ask some questions of the Leader.

Senator David Norris: When the Commissioner came to this country, he gave undertakings to a small unrepresentative clique of people in the same way as we got the protocol on abortion 213 Order of 22 April 2008. Business

[Senator David Norris.] in a previous treaty. That is not very democratic. I am making my way through the treaty. I have not yet decided how I will vote, although I am pretty close to deciding on a “No” vote.

An Cathaoirleach: The Senator should ask a question.

Senator David Norris: I am entitled to do that. I will distance myself from anyone who attacks an elected representative. I deplore the attack on Proinsias de Rossa, MEP.

Senator Jim Walsh: Are we having the debate now?

Senator David Norris: I also deplore the condescension that has been doled out to people who may honourably, decently and with integrity take a different view. That is not democracy, nor the Europe in which I want to be. I want to be in a social Europe, not a neoliberal economic mess.

Senator Eugene Regan: I hope that prior to the finish of the debate on the Lisbon treaty, Senator Norris can be brought around to vote “Yes”. He raises an interesting question as to why we will have a referendum in Ireland. It is not for constitutional reasons. It is because we have a tradition of having referenda in light of the Crotty judgment of 1986.

Senator David Norris: We are promised them and half the time they cancel them.

An Cathaoirleach: Senator Regan without interruption.

Senator Eugene Regan: The reason other member states do not have referenda is because they do not consider that the treaty has constitutional implications. It is also a question of sovereignty that each member state in accordance with its constitutional traditions will decide how it adopts treaty changes. This is an important point. With regard to the Lisbon treaty, I wish to take up the remarks of Senator Fitzgerald and those made by the Leader last week. I imagine his remarks about the approach of Fine Gael to the Lisbon treaty were made in the heat of the moment. However, I ask the Leader to withdraw those remarks and correct the record of the House. Fine Gael has been consistent on the Lisbon treaty and all previous treaties. We do not allow domestic political issues to get in the way and distract from what is in the interests of the country. Last week I did not have the opportunity to say a few words about the late President Hillery. I worked with him in his cabinet 34 years ago. He established the Irish presence in Brussels as we entered the EEC and he showed an independence and professionalism which has stood the test of time and has benefited Ireland in our 35 years of membership. I accompanied him, along with a former Senator, Neville Keery, when he addressed the Oxford Union in 1974. It was on this evening one of the major bombing incidents occurred. As a Senator, it was an honour for me to attend the State funeral of a man of honour and integrity. On an entirely different subject, we must discuss in this House the statements made by the outgoing Taoiseach and the incoming Taoiseach on the Tribunals of Inquiry Act. I believed the resignation of the Taoiseach drew a line in the sand with regard to the preoccupation of this House and the Lower House with the Mahon tribunal. Based on the statements made by the incoming Taoiseach yesterday, it seems a continuous effort will be made, and it will be his policy, to undermine the Mahon tribunal, ostensibly by calling into question the very legislation by which tribunals are appointed and which gives the power to the Oireachtas to determine the terms of reference of tribunals. 214 Order of 22 April 2008. Business

We all agree the tribunals have gone on too long. However, we must also agree it has been difficult and has taken a long time to get to the truth of the finances of former Taoisigh and Ministers. I do not want to prolong the discussion on this. However, I must ask the Leader whether it is the intention of the incoming Taoiseach and his Ministers to continue the process of undermining the Mahon tribunal by calling into question the Tribunal of Inquiries Act which the Standards in Public Office Commission and our ethics legislation have clearly outlined are essential to restore confidence in the political system.

Senator Jerry Buttimer: I congratulate Senator Cannon on his election and I wish him well in his endeavours. I echo the calls of Senators Fitzgerald and Regan on the Leader to clarify the record to show that we in Fine Gael are extremely pro-active with regard to the Lisbon treaty. I have been canvassing door to door for the past two weeks with Colm Burke, MEP. As Senator Norris stated, there is a great chance the Lisbon treaty will be defeated; it is not a fairytale. It is a reality resulting from the arrogance of the Government which has done very little to promote the treaty. It is incumbent on the Government to lead the challenge and join us on this side of the House in promoting the Lisbon treaty. I appeal to farmers not to vote “No” to the Lisbon treaty to get at the Government in respect of the WTO talks because they are a separate issue and the treaty will reduce the power of Commissioner Mandelson. I reiterate my appeal to the Leader, for whom I have much time, for a debate on aviation policy for which I have called on four occasions. I call for such a debate in light of the capitu- lation of the Government, aided by Senator Boyle and his party, in regard to the alleviation of the Cork Airport debt. A debt of \130 million has been levied on Cork Airport by the Govern- ment which includes Senator Boyle’s party. The Minister for Transport has not addressed this House on the issue. I put down an Adjournment matter on the issue but he did not come to the House nor did he turn up in Cork yesterday. He has treated the people of Cork badly and the silence of Senator Boyle on the matter belittles the statements he made on Cork Airport while in Opposition. I call on the Leader to arrange a debate on the Government’s aviation policy as a matter of urgency because the people of Cork have been let down badly by the Government.

Senator Ro´ na´n Mullen: I wish Senator Cannon the very best as he sets out on a great adventure. As a fellow east Galwegian, I can tell him that many people in that part of the country are very proud of his achievement, although we see him as somewhat reminiscent of an arctic explorer and hope he will get back safely from this adventure. As a former GAA referee, I am sure the Cathaoirleach will support me in saying that there is a need for a debate on conduct in sport. I was at the hurling league final last Sunday and the only thing wrong with that match was the result but one could not say the same about the football match. The president of the GAA was right in describing the conduct at the Dublin versus Meath match as “disgusting” and “unacceptable”. We need to ask ourselves whether it is time for a debate on promoting the best standards in sport. I recognise the GAA is doing its best but are suspensions for a number of weeks enough to deal with this problem? We have reached a situation where some of these outbreaks of brawling become the stuff of legend in that people talk of “the battle of Omagh” a couple of years ago and so on. When one considers not only the importance of sport as a means of uniting people and something which promotes healthy attitudes in the community, but also the fact we will pretty much be paying these participants in sport, we might be——

An Cathaoirleach: The Senator can raise that in the debate. 215 Order of 22 April 2008. Business

Senator Ro´ na´n Mullen: ——reaching the point where we need to talk about the GAA to understand what it is doing to resolve this problem.

An Cathaoirleach: There are rules. We can have a debate on sport if the Leader so wishes but we cannot go into the rules of any organisation and tell it what to do.

Senator Ro´ na´n Mullen: Speaking of fair play, it is important we do justice to people who cannot be present when we refer to them in the House. I am sure Senator Norris did not intend to mislead the House when he claimed last week that Professor Patricia Casey had been accused by Swedish researchers of making inappropriate use of their research and drawing inaccurate conclusions in her evidence in the Zappone-Gilligan case. The Swedish report in question did not exist at the time Professor Casey gave evidence. Not only that but the reference Professor Casey made to that Swedish research was to the effect of the importance of fathers in children’s development. That is a not a proposition which any reasonable——

Senator David Norris: UNICEF has reproached her as well for inappropriate and inaccurate use of——

Senator Ro´ na´n Mullen: That is not——

Senator David Norris: Let us come back to that.

An Cathaoirleach: Senator Norris has made his contribution so I would appreciate it if he would let Senator Mullen complete his.

Senator Ro´ na´n Mullen: He made it eloquently and at length.

(Interruptions).

Senator Terry Leyden: Senator Mullen should not let Senator Norris bully him.

Senator Ro´ na´n Mullen: The proposition that fathers are important to their children’s development is indisputable and we should not be surprised if, for some ideological reasons of their own, those Swedish researchers might have further difficulties with Professor Casey’s assertion that the best way to promote parental development is to support marriage between biological parents. However, we should remember that even academics are capable of being blinkered by ideology on occasions. I note that Senator Norris, whom I esteem greatly, has almost come out as a “No” voter on the Lisbon treaty.

(Interruptions).

Senator Ro´ na´n Mullen: I look forward to the debate on this issue.

An Cathaoirleach: I must call the next speaker. A number of speakers are offering and the time for the Order of Business has almost elapsed.

Senator Ro´ na´n Mullen: It appears he is coming out on the wrong issue in desiring that the European Union be able to over-ride the right of the Irish people to determine their employment equality legislation. Surely, that is desirable as an expression of the principle of subsidiar- ity. If Senator Norris is to come out as a “No” voter, I suggest he do so for more considered reasons.

Senator David Norris: I did not say that; that is rubbish. 216 Order of 22 April 2008. Business

Senator John Paul Phelan: Whatever about the violence on Sunday between the Dublin and Meath players, I thought we were going to experience violence in the House today between Senators Norris and Mullen. I again call on the Leader to invite the Minister for Agriculture, Fisheries and Food to this House. On each occasion since Christmas that I have been present in the House for the Order of Business I have asked for a debate on agriculture with particular reference to the World Trade Talks. Many Members attended the large demonstration last week at which farming organisations expressed their concerns in regard to Commissioner Mandelson’s proposals. It would be appropriate that the Minister attend this House sooner rather than later. The Leader might also invite the Minister of State at the Department of Enterprise, Trade and Employ- ment, Deputy McGuinness, who has responsibility for the World Trade Talks to attend this House with the Minister to hear the legitimate concerns of those involved in agriculture in respect of Commissioner Mandelson’s proposals. I echo some of the sentiments expressed by previous speakers in calling on the Leader to invite the Minister for Finance to this House. There have been several calls on the Leader each week by Government and Opposition Senators to invite the Minister to this Chamber to discuss the public finances, the economy, rising inflation and rising unemployment. It would be appropriate that we hear the views of the Minister for Finance on these particularly important subjects before he assumes the position of Taoiseach.

Senator Feargal Quinn: The Irish people have had a strong record for many years in terms of assisting the Third World and of providing aid. As Senator de Bu´ rca stated, today is Earth Day. We should take this opportunity to remind ourselves of the recently published statistic that more than 1 billion of the 6 billion people on Earth live on less than $1 per day yet food is increasing in price by approximately 20%. This puts these people into dire poverty and increases the risk of famine. As Senator O’Sullivan stated, it is time we debated this issue. Before I came into the House today, I visited the Irish National Environmental Showcase in the Royal College of Physicians which focuses on concerns in respect of climate change. Part of the problem is that given much of our food is being diverted to fuel, it is likely we will not have enough food to feed the world’s population. Let us ensure people do not come back to us in 20 or 30 years time and say that Ireland, a wealthy country, in debating issues such as the position taken by Commissioner Mandelson and Irish farmers, turned its eye away from the problems of the world and the 1 billion people likely to starve.

An Cathaoirleach: As there are three Members remaining to speak and there are only two minutes left for the Order of Business, I ask them to be brief.

Senator Dan Boyle: I again break the silence I have broken on three other occasions during the Order of Business in calling for a debate on national aviation policy. The Government has appointed a mediator to Cork Airport. The mediator’s report has been accepted by the board of Cork Airport. It is a situation which, unfortunately, we are going to have to learn to live with.

Senator Jerry Buttimer: Senator Boyle should read that script when in Opposition.

An Cathaoirleach: Senator Boyle, without interruption, please.

Senator Jerry Buttimer: He has changed his tune and is flying on one wing again.

Senator Dan Boyle: At least I am still singing in tune.

Senator Jerry Buttimer: Senator Boyle has changed his tune again. 217 Order of 22 April 2008. Business

Senator Dan Boyle: I support the call by Senators O’Sullivan and Quinn for a debate on energy and food security. No one has called for food substitution in relation to meeting the energy needs of the developed world. The more clear that message is and the sooner it goes out, the better.

Senator Jim Walsh: I ask the Leader if we might have a debate on the legislation under- pinning the tribunals. Soundbites such as we hear from Senator Regan is not the way to deal with this. It is a very serious issue that is costing the taxpayers an arm and a leg. I can understand that people in the legal profession would want to see it continue. It has really been a gravy train where excessive and exorbitant fees——

Senators: Hear, hear.

Senator Jim Walsh: In that regard, the Government is not blameless for having, in the first instance, agreed the extraordinary fees which these people are getting, but we must recognise that the chairmen of some of those tribunals in fact use their position in order to act more or less as shop stewards for the wealthy legal profession in extracting——

(Interruptions).

Senator Alex White: What are we listening to now?

Senator David Norris: That remark should be withdrawn at once.

An Cathaoirleach: Members should confine their comments to questions to the Leader

Senator David Norris: Excuse me, I am sorry, this is a democratic State and that is a most dangerous accusation to make about a legally established body and its chairman. It is outrageous and I demand that it be withdrawn.

Senator Jim Walsh: In regard to the tribunals, there is a Bill pending in the Lower House which is to come before us. I ask the Leader that the Bill be brought to this House as soon as possible.

(Interruptions).

Senator Jim Walsh: The Cathaoirleach will be aware that these are statements I have been making for the past four or five years——

Senator Joe O’Toole: On a point of order——

An Cathaoirleach: Senator O’Toole——

Senator Jim Walsh: The commissions of investigation legislation----

Senator O’Toole: On a point of order——

An Cathaoirleach: Senator O’Toole.

Senator O’Toole: On a point of order——

Senator Jim Walsh: ——came before the House two or three years ago. That legislation——

An Cathaoirleach: Senator Walsh, a point of order has been requested. 218 Order of 22 April 2008. Business

Senator Joe O’Toole: I believe the House has been disgraced by that remark. In all fairness we can have strong debate over and back but we have a long term rule that we do not have a go at people outside. The separation of powers is crucially important as well. There are constitutional and conventional reasons and a strong history of this House which should surely make it clear to Senator Walsh that he should retract that comment immediately.

Senator Jim Walsh: I wish to say——

An Cathaoirleach: I have always outlined that it is wrong to discuss people — whether a group or an organisation — from outside the House who are not here to defend themselves.

Senator David Norris: The Senator has made serious criminal charges.

Senator Jim Walsh: Can I say that the commissions of investigation legislation which was passed by these Houses during the time of the last Government——

Senator John Paul Phelan: The Senator has not withdrawn——

Senator Maurice Cummins: That is not what he said——

Senator Jim Walsh: ——clearly set down

(Interruptions).

Senator David Norris: I have asked the Cathaoirleach to rule that that remark be withdrawn. Will he give a ruling on it?

An Cathaoirleach: I inform Senator Norris that I have asked Senator Walsh to withdraw his comment.

Senator Jim Walsh: In that regard, I welcome the Cathaoirleach’s comments——

Senator Jerry Buttimer: The Senator should withdraw the remark.

Senator Jim Walsh: ——that we should not discuss people from outside this House. I have written to him about that matter in relation to Senator Regan who has consistently referred to people from outside this House and has been given tremendous latitude in that regard.

Senators: Hear, hear.

Senator Jim Walsh: Can I say——

(Interruptions).

Senator John Paul Phelan: No.

An Cathaoirleach: We are not discussing Senator Regan but another matter, namely, the point the Senator raised which I have asked him to withdraw.

Senator Jim Walsh: Can I say, regarding the comments I made about chairmen of the tribunals making representations to the Government with regard to the fees of lawyers, I stand over them 100%. It is absolutely true, a Chathaoirligh, and it should not have happened and should never have been acceded to.

Senator John Paul Phelan: The Senator should withdraw that. 219 Order of 22 April 2008. Business

An Cathaoirleach: I asked the Senator to withdraw that.

Senator Jerry Buttimer: He called them shop stewards.

Senator Jim Walsh: It is true and therefore I am not withdrawing it.

An Cathaoirleach: I cannot hear anyone.

Senator Jim Walsh: The record will clearly show that is the position.

An Cathaoirleach: I cannot even hear what the Senator said. Other Senators are asking why he did not withdraw his comment. I asked him to withdraw it and, with the interruptions, I could not hear what he said.

Senator John Paul Phelan: He just said he stood over it.

(Interruptions).

Senator Peter Callanan: The Senator should be allowed to repeat the comments——

Senator John Paul Phelan: He said he stood over them.

An Cathaoirleach: If the Senator continues with that, I will adjourn the House.

Senator David Norris: We now have an extremely serious situation. Senator Callanan has said that he is telling the truth, in defiance of the Cathaoirleach’s authority. It is a very serious constitutional matter.

Senator Callanan: ——and listen to the bloody airy fairy tales we are getting from over there.

An Cathaoirleach: I ask Senator Walsh if he withdrew his comment. I ask for silence.

Senator Jim Walsh: The disruption from the far side is totally out of order. The Cathaoirleach has made no attempt to protect me, which he should have done.

(Interruptions).

Senator Jim Walsh: It is still happening. I state clearly, regarding the point I made, that representations — strong representations — were made with regard to the continuance of the tribunal that unless the fees for the lawyers were agreed and maintained at a certain level, it would not continue. Those were made by former chairmen of the tribunal.

A Senator: Hear, hear.

Senator Jim Walsh: That is correct. That is a fact that anybody in this House can verify.

A Senator: True.

Senator Joe O’Toole: On a point of order——

An Cathaoirleach: In respect of the separation of powers, one must separate them.

Senator Joe O’Toole: On a point of order, as someone who has taken a middle of the road position in respect of this debate, has not been critical of the Taoiseach and has been fair and balanced, I cannot accept the situation we are in. If that remark, which referred to the chair of the tribunal as being the shop steward for the legal profession, etc., is not withdrawn, the House 220 Order of 22 April 2008. Business (Resumed) is in disrepute. If Senator Walsh is not prepared to withdraw it, I ask that he be named and asked to leave the House.

An Cathaoirleach: I have asked Senator Walsh to withdraw that specific remark on three or four occasions. To be fair to the Senator, I do not know if he withdrew it because I could not hear what he was saying.

Senator Jim Walsh: I have said what I have said. I stand over everything I have said as being factual. I would not have said it otherwise.

An Cathaoirleach: The House stands suspended.

Sitting suspended at 3.31 p.m and resumed at 3.41 p.m.

Order of Business (Resumed). An Cathaoirleach: We were dealing with the Order of Business and the Senator to whom I wish to speak is not in the Chamber at the moment. Therefore, the only thing I can do now is continue and ask the Leader——

(Interruptions).

Senator Maurice Cummins: The Senator should withdraw the remark.

Senator Joe O’Toole: The Senator should be named.

(Interruptions).

An Cathaoirleach: At the moment, until the man is present, I would prefer to continue. I would prefer if any Member I am to name is present when I am doing so. I would not like to do it in his or her absence. I would like to give any Member, no matter who it is, an opportunity to——

Senator Maurice Cummins: The Senator had the exact same opportunity as every other Member to attend when the bell rang.

An Cathaoirleach: I would like to give the opportunity to any Member to withdraw a remark. I would like to do that, to be fair.

Senator Liam Twomey: The sitting should be suspended for a further ten minutes.

Senator Nicky McFadden: The Senator should be here.

(Interruptions).

An Cathaoirleach: I am chairing this sitting. We will suspend for a further three minutes.

Senator Donie Cassidy: I understand that Senator Jim Walsh is watching a playback of the proceedings in his office. As his office is a short distance from here——

(Interruptions).

Senator Donie Cassidy: I will abide by the ruling of the Cathaoirleach with regard to the proceedings. 221 Order of 22 April 2008. Business (Resumed)

An Cathaoirleach: I will suspend the sitting until 3.55 p.m. I had a look at the playback myself. To be honest and fair — and I wish to be fair to everyone — I do not know if an apology was made. I could not hear, as other people were speaking.

Senator Eugene Regan: It most certainly was not.

Senator John Paul Phelan: There was no apology.

An Cathaoirleach: I listened to it and am not sure exactly what happened. I would prefer to deal with the matter when the Senator is here. I will suspend the sitting again for another three minutes, by which time I hope the Senator will be here. If he is not, I will move on the issue then.

Sitting suspended at 3.43 p.m. and resumed 3.46 p.m.

Order of Business (Resumed). An Cathaoirleach: I ask Senator Walsh to withdraw the remark.

Senator Jim Walsh: Could the Cathaoirleach clarify what remark I am being asked to withdraw.

An Cathaoirleach: As I understand it, the remark was that chairmen of these tribunals use their position to act as shop stewards for the legal profession. That is as I understood it and as I listened to it. I am asking the Senator to withdraw that remark.

Senator Jim Walsh: That is a comment that I would have made in this House previously. It is a comment which——

An Cathaoirleach: I do not want any elaborations.

Senator Jim Walsh: Can I just finish——

An Cathaoirleach: Please, I do not want any interruptions.

Senator Jim Walsh: Can I finish without interruption?

An Cathaoirleach: I do not want this to be made awkward for me as Cathaoirleach and I want all Members of the House to respect that. I am asking you a “Yes” or “No” question. You fully understand, as an intelligent Senator. I am asking you to withdraw the remark. If you withdraw it, that is acceptable but if you do not, I will have to take another step.

Senator Jim Walsh: I am not prepared to withdraw that remark but I am prepared not to put my colleagues in the position of having to vote on the issue. I would like to withdraw from the House.

(Interruptions).

An Cathaoirleach: I am asking you to leave the House for the remainder of the sitting today. I ask the Leader to reply to the Order of Business.

Senator Nicky McFadden: I understood that I was going to be given the opportunity to speak before the incident arose. 222 Order of 22 April 2008. Business (Resumed)

An Cathaoirleach: Time has run out. Two Senators on the other side of the House also missed out.

Senator Nicky McFadden: The Cathaoirleach made reference to three Senators and I thought I was the third one. That is fine.

An Cathaoirleach: No, there were two more Senators due to speak and I regret that they could not do so. I was doing the best I could. I call on the Leader to reply to the Order of Business.

Senator Donie Cassidy: Senators Fitzgerald, O’Toole, Alex White, Regan and Bacik all expressed their concern for the unfortunate child in Our Lady’s Hospital for Sick Children, Crumlin, who had the wrong kidney removed during an operation. We can all sympathise with their sentiments. On the issue of the pharmacy dispute, the Minister for Health and Children will be in the House this evening, from 5 p.m. to 7 p.m. Senators can raise the matter with her then.

Senator Paddy Burke: We only have ten minutes to speak.

Senator Liam Twomey: There will not be enough time.

Senator Donie Cassidy: On the issue of the Lisbon treaty, I did not mean to give the impression that Fine Gael was not actively involved, on a national basis. That was not meant to be the basis of my remark. I was speaking locally and I believe that is obvious if one checks the transcripts. I can tell Senators what is happening in County Westmeath.

Senator Nicky McFadden: That is unreal.

Senator Maurice Cummins: I have the transcript in front of me.

Senator Nicky McFadden: There have been several local meetings in that county.

Senator Maurice Cummins: We have checked what the Senator said.

Senator Donie Cassidy: I am pleased Fine Gael is going to play a full part.

Senator Nicky McFadden: Deputy Enda Kenny spoke on Midlands Radio. It was all over the Westmeath Independent ——

An Cathaoirleach: The Leader to reply, without interruption.

Senator John Paul Phelan: The Senator should give credit where credit is due.

Senator Donie Cassidy: I join Senators in condemning the attack on Mr. Prionsias de Rossa, MEP. That cannot be condoned by the membership of any political party. No matter how strongly people may feel about an issue, they do not have the right to make personal attacks such as the one made on Mr. de Rossa. I join with Senators in strongly condemning those who carried out that attack. Senators Alex White, de Bu´ rca and Bacik called for the Minister for Justice, Equality and Law Reform to come to the House to have a debate on e-mail and Internet activity. I will endeavour to put time aside for such a debate. Senator de Bu´ rca drew our attention to the fact that today is Earth Day and congratulated the Minister for the Environment, Heritage and Local Government, Deputy Gormley. I agree with the Senator’s sentiments regarding the challenge of climate change. 223 Council Framework Decision: 22 April 2008. Referral to Joint Committee

[Senator Donie Cassidy.]

I join with Senators Reilly, Buttimer and Mullen in congratulating Senator Leyden on his appointment as vice president of the political grouping within the Council of Europe. I also wholeheartedly congratulate Senator Cannon on being elected leader of the Progressive Demo- crats Party and I wish him well in his appointment. I look forward to working with him as the leader of his group. I commiserate with Senator O’Malley and I also wish her well in the future. Senators O’Sullivan, Quinn and Boyle called for a debate on energy security. I will set time aside for this, particularly to address the serious issues faced by Senator O’Sullivan’s constituency of Kerry North. Senator Hannigan sought a debate on broadband speeds. Everyone supports the Senator’s request and this issue will be debated at the earliest opportunity. I will pass on Senator Harris’s strong views on the issue he raised to the Taoiseach. Senator Twomey referred to the two-hour debate to be held later with the Minister for Health and Children. The Senator may not be aware that this debate will represent a new departure with the Minister engaging in a question and answer session for the final ten minutes of the debate. She will be present for two hours and this was agreed by the group leaders. The Senator should confer with his party leader if he wishes to raise a serious issue at the meeting of group leaders before the Order of Business on the first sitting day of the week.

Senator Liam Twomey: It is not long enough.

Senator Donie Cassidy: We are not in the Da´il. Senators Buttimer and Boyle called for a debate on aviation policy, with particular reference to Cork Airport. I would like to extend the debate to cover all airports, which serve our people well. Senator Mullen raised the issue of conduct in sport and I will arrange a debate on this. Senator John Paul Phelan called for a debate on the WTO talks. This was scheduled to be debated last week but due to the death for former President, Patrick Hillery, it had to be deferred. I will make the debate a priority in the coming weeks. The Senator also called for a debate on the economy, on which I previously made a commitment to the House. Senator Walsh sought a debate on the tribunals of inquiry. We could have a lengthy debate on this and I will endeavour to have it take place at the earliest opportunity. Senator O’Reilly asked about the rail link to Navan. The Minister for Transport, Deputy Noel Dempsey, who is from Navan, will be in the House tomorrow to introduce a Bill that will assist the Senator. He will be able to drive or avail of park and ride from Navan in a few years and he will have all the time in the world to deliberate on the way.

Order of Business agreed to.

Council Framework Decision: Referral to Joint Committee. Senator Donie Cassidy: I move:

That Seanad E´ ireann approves the exercise by the State of the option or discretion provided by Article 1.11 of the Treaty of Amsterdam to take part in the adoption of the following proposed measure:

a proposal for a Council Framework Decision on the organisation and content of the exchange of information extracted from criminal records between Member States, 224 National Skills Strategy: 22 April 2008. Statements

a copy of which proposed measure was laid before Seanad E´ ireann on 11th February, 2008, be referred to the Joint Committee on Justice, Equality, Defence and Women’s Rights in accordance with paragraph (1) (Seanad) of the Orders of Reference of that Committee, which, not later than 8th May, 2008, shall send a message to the Seanad in the manner prescribed in Standing Order 72, and Standing Order 74(2) shall accordingly apply.”

Question put and agreed to.

National Skills Strategy: Statements. An Leas-Chathaoirleach: I welcome the Minister of State to the House.

Minister of State at the Department of Enterprise, Trade and Employment (Deputy Sea´n Haughey): I apologise to the House because I have laryngitis and I hope Members will bear with me. I welcome this opportunity to discuss the national skills strategy and its implementation. Ireland’s ability to compete in an ever increasingly competitive global market place is now more than ever dependent on the skills and competencies of our labour force. The Government has long recognised that Ireland needs to have a competitive advantage in the area of skills to ensure it stays ahead of its competitors. Investment in education and training is key to securing competitive advantage. Our success in transforming our nation in both its economic and social development can be directly linked to our past investment in education and training and such investment will increase under the Government. Investment in education and training is not the sole reason for the dramatic transformation we have experienced over the past 15 years. However, without this investment, our workforce would never have become the bedrock for our remarkable success over recent times. In the information age, only competitive and knowledge-based economies have a future. The capacity for adding value, high productivity rates, and a high skills profile of the population will create economic and social progress. As one of the world’s most open economies, these features particularly apply to Ireland. We have been successful in attracting major international corporations to invest and support the development of indigenous business. However, key to both policies is the strength of our education and training system and the high level of skills of our graduates. The profile of employment has changed in this country over the years. We now have more and better paid jobs, an expanding services sector and a modern, expanding and evolving economy which is exactly as it should be. Our continued evolution as an economy is dependent on the skills of our citizens. Our future success will be determined by our ability to continue to meet the needs of enterprise. Recognising that future skills needs will play an ever increasingly important role in determining the future prosperity of our country, the Government established the expert group on future skills needs in 1997. The expert group is representative of the major private and public interest groupings. Its core function is to continuously and closely monitor 4 o’clock changes in the labour market, to anticipate movements in demand for skills and to ensure necessary adaptations are introduced. In 2005 the Minister for Enterprise, Trade and Employment asked the expert group to undertake a forecasting analysis and to map Ireland’s labour market and skills needs to 2020. This report, Tomorrow’s Skills — Towards a National Skills Strategy, was launched early in 2007. The national skills strategy contains an ambitious vision for the skills profile in Ireland in 2020. It shows clearly that if Ireland is to progress ahead of our competitors then we need to increase our focus on skills development at a number of levels. First, it shows that more than 225 National Skills Strategy: 22 April 2008. Statements

[Deputy Sea´n Haughey.] 70% or almost 1.5 million of our current workforce will still be in employment in 2020. It is vital, therefore, for our continued economic success that this cohort achieves its potential. Second, and probably most important, an additional 500,000 people need to be upskilled by at least one level on the national framework of qualifications by 2020. Third, it needs to be ensured the output from our education system reaches its potential. This will involve increasing focus on improving participation rates in upper secondary level to 90% and ensuring the progression rate to third level increases to 70%. Fourth, we need to address the skills needs of the immigrant population and those wishing to re-enter employment. The strategy also contains employment forecasts on a sectoral basis for the period up to 2020. These forecasts suggest certain sectors, such as the services and high value manufacturing sectors, will continue to experience employment growth in the years ahead. However, employment in other sectors is expected to remain constant or, in some cases such as agriculture and traditional manufacturing, decrease. This means we must prepare accordingly. The strategy has helped us to target specific skills and sectors that will become increasingly important in the next few years. It has allowed us to identify and address specific gaps in our skills base and it will help us to build an education and training system that will allow us to adapt quickly and respond to the changing global business environment. The national skills strategy will facilitate the development of Ireland’s competitive advantage in world class skills, education and training. The strategy is not a stand-alone policy initiative. It builds on Government policy, including the strategy for science, technology and innovation, the social partnership agreement, Towards 2016, and the national development plan, all of which contain specific commitments aimed at upskilling the workforce. These documents have set the agenda and objectives for what Ireland must achieve over the medium term if we are to continue to maintain and enhance further the living standards of our citizens. In an ever-expanding global marketplace the Government is committed to ensuring Ireland continues to embrace its transition to a knowledge-based economy. The focus has turned towards the implementation of the strategy. Given the broad nature of the objectives contained in it, an integrated approach led by the Department of Enterprise, Trade and Employment and the Department of Education and Science is required. An interdepartmental committee has been established to achieve this and I will chair the first meeting of that committee tomorrow. It will oversee the development of an implementation plan and its subsequent delivery and will consist of senior officials from the Department of Enterprise, Trade and Employment, the Department of Education and Science and the Department of Finance. The implementation plan will examine the existing provision of education and training and determine the key areas and initiatives that will require additional focus to achieve the objectives of the national skills strategy. It will also determine the key benchmarks and targets that will be monitored progressively over the 12-year period to 2020. I look forward to driving this process forward and am confident we will be successful in implementing the vision contained in the strategy. While the first meeting of the interdepartmental committee takes place tomorrow, significant progress has occurred already in terms of implementing several of the objectives of the strategy. For example, in parallel with the establishment of the interdepartmental committee, the expert group on future skills needs was asked to examine the potential of a number of innovative measures to incentivise both employers and employees to engage more fully in education and training. The measures under review include paid learning leave, individual learning accounts for employees, brokerage services to help firms identify training needs and source suitable 226 National Skills Strategy: 22 April 2008. Statements training, tax measures to increase the numbers undertaking training and upskilling, and the potential of regional advisory groups. The findings of the expert group will be considered in the context of developing the implementation plan for the skills strategy. While the State has a key role to play in achieving the vision contained in the national skills strategy, enterprises and individuals also have a major role to play. Enterprises need to identify clearly and articulate their short and long-term skills needs. This needs to be communicated proactively to education and training providers at regional, sectoral and national levels. Enterprises also need to work in collaboration with providers in developing programmes that respond to these needs. Public funds must be targeted at those who otherwise would not receive training, especially the low skilled. In this regard, the Department of Enterprise, Trade and Employment has instructed its two key training agencies, FA´ S and Skillnets, to increase their focus on this cohort, and has been active and innovative in the provision of training for this group. This has resulted in new measures being launched which aim to work with employer and trade union representatives in providing training for the low skilled. In particular, the strategic alliance project between FA´ S and the Irish Congress of Trade Unions has allowed for the training of trade union representatives in identifying the education, training and personal development needs of members and work colleagues. There is a special challenge for the higher education system as we strive to achieve key objectives, such as doubling the number of PhDs and growing our participation rate from 55% to 72%. This growth will be accompanied by a greater diversity in our student population, including diversity in terms of previous academic attainment, which in turn will create challenges regarding the development of new and appropriate teaching and learning methodologies. The growth must be managed so that high quality teaching, learning and assessment continue to drive the system. The Government is committed to the implementation of the national skills strategy and to continuing to improve and refine publicly funded education and training programmes. Over the course of the current national development plan, we will invest approximately \7.7 billion in the training and skills development programme. This will include investment in the upskilling of the workforce, offer enhanced opportunities for school leavers, invest in the activation agenda and increase the participation and engagement in the workforce of individuals who are not participating at present. We must realise that the achievement of the vision set out in the national skills strategy will be dependent not only on the Government but also on the willingness of employers, trade unions and individuals to commit to the need to upskill and participate actively in lifelong learning which will be crucial in enabling all learners to engage in the pursuit of ongoing education and training. Education and training should be seen not only as the preserve of the younger generation but as an essential tool in the development of people within and outside of the workforce at whatever stage of their life they may be. Only in this way will we enhance and contribute to the development of a knowledge-based economy. Accordingly, we must encourage greater participation in lifelong learning by facilitating and motivating employees to increase their skills levels and qualifications, to acquire new skills and knowledge in different areas and to renew existing skills to stay abreast of technology and other developments. This is something on which the Government has been focusing in recent years and it will continue to do so. I am determined the interdepartmental committee will work effectively to realise the objectives of the national skills strategy. Given the positive commitment of all, I have no doubt measurable progress will continue to be a primary feature of our education and training systems. 227 National Skills Strategy: 22 April 2008. Statements

Senator Jerry Buttimer: I welcome the Minister of State to the House. This is an important debate because the national skills strategy is of paramount importance to the nation, not just for the short or medium term but also for future generations. As the Minister of State said, our competitiveness is at stake and it is essential we succeed in upskilling the workforce. The Opposition side of the House supports the overall goals of the national skills strategy in terms of moving Ireland towards a knowledge-based society, the need to create high value jobs, emphasising arts and crafts and the need for higher qualifications. As a former director of adult education, I urge that the importance of adult education be stressed for all. We need to upskill and retrain constantly to maintain our necessary knowledge-based economy. We must focus on some of the statistics. Almost 30% of the workforce, 650,000 people, have only junior certificate qualifications. Some 10% have only primary level education or have no qualification and some 25% of adults have issues with basic literacy and numeracy skills. How realistic are the aspirations of the Government to upskill 330,000 members of the workforce up to leaving certificate level by the year 2020? I wish the Government well with that goal and hope we will all be here in 12 years to see if it has attained that. We need to improve access to adult education. There are still obstacles to people’s involvement in education. The Minister of State was in Cork last week for the lifelong learning festival which aimed to inculcate a love and desire in people to participate. I pay tribute to Tina Neylon, the organiser, and her crew and volunteers. Information empowers people. By giving citizens information and making it easy for them to participate, we demystify the learning experience. I commend people like MaírtıńO´ Fathaigh of UCC who have brought third level institutions into townlands and villages and the suburbs of our cities. They have made education accessible and removed the snobbish element attached to it. That is welcome. I note the role that community schools play, acting as providers. I have met with the National Association of Community Education Directors, NACED, in my role in Ballincollig Community School as has the Minister for State at the Department of Education and Science, Deputy Seań Haughey. This role of community schools maintains the traditional ethos of bringing people in, which is important. It is also important that we enhance the lives of people through participation in education. I ask the Minister to examine the role of the community education provider in regard to the self-financing ethos which inhibits some schools and directors of adult education from putting on courses because of the cost factor. We should not preclude the options for people because of cost and financial burden. People in the workforce at present with reasonably good qualifications may in ten or 12 years’ time, or less, have no job. This is because of the changing work environment, the evolution of different jobs and information technology becoming outdated. We need to work to prevent this. We need to invest in research and development and the Minister of State alluded to this in his report. We need to do this so that we can remain competitive and keep jobs in Ireland. The life long learning festival in County Cork has a simple motto, which is “Investigate, Participate and Celebrate”. In that simple motto, the investigation allows people to be part of the learning process which is creative and different from the three R’s which applied before we moved into the more innovative educational techniques. The festival encourages participation, which is fun and this helps to demystify education so that it is no longer a barrier and the formality is gone. We celebrate, whatever the educational achievement or level attained, which is important. I sometimes worry about the role of FETAC. I welcome the organisation and the framework being put in place, but schools and providers dealing with FETAC do not always get the necessary support. There can be difficulties in terms of trying to log on to the system with a 228 National Skills Strategy: 22 April 2008. Statements

PIN number — I refer to the provider here — and access can be difficult. Perhaps the Minister of State can examine this system to see how it can be made more user friendly. It is critical that people have the right skills. It is essential, given that this underpins the whole national skills strategy, that we have people in the correct categories and that we upskill people. We are committed to this. The obstacles that persist are those of time and finance and we have not addressed these. I hope if the Minister of State survives the Departmental changes next week — if he is not promoted of course — that he will take on board the need for adult education to be given priority. Adult education is critical to this national skills strategy and it is critical for the evolution of society. The leaving certificate should be the minimum target for everybody. I may get assassinated by the teachers unions for saying this, since I am a member, but perhaps it is time to examine the leaving certificate and change it completely. We should not be afraid to have a debate about this issue because the minimum standard for everybody should be the leaving certificate. I am a teacher of applied leaving certificate which is a wonderful addition to the school curriculum. It gives people who would have left school with no qualifications an opportunity to stay on and learn and, to use the life long learning festival motto, “Investigate, Participate and Celebrate”. We are behind the target for participation in adult education compared with other EU countries. The minimum level is 12.5% and we have a level of 8%. This compares to 35% in Sweden and 29% in the UK. Ireland is way behind. I reiterate to the Minister of State that we must equip people. Training people in employment must be a part of this process. Our party has made several proposals which I hope the Minister of State will consider. These include the proposed overhauling of the role of FA´ S. It is doing a wonderful job and I commend it and the community employment scheme. The amount of money devoted by FA´ S in its budget to re-training and up-skilling people is inadequate in the overall picture. I am concerned that the Minister announced only today that the first meeting of the new interdepartmental committee will take place tomorrow, given that the formation of the committee was announced to much fanfare some time back, nearly six weeks ago. I am open to clarification on this. The profile of our employment has changed. However the skills, up-skilling, training, investment in life long learning, investment in education for adults and investment in education for people who leave school early needs to be continued. This side of the House will be vigilant regarding the literacy and numeracy rates and we will pursue this issue. Deputy Brian Hayes will bring a motion in this regard before the Da´il in the coming weeks. It is important that we devote moneys and ample time for debate in this area. It is also important the resources are in place. I ask the Minister to recognise the role of adult education providers in community schools under the umbrella of NACED. They are doing an excellent job and deserve greater recognition.

Senator Brian O´ Domhnaill: Go raibh maith agat. Ba mhaith liom glacadh leis an deis seo faílte a chuir roimh an Aire Staít, an Teachta Haughey, go dtı´ an Teach inniu chun an national skills strategy a phle´. I welcome the Minister of State at the Department of Education and Science, Deputy Seań Haughey to the House. I welcome the opportunity to discuss the important issue of the national skills strategy. The Minister of State referred to the national skills strategy in September 2005. The Department of Enterprise, Trade and Employment, under the stewardship of Deputy Michea´l Martin, requested the expert group on future skills needs to undertake research to underpin the development of a national skills strategy. This 229 National Skills Strategy: 22 April 2008. Statements

[Senator Brian O´ Domhnaill.] was to include the identification of the skills required for Ireland to develop until 2020 as a competitive, innovation-driven, knowledge-based, participative and inclusive economy. The terms of reference of the study included the identification of skills required for Ireland to make the transition to a competitive innovation-driven, knowledge-based economy by 2020; to provide projections of the skills profile of the labour force necessary to make the transition required to such an economy and to compare that profile to that which current projected output would yield; and to provide training and education objectives where gaps and deficiencies are evident between the desirable situation and the likely supply. Skills and human capital development have played a significant role in productivity increases, economic growth and improvements in living standards in Ireland. Human capital development will continue to play a key role in economic growth into the future. Therefore sustained and enhanced investment in the educational and training infrastructure is essential to our economic and social development over the medium term. The national skills strategy report advocates and comprehensively justifies the need for a more highly educated workforce by the year 2020. This will involve both increased participation of young people in second and third level education, as Senator Buttimer mentioned, and the up-skilling of half a million people into the labour force. Accordingly, as the Minister of State mentioned, the Government has made provision for an investment of \7.7 billion in training and skills development under the National Development Plan until 2013. This includes \2.8 billion to improve workplace adaptability. The budget will include providing training for people in employment, upskilling those affected or likely to be affected by industrial restructuring, enhancing the apprenticeship system and providing progression opportunities for school leavers. The Government has significantly increased funding to FA´ S and Skillnets in recent years and has provided training opportunities for employed persons. Funding available to FA´ S has increased more than fivefold between the years 2004 and 2007 and up to last year totalled \43 million. Funding provided to Skillnets has increased almost threefold to \23 million for the period up to 2007. The expert group on future skills needs was asked to advise on a number of possible approaches to realising the objectives of the national skills strategy. We all need to be clearly informed by considerations of how best to make both employers and individuals more aware of the benefits of training and how significant resources and facilities can best be provided in an equitable way. The national skills strategy sets out clear, long-term objectives in developing Ireland’s human capital through upskilling, training and educational opportunities up to the year 2020 in just 12 years’ time. The strategy will be essential in ensuring Ireland’s education and training systems are able to meet the future demands of industry in the medium to longer term. One of the key recommendations of the national skills strategy is the need to raise the educational and skills levels of 500,000 people in employment. The upskilling of 500,000 individuals within the workforce leading to awards on the national framework of qualifications is a significant challenge which will require new and innovative delivery models. It will require convincing both employers and employees of the need and value of upskilling in a knowledge economy. The Government, employers and individuals will have to work together if we are to achieve this objective through significant additional investment in the labour force. Approximately \7.7 billion will be used in the course of the national development plan to support training and skills development. This is indicative of the importance the Government attaches to having a skilled, productive, flexible and mobile workforce that will support national competitiveness and sustain economic and social prosperity into the future. 230 National Skills Strategy: 22 April 2008. Statements

In 2006 the Department invested almost \480 million in training programmes operated by FA´ S, Skillnets and other organisations to upskill the labour force. Out of this sum, \280 million was allocated to training programmes to prepare people to enter employment. A further \70 million was provided to train those in employment, a significant increase on allocations in recent years. In addition, \130 million, a significant increase on the previous year’s provision, was made available to fund apprenticeships and training programmes in 2007. The Minister of State at the Department of Education and Science, Deputy Sea´n Haughey, recently announced a new interdepartmental committee with responsibility to implement the national skills strategy. The first meeting of that committee takes place tomorrow and will be chaired by the Minister of State. It brings together all the stakeholders and is critical to the future development of skills. I wish the Minister of State well in his endeavours. The committee brings together for the first time all the key agencies responsible for adult learning and training and enables us to develop an integrated implementation plan for the upskilling of our workforce. This committee will have a strong and hands-on role. The national skills strategy sets an overall objective of upskilling 500,000 people by 2020. This is a significant undertaking and a very challenging task. The balance of skills demanded for the workforce is changing and we must respond fully to these changes to facilitate the growth of a knowledge economy and ensure Ireland’s global competitiveness well into the 21st century.

Senator Brendan Ryan: I welcome the Minister of State to the House. The report from the expert group on future skills needs, entitled Tomorrow’s Skills, is an excellent resource based on sound research and will be very useful if acted upon to plan for the delivery of the skills required for our future economic growth. It sets out a sound and well-crafted vision of Ireland in 2020 in which a well-educated and highly skilled population contributes optimally to a competitive, innovation-driven, knowledge-based, participative and inclusive economy. If Ireland is to prosper and generate more and better jobs, we must invest in our people. A knowledge- based economy requires a skilled, flexible and adaptable workforce based on strong educational attainment and ongoing training and skills enhancement. In modern economies, an increasing number of people will move jobs several times in the course of a career and retraining and upskilling beyond the traditional education years will be essential to enhancing productivity and protecting the employability of individuals during these transitions. Education and learning also should be valued for their own sakes. The opportunity to learn should be flexible and open to people of all ages, backgrounds and needs, whether in work, at home or retired. This report is about upskilling the workforce, however, and I wish to deal with some of the issues involved. As well as the vision, the report sets out a number of specific objectives based on analysis of current skills, albeit 2005 figures; a projected skills profile for 2020 if there is not a policy shift; a projected demand for skills based on current economic mix; and the skills required if we are to realise the vision. The specific objectives are as follows: 48% of the workforce should be qualified to NFQ levels six to ten, as against 38% if we continue as is; 45% of the workforce should be qualified to NFQ levels four to five, as against 44% if we continue as is; and 7% of the workforce will remain at NFQ levels one to three, down from 28%. This is a major challenge which should not be underestimated, especially at levels one to three, because our participation rates in continuous learning are quite low compared with other countries. An additional 500,000 people will have to progress by at least one level and the estimated cost over a 13-year period is in the region of \460 million. Much of the work will need to be done pre-employment while a great deal will need to be done within employment. Major chal- 231 National Skills Strategy: 22 April 2008. Statements

[Senator Brendan Ryan.] lenges exist. The challenge of upskilling 500,000 people in employment, is immense. We must increase support for employer-led training networks delivered through Skillnets and the enterprise development agencies. Greater support should be provided for training networks that focus on transferable skills such as information technology literacy, particularly in the case of low skilled workers. We must accelerate the development of a national framework of qualifications which is well understood and recognised by individuals, employers and providers and which makes access, transfer and progression a reality. This will require the rapid development of the certification and accreditation system to ensure workplace learning can be properly certified and recognised. The one-step-up approach to skills enhancement being rolled out by FA´ S is a very good idea which has been well communicated and will continue to form part of the solution. The role of FA´ S must be enhanced and it must be challenged to achieve greater focus and efficiencies. FA´ S should be given a strong mandate to expand work training schemes and apprenticeships and to empower individuals and small businesses to access relevant training. We must provide for and encourage workers to take two weeks’ paid study leave from work. This should be paid for out of the social insurance fund. We should make this mandatory for the employer and employee and this should be based on a proper training needs analysis and should be individually tailored where possible to avoid putting unbearable pressure on any individual. A proper training needs analysis for all employees, together with an individual training plan for every employee and a target spend of at least 3% of turnover, should be made mandatory to achieve certain supports or else incentivised in some way to achieve greater supports. Many employers and employees, particularly in the small and medium enterprises, SME, sector, cannot see the day when their company or job might cease to exist. They are operating in their comfort zone and see no immediate benefit in moving out of it. However, the changes that are happening must be confronted. Business models that made sense and were successful a decade ago are rapidly running out of time. Trade unions and employer organisations have a role to play in bringing about a change in mindset in this regard. Both are rising to the challenge. Employers must be convinced that identifying skills needs and providing training for their employees will benefit their firms to the extent that they are prepared to make the investment. This report sets out the vision for and objectives of a national skills strategy, deals with the key issues to be addressed and acknowledges the difficulties and costs. However, it does not provide strategies for the delivery of those objectives. In fairness, it does not purport to do so. Instead, it proposes that an implementation mechanism under the auspices of the Departments of Enterprise, Trade and Employment and Education and Science be put in place. The first meeting on the implementation of such an approach will take place tomorrow. This process must include all the stakeholders, without becoming too large and unwieldy. The report rightly states that a one-step-up approach must include a broad range of providers, including universit- ies, institutes of technology, vocational education committees, Skillnets, FA´ S and other Government agencies and education providers. Trade unions, through the ICTU, and employer bodies should also be involved. This is a useful and worthwhile report which sets out the overall vision and identifies the objectives and the issues to be tackled. The time has come to deliver the strategies that will meet this vision. In preparation for today’s debate, I contacted Forfa´s to ask when the first meeting on the implementation strategy would be held. I was informed that it took place in March. I am pleased the next meeting is tomorrow but surprised at the news that it is the first 232 National Skills Strategy: 22 April 2008. Statements one. I commend the strategy but urge that it be acted upon without delay. There must be a high-level commitment to its delivery.

Senator Dan Boyle: This is an important debate at a time of economic change and adjust- ment. During the height of the Celtic tiger, the economy perhaps relied too greatly on the construction industry. For example, some 14% of GDP was produced by the house building boom. Now we have a situation where fewer houses will be built and where those involved in the construction industry must seek either to regrade their skills or secure alternative employment. Thankfully, one opportunity already exists. Although some 50% of our housing stock was built since 1990, many of these properties were not constructed to proper energy standards. This presents a great opportunity to augment the skills of workers in the construction industry so that they can retrofit the existing housing stock to make it more energy efficient. The Government has an important role to play in helping to implement the targets and objectives outlined in the national skills strategy. In particular, we must consider the changes required in the education system. I recently attended several events in Cork that gave me great heart for the future. One of these was an awards ceremony for participants in the Ballyphehane- Togher community development project. While there has been much talk of third and fourth level education, informal education in community settings is playing an increasingly important role in helping people attain basic skills, including literacy, communications skills and computer and information technology skills. At this event, certificates were handed out by the Minister of State at the Department of Community, Rural and Gaeltacht Affairs, Deputy Carey. It was a joyous occasion celebrating those who had acquired particular skills in a community setting, a service that would not have existed ten to 15 years ago. Such projects are a welcome development in terms of providing basic skills education for people in their community. In the case of Ballyphehane-Togher, the project is also used as an education centre for workers from An Post who are located nearby. The links between community education, formal education and further education will be an important element in rolling out our skills strategy in the future. The term “upskilling” is unsatisfactory. It is a question of adding to people’s skills and putting those skills in a new context. People’s skills are valid throughout their working lives. We must look too to reskilling people in skills that may have lost their practice. The second event I attended in Cork in recent days was the Irish Heritage Trust function arising from the announcement of the Minister for the Environment, Heritage and Local Government in regard to Fota House. Much of the restoration work involved in that project, including carpentry, plastering work, the restoration of windows and so on, involves skills that are fast disappearing. As well as teaching the new skills of information technology, we must look to reviving skills that have been lost. If we can make that marriage of convenience, I am confident the skills strategy will achieve its objectives.

Senator John Paul Phelan: I propose to share time with Senator Ormonde.

An Leas-Chathaoirleach: That is agreed.

Senator John Paul Phelan: As Senator Boyle remarked, it is opportune to have a debate on the skills strategy at a time when there is some difficulty within the employment market. Pre- vious speakers have observed that the unemployment rate is the highest for several years, with the ESRI predicting a rate of 6% by the end of the year. This represent a significant change from the situation that prevailed in recent years. It is appropriate that we take stock at this juncture. 233 National Skills Strategy: 22 April 2008. Statements

[Senator John Paul Phelan.]

As a former maths teacher, I have a particular interest in this issue. I hope I never have to return to my former occupation. In the midst of the general discussion on upskilling, there are some startling statistics on the problems in the education system at primary and second level and the difficulties experienced by many adults as a result. A recent survey by the National Adult Literacy Agency showed that up to one quarter of adults have difficulty in filling out official forms. Some 40,000 adults are currently availing of adult literacy courses run by vocational education committees throughout the State. It is a deep rooted problem but this section of the population seldom receives adequate consideration. Upskilling efforts must include the entire workforce instead of focusing only on those who aspire to go on to third or fourth level education. I encourage the Minister and the Department to provide greater investment in services for adults seeking to improve their literacy. We must ensure that all children have attained basic literacy levels on leaving primary school. Sadly, that is not the case at present.

Senator Ann Ormonde: I thank Senator John Paul Phelan for sharing time. I have a particular interest in the issue of how we my assess future trends. I welcome the skills strategy, which highlights the current situation and outlines what can be achieved via education and training between now and 2020. The Minister of State, Deputy Haughey, spoke about access to career guidance. That is crucial. Community education is of vital importance. Those involved in such projects can link up with employers and identify trends. They know the service industry is on its way up. They know that areas like traditional manufacturing and agriculture are on the decline. Such people can come together. The community should help to develop the skills of the future. I ask the Minister of State to concentrate on community education. We need to use awareness programmes to identify and highlight the benefits of education and training. We need to consider how we can reach every household. Many people want second chance education. Some people did not even get a first chance. Many people want to get back into education and training. Like Senator Boyle, I hate to use the word “upskilling”. Many people want to change job styles in some way. We need to increase awareness of what is available. I spoke this morning to a lady who asked me what the House would discuss today. I said we would debate second chance education and lifelong learning. Adult education, which can be described as the scenic route, is the way forward. I know the Minister of State’s heart is in the right place. I ask him to identify how we can reach out to people as part of an awareness campaign. The community does not know what is available. People do not know what they can pursue. Are the courses flexible? Are employers flexible? Will those involved in adult education be given time off? We need to keep community education fairly simple and tight if we are to get to the root of it. Small is beautiful. If we start in the community, we will quickly identify certain trends and we can have a competitive, knowledge-based economy by 2020. We can reflect the needs of this country as we go along. I wish the Minister of State well. The ideas which underpin this concept are excellent. This national strategy will help us to think about these matters. I know the Government has invested more than \25 billion in the national development plan, which will help us to pursue the Minister of State’s agenda in this area. If I can help the Minister of State in any way, I will be happy to do so. I have been interested in this area for some time. I made a career in this area before I came to this House. Like Senator John Paul Phelan, I do not want to go back to that career. I am very interested in this matter.

Minister of State at the Department of Education and Science (Deputy Sea´n Haughey): I thank Senators for the contributions they made during this evening’s constructive debate on the implementation of the national skills strategy. I welcome the support of all Senators for 234 National Skills Strategy: 22 April 2008. Statements the validity of the strategy, as a national policy, and the importance of its aims and objectives. I thank Senator Buttimer, who raised a number of issues, for his general support for the strategy. I accept that the targets set out in the document are ambitious and that it will be challenging to achieve them. A number of Senators, including Senator Buttimer, mentioned the question of literacy, which is extremely important in the context of this discussion. The acquisition of adequate literacy skills is necessary if participants are to derive any benefit from the education and training courses in which they engage. Adult literacy involves not only reading and writing, but also numeracy, social and personal development, learning to learn and information technology skills. The Department of Education and Science attaches great importance to improving literacy levels. It has increased its funding for adult literacy from \1 million in 1997 to more than \30 million this year. As a consequence, the number of adult learners catered for annually increased from 5,000 in 1997 to almost 44,000 in 2007. Some speakers mentioned the role of the National Framework of Qualifications. It is important to note that the establishment of the National Qualifications Authority of Ireland and the subsequent development of the National Framework of Qualifications, in 2003, revol- utionised how we compare various educational qualifications and levels of learning outcome. These developments have brought a welcome degree of transparency to learners of all ages and stages. They emphasise the potential for further broadening and growth of routes of entry to continuing, further and higher education. A number of Members, including Senator Ormonde, spoke about the importance of community education. As Minister of State with responsibility for lifelong learning, I fully accept, acknowledge and support the role of community education in the overall context. The budgets which have been made available in this regard have increased substantially in recent years. The vocational education committees are doing a great deal of work on the ground to promote community education. Senator O´ Domhnaill correctly highlighted the importance of the national skills strategy and pointed out that a substantial amount of money — \7.7 billion — has been earmarked for training under the national development plan. It is extremely important, in the context of our overall economic development, that such funding is provided and the necessary training is made available. I thank Senator Ryan for his constructive suggestions, many of which are being considered by various organisations. The expert group on future skills needs is examining a number of issues on foot of the publication of its initial strategy. It is involved in ongoing work in that respect. Many of the subjects the Senator mentioned are being studied and reports on them are expected in the coming months. I assure Senator Boyle, who expressed concerns about the construction industry, that FA´ S and the expert group on future skills needs are examining the upskilling needs of construction workers. The Government is conscious of the fact that many workers will need upskilling as the construction sector slows down. Reports and recommendations to tackle this urgent issue are being prepared by FA´ S and the expert group. I look forward to receiving those reports. The establishment of an interdepartmental committee comprising representatives of the Departments of Education and Science and Enterprise, Trade and Employment was formally announced in the Da´il on 22 February last. Some discussions have taken place since then at Civil Service level to prepare for the first formal and official meeting of the committee, which I will chair tomorrow. I am not sure about the other meetings to which Senator Ryan referred. I can state categorically that the interdepartmental committee will have its first formal meeting tomorrow. Its agenda will be set out during the discussions which will take place at that meet- 235 Patient Safety: 22 April 2008. Statements

[Deputy Sea´n Haughey.] ing. The committee was established on foot of an essential recommendation made by the expert group on future skills needs. It is now up and running, in effect. I hope an implementation plan can be agreed before the end of the year, at the latest. Senators have suggested that financial problems are making it difficult for people to engage in adult education. The Government’s back to education initiative is an important part of this country’s adult education system. It is being availed of free of charge, on a part-time basis, by many people who do not have upper second level education. Some 9,500 places are offered as part of the initiative, which was announced last year to make it easier for people to undertake adult education. There is lots happening. I thank Senators for their support. I think everybody is agreed on the strategy. It is now a question of implementing it in the most effective way, as soon as possible.

Patient Safety: Statements. An Leas-Chathaoirleach: I welcome the Minister for Health and Children, Deputy Harney, to the House.

Minister for Health and Children (Deputy Mary Harney): I am happy to be before the Seanad to speak about the issue of patient safety. A new era has arrived in the Irish health care system. It is an era where patient safety is central to everything we do. The journey of ensuring the setting of standards and the enforcement of those standards has begun with a couple of key milestones. The first was the establishment of the Health Information and Quality Authority, HIQA, a State body independent of service providers whose sole remit is to set standards and monitor their enforcement. I will speak more on this later. Patient safety is central to the manner in which we regulate health professionals. Just over a year ago, we brought through the Oireachtas major legislation which reformed the Medical Council. At present, elections to the new Medical Council are taking place. In particular, the fact that the new council will have a lay majority is a significant step in ensuring the profession does not regulate itself. Ireland is the first country in the world to embrace a lay majority but I am aware of several jurisdictions following in our footsteps. The same applies to the changes made to the legislation governing pharmacists, which was almost 200 years old. The new Pharmaceutical Society of Ireland, which I established last summer, also contains a lay majority. I understand from the society that it is working incredibly well in terms of the regulation of the pharmacy profession. As part of the patient safety agenda and journey upon which we have embarked, we must ensure that when errors and mistakes occur they are properly investigated so we can minimise the capacity of those mistakes ever happening again. We must learn from errors and not in a culture of blame. If I have learned anything over the past three years from a 5 o’clock number of key conferences I attended under the auspices of the World Health Organisation, during the British Presidency of the EU during which patient safety was central to the agenda — the chief medical officer heads the world alliance for the World Health Organisation — and in conferences I attended in this country, it is that those health systems which seek to investigate when errors occur and to learn free from a culture of seeking to blame an individual are those which improve fastest. We have a history of serious errors occurring without being investigated. We know that for 25 years in Our Lady of Lourdes Hospital in Drogheda people knew that what was happening in the maternity unit was wrong yet no audit or investigation took place. Audit will be a common feature of how services are provided in the Irish health care system. From here on in 236 Patient Safety: 22 April 2008. Statements all community and hospital health care settings and even within hospitals themselves, standards of patient care will decide where and how things happen. Perhaps one of the best examples of this is the new cancer control programme. We have learned not only from our own experience but from strong international evidence on symptomatic breast cancer, for example, that unless this is treated in a unit dealing with at least 150 new cases a year and by a surgeon dealing with at least 50 individual cases a year, we will not obtain the best possible outcomes for the women concerned. We know from at least 250 medical publications that the chances of a woman treated in such a centre are improved by 20%. This means one in five women who would die otherwise survive and have a good outcome. This is compelling evidence for moving with the cancer control programme adopted by the Government and which is now being implemented by Professor Tom Keane. The change driven from a standards of patient safety perspective is far more powerful than change driven by budgets, industrial relations or staffing issues. Change is often driven by these factors. One of the issues highlighted in the Irish health care system, as it is elsewhere, is the issue of hospital-acquired infections. A national plan is now in place and being implemented by the HSE to reduce the incidence of infections acquired in the Irish health care system. We want to reduce the overall incidence by 20% over the next five years. We want to reduce the incidence of MRSA by 30% and that of antibiotic prescribing, which is a major contributory factor, by 20% over the same period. Unless we know the starting position, we will not be able to measure progress. Later this month, the HSE will publish data, hospital by hospital, on hospital-acquired infections. This will give us a baseline from which to measure progress. Thereafter, the data will be published every quarter. We saw the results of an investigation by the HSE on the outbreak of c.diff in one hospital. I recently made this a notifiable disease. If we are to improve standards from a patient safety perspective, it is important we audit performance, know what the base is and that we measure performance against it. With regard to MRSA in particular, the countries which do best, such as the Netherlands, are those with a much lower level of antibiotic prescribing than we have in Ireland. It is equally important that we have appropriate isolation facilities in place, especially in our acute hospitals. I wrote to the HSE several months ago and directed it that private beds in public hospitals which were heretofore ring-fenced for privately insured patients had to be made available as a matter of priority for those patients requiring isolation and that there could be no situation where a private patient in a publicly funded facility could take precedence over a patient who required an isolation facility. This is important. In the context of the co-location proposal, where we will have 1,000 more public beds in our public hospitals, many of which will be in single rooms, we want to ensure these rooms are used to improve the much-needed isolation facilities we require in our acute hospital sector. I stated at the outset that the establishment of the Health Information and Quality Authority was a significant step. At present, this authority works with clinicians and managers on putting in place appropriate procedures and processes at every health care setting to minimise hospital- acquired infections, especially but not exclusively MRSA. Obviously, c.diff and other infections now commonplace are also included. It is important to have a standards body which can work with the individuals whose jobs will be to implement the change locally. Hygiene audits are a new feature of our performance measurement for hospitals. They will be carried out in a wider number of health care settings. We have had three audits to date and they indicated a major improvement, particularly as far as cleanliness is concerned. Hand washing is one of the most important things we all can do to minimise the capacity to pass on 237 Patient Safety: 22 April 2008. Statements

[Deputy Mary Harney.] infection. Hand washing is important for visitors to hospitals, family members and especially important for health care professionals. On a recent visit to a family member in an acute hospital in Dublin I was very impressed at how prominent the notices were at the entrance of the hospital. Many people did not know I was there because I stood way back in the corner and I noticed that virtually every visitor who came in washed their hands because the signs were so prominent and because they saw other visitors do so. I found that very encouraging and I hope every hospital can adopt the kind of prominent postering used by this hospital to advise visitors as they enter the premises. The setting of standards is important but so too is the monitoring of standards. The Health Information and Quality Authority recently produced draft standards as far as nursing home care is concerned. Heretofore, nursing homes in the private sector were inspected but those in the public sector were not. From here on, all nursing homes, whether in the public or private sector, will be monitored. Not only will stronger standards be in place but each patient will have his or her own care plan, which is important because the care needs of older people differ hugely. It is important that each patient is required to have his or her own care plan so that those inspecting the facilities can ensure the care plan is being implemented. The setting and monitoring of standards must be applied across the board in the public and private sectors and not only in public and private sector nursing homes. We have no licensing or accreditation regime as far as private healthcare provision is concerned. On my appointment as Minister for Health and Children, I said I regarded that as a major deficit in our regulatory framework as far as health regulations were concerned. No work had been done on accreditation or licensing and, therefore, we established a patient safety commission to make recommendations around the patient safety agenda but especially as far as licensing and accreditation were concerned. That commission is chaired by Dr. Deirdre Madden and includes healthcare professionals, experts from other industries which have very high standards of safety in their sectors, patient representatives and family members of those who have had an adverse experience in our healthcare system. The commission is due to report to me in July and the report will be published immediately. I will act on the recommendations of the report as far as accreditation, regulation or licensing is concerned. When that happens, the role of the Health Information and Quality Authority will apply to the private setting as it does to the public one. That was not possible in advance of legislation and regulation. I refer to a number of the inquiries which, I suspect, led to the request to have this debate. We have had a period of unprecedented inquiry, which is a good thing. For too long the only way people could establish what happened was by litigating. One of the first people I met on becoming Minister for Health and Children was Margaret Murphy from Cork whose son Kevin died as a result of a series of errors in hospitals in Cork. She wanted to find out why it happened. She knew she could not bring back her son but wanted the system to learn from the mistakes that had been made. She could not get any answers to the questions she raised so she had to litigate. She won and received compensation which she donated to a charity. She was not interested in any financial compensation but simply wanted to establish what happened. The remarkable thing was that I met her in the UK. She had been identified by the chief medical officer there as a champion of patient safety and he had involved her in a world health alliance for patient safety. I subsequently appointed her to different bodies, as I have other patient representatives. That was the era when one had to litigate to find out what happened but we are in a different era now. We must be brave and courageous enough to inquire and learn from those inquiries. 238 Patient Safety: 22 April 2008. Statements

After the inquiries into Portlaoise, a number of measures were taken. In the first instance, we established that the failure to have multidisciplinary care in cancer care leads to bad outcomes for patients. We also learned that there were serious governance issues as far as the Health Service Executive was concerned. I wrote to the chairman of the HSE following receipt of the Fitzgerald report, which I asked it to commission, asking it to take a number of steps. The first one was to put in place a protocol to deal with serious errors when they arise and I am happy that an interim protocol is now in place. However, it is not enough just to have a protocol. We need to make sure somebody is responsible for its implementation. The HSE has appointed an individual at national level who must oversee the implementation of that protocol. Among the features of the protocol is that patients must be informed in the first instance. As often happens in healthcare settings when information is put or leaked into the public domain, every patient of that service worries that it applies to him or her. That was one of the major problems which arose in Portlaoise. Huge panic sets in and the system cannot respond to inquiries made. That was the experience in Portlaoise. A recommendation in the Fitzgerald report was that the patient must come first instead of me, other politicians or journalists. We must make every reasonable effort as quickly as possible after an error, or a potential error, is identified to contact patients and to make sure we engage with them. In cases since Portlaoise, that is the procedure in place which I very much welcome. Reporting in itself is not sufficient if the mistakes identified are not put right. Everybody here knows that as long as we have roads and cars, we will have accidents and that as long as we have healthcare and hospitals, unfortunately, we will have errors. The best hospitals in the world make errors and sometimes very simple things can cause very serious errors. An X-ray read back to front can often lead to the wrong procedure happening. I attended a conference in the UK last year at which a surgeon from New York with 25 years experience said he removed the wrong leg from a colleague because he was in a theatre which was turned the other way from the one to which he was used. It sounds very simple but sometimes such errors can have fatal consequences, depending on the form of surgery. Therefore, we cannot be careful enough, especially as far as surgery is concerned. Two years ago I launched a booklet by the Health Information and Quality Authority, which Senator Twomey attended, that contained a patient guide to best care. It advised patients to be vigilant in asking the hospital to mark the left leg or the left side of the brain, depending on the side being operated on. I remember thinking as I launched the booklet that one would want to be a very brave patient before one went to the theatre to think of that. Experts in the area inform patients and their families to do as much as they can to minimise the capacity for error making. When errors occur, we must make sure we learn from, and minimise, them. I say “minimise them” because we will never have an error free healthcare system. No matter how many staff we have or what procedures and protocols are in place, unfortunately, errors will occur. Human beings will make errors no matter what we do. However, we must minimise the capacity for error making because errors in healthcare, unlike many other areas such as law, accountancy or engineering, can have dire consequences for patients and their families. Members of the House will no doubt have questions. We are embarked on a massive transformation of healthcare. In particular, we are seeking to make sure acute services are provided in a safe environment with the multidisciplinary care that is not only important in cancer care but in many other areas of care. With a population of 4.3 million, that means we will not be able to have the expertise everywhere. There are 52 acute hospitals in the country. Many of 239 Patient Safety: 22 April 2008. Statements

[Deputy Mary Harney.] the experts are sought after globally and they are in scarce supply. Therefore, when we acquire expertise, we must put it to best effect as far as patients are concerned. I very much welcome the new contract of employment we have agreed with the Irish Hospital Consultants Association which represents 80% of practising consultants. I hope that the Irish Medical Organisation will, in time, be in a position to recommend the acceptance of the new contract. Central to that is the appointment of clinical directors. Doctors will work as part of a team rather than work as individuals and they will work under the direction of a clinical director who will have specific responsibility for risk, patient safety and so on. Although many other aspects of the contract, including longer working days, equal access for public and private patients to outpatients and a one-for-all list instead of the separation we have at present, are fundamental changes, the clinical directorate model where clinicians are centrally involved in a leadership role within the hospital will act to improve patient safety in the healthcare system.

Senator Frances Fitzgerald: I wish to share time with Senator Healy-Eames.

An Cathaoirleach: Is that agreed? Agreed.

Senator Frances Fitzgerald: I welcome and thank the Minister for her attendance in the House today. I regret we do not have more time to discuss with her the many issues of the health service which Senators would like to raise. We should not have to request the Minister’s presence in this House. We should not yet again have had to ask her to come to the House owing to deep rooted and genuine concerns in respect of patient safety in our hospitals and health system. As I stated earlier at a meeting of the Joint Committee on Health and Children during which the Health Information and Quality Authority presented its report, HIQA is undoubtedly a beacon of light. There is huge concern about quality and standards in our hospitals and the care patients are receiving. There have been seven reports in the area of breast cancer care alone. The Minister said she welcomes that there have been inquiries and reports. One could equally say, however, that failure to deliver for patients on the frontline over a ten year period, a time of unprecedented wealth and the Celtic tiger, is the reason our services are in the state they are in and the reason these reports were commissioned. I have referred already to services in respect of breast cancer care. However, if one looks at the spectrum of health care in terms of MRSA levels, over-worked staff, maternity services, cut-backs in community care, children at risk of not getting services — as reported on Friday last — and the closure in many counties of mental health waiting lists for children with effectively no service available for children with mental health difficulties, one could not be com- placent but could predict the commissioning of many more reports on the current delivery of service to individuals in every region. Something has gone seriously wrong in the delivery of frontline services. While I understand the vision outlined by the Minister, I must question her about delivery during the past ten years and during her tenure as Minister for Health and Children for the past three and a half years. The names add up to a tally of disgrace and betrayal for many people. I will speak in a moment about what the Minister for Finance, Deputy Cowen, said in the Da´il last week. Names that come to mind are, Tania McCabe — Members will have seen the recently published report in that regard — Patrick Joe Walsh — we all know what happened to that elderly gentleman — Beverly Seville-Doyle’s experience in the Mater Hospital, Peter McKenna, Susie Long and Rebecca O’Malley. Each of those names represents a person brutal- 240 Patient Safety: 22 April 2008. Statements ised by the system of care he or she tried to obtain, each of whom was crushed by the system. While the Minister’s words and the initiatives outlined are fine, the day-to-day experience of many people in our health service has been one of upset and death, deaths that should never have happened. I am concerned that last week when Deputy Enda Kenny raised the case of Mrs Peg McEntee, the 76 year old lady left on a trolley in the Mater Hospital for 48 hours, the Minister for Finance, Deputy Cowen, did not apologise to the family for their ordeal but criticised Fine Gael for raising the issue and referred to the matter as facile. I do not believe patient care and safety and raising individual cases to illustrate the experience of many people is facile. I hope the Minister does not believe that and that she will say so. If she agreed with Deputy Cowen’s statement she would then also be suggesting it is facile to raise the issue of the distress caused to the women given the all clear from cancer only to find out later the tests were unreliable and they had a cancer that was advanced due to misdiagnosis. These are emotional nightmares for the people concerned. The Minister apologised to the women concerned and I have no doubt she meant it and that she felt deeply for them. However, that in itself, as the Minister has already stated, will not protect women from future errors. The Minister needs to outline for us the changes being introduced to deal with these situations. There have been many reports such as the Fitzgerald, O’Doherty and Doherty reports. Though there was no collusion between the authors, they all reached the same conclusions and listed problems in respect of governance, communication, delays in responding to patients’ concerns and to what can only be described as general confusion among some staff in respect of their roles and responsibilities. I would like the Minister to respond to the problems identified in these reports which are compromising patient safety day in and day out. If people do not know what are their roles and responsibilities in delivering health services, how can they deliver them? The Minister said in 2004 that we needed clarity of roles and accountability, political responsibility for the Minister and management responsibility for management. Has this happened? The reports clearly show nothing has happened three and a half years after that statement was made. Why is there confusion in respect of roles within the health service? Does the Minister accept that confusion and lack of clarity poses a risk to patient safety and damages the level of efficient care afforded to patients? The buck has to stop somewhere. We must know what action is being taken in respect of governance and accountability within the health service. Many of the reports have addressed this issue. The Minister needs to clarify it; it is not new but has been commented on in many reports. I would like if the Minister could respond to Senators’ concerns about the move to specialist centres. Let us take for example the closure of maternity services and the redirection of expect- ant mothers to other services——

An Cathaoirleach: Senator Fitzgerald indicated earlier she wished to share her time. The Senator has only one and a half minutes remaining.

Senator Frances Fitzgerald: What is the plan of action in respect of the removal of local services before specialist services are in place? I do not have to time to deal with issues such as MRSA or mental health services for children but I ask that the Minister address some of the points I have raised. Clearly, we need more time to discuss this issue.

An Cathaoirleach: Senator Healy Eames has less than one minute.

Senator Fidelma Healy Eames: I thank Senator Fitzgerald for sharing her time with me. I welcome the Minister to the House. 241 Patient Safety: 22 April 2008. Statements

[Senator Fidelma Healy Eames.]

I wish to raise with the Minister today the pharmacy crisis in the west. The Department and Health Service Executive is currently swamping pharmacists with litigation injunctions. It was confirmed to me yesterday by senior sources that there is no contingency plan for the distribution of medicines as of 1 May. We are talking about an estimated 4,000 to 5,000 people descending upon community care and accident and emergency at Merlin Park Hospital for medication. Only one pharmacist remains standing in Roscommon and there is a question hanging over Sligo.

Deputy Mary Harney: Standing where?

Senator Fidelma Healy Eames: All of the pharmacies are pulling out of the community services contract. I am informed the HSE in these local areas have been told to order in medications. Where will they be stored and who will dispense them safely? Where are the labels and computers required for labelling? What is required is a controlled professional environment. Who is familiar with patients’ allergies? What will happen to those patients allergic to aspirin or penicillin?

An Cathaoirleach: I must call the next speaker.

Senator Fidelma Healy Eames: Anecdotal evidence suggests the civil defence forces will be used to try to mobilise medication.

Deputy Mary Harney: I do not know from where the Senator is getting her information. This is the first I heard of it.

Senator Fidelma Healy Eames: That is the anecdotal evidence. I ask that the Minister confirm today her contingency plan for the safe distribution of medication as of 1 May.

An Cathaoirleach: I call Senator Feeney who has eight minutes.

Senator Geraldine Feeney: I, too, welcome the Minister to the House and compliment her on her excellent presentation. The Minister had no notes and spoke on this issue for 22 minutes which tells me she is at home with her brief and knows it intimately. It is obvious it is very much part of the Minister’s day to day working life. I do not know of any other Minister who comes to this House and deals as adequately with issues arising from his or her brief. I am delighted to have an opportunity to contribute to the debate. As the Minister has said, it is timely because unfortunately we have seen an unprecedented amount of negative fallout. We went from the cases in Portlaoise hospital to those of Ms Rebecca O’Malley and Ms Susie Long to the MRSA infections and, in recent days, to the case of the young child in Crumlin who had a kidney removed in error. That last case is the first time that I have heard of so- called wrong site surgery. Apparently there have been only two confirmed cases of it in the UK. It is most uncommon worldwide and I would say that the present case is a first in this jurisdiction. It is terrible and there are no words I can imagine that would console the parents, the young patient or his family concerning what has happened, never mind finding words to try to explain how it occurred. It is most unfortunate. I have no doubt it will be dealt with accordingly. The Minister mentioned the Medical Practitioners Act which this House passed and which provided for a lay majority for the first time. The Minister was very brave in the face of much negativity from medical personnel and despite receiving a great deal of abuse. Everyone told her she was wrong but she went ahead and pushed the legislation forward. Elections are due 242 Patient Safety: 22 April 2008. Statements to be held which will provide a lay majority. I commend the Minister on that. It was the way to go. We would not have a hygiene audit were it not for the terrible fallout from MRSA. Again the Minister was brave enough to put this audit in place. She is blamed for everything that goes wrong despite the fact she is not in any of the 52 hospitals on a daily basis and cannot be held responsible for all that goes wrong. For all that, she does try to put things right when things go wrong. She is a woman of actions rather than words. She will say the words but she will also put them into action. I am glad to see that the Coroners Bill, which was debated in the House in 2007, has classed MRSA as a reportable death. I am even happier that from 4 May, what I would term the new disease, c.diff, will also be a reportable disease and is now listed on the infectious diseases reporting system. We can see now what cases are showing up and which ones are being monitored. It was a shame that the recent cases in Ennis showed the presence of this terrible disease when the post mortems were done. It was a contributing factor in the deaths of those people. As Senator Fitzgerald remarked, the Health Information and Quality Authority, HIQA, earlier today met the Oireachtas Joint Committee on Health and Children. Everyone was greatly impressed by its presentation, the more so because that organisation is less than a year in operation and had wonderful work to show us. I take my hat off to the people concerned who are all hard-working, committed members. They explained the different areas where changes can be seen. Regarding the placement of children under 12 in residential care, there will be an inspection of each residential unit before a child in that age group is placed in it. It seems only yesterday but it is two years since this House debated the fallout from the Leas Cross nursing home situation. I was greatly impressed to see what is in place now to monitor and set standards for nursing and residential homes. The residential care people with disabilities receive is also being monitored. All these matters are part of the major reform that is needed. I have no doubt the situation will improve. The Minister said at the beginning of her presentation that she would like to see us learn from our errors rather than enter into a culture of blame. We always appear ready to jump in and blame someone. Perhaps that is human nature but it would be much better if we could stand back without jumping in and pointing a finger of blame. As the Minister rightly points out, if we adopt this approach and learn from our errors, we will improve much more quickly. The Minister and referred very briefly in her presentation to the Dr. Neary case and she was in the House for the debate on the repercussions of that. It encompassed more than 20 years of terrible practice but as the Minister pointed out, everyone knew about it yet no one wanted to point a finger. That situation was allowed to occur because of a culture of silence. I do not know what one needs to do to try to break down that culture but I believe the Minister is well on the way to ensuring such a culture is eroded. The Medical Practitioners Act was passed by the previous Seanad, the first such legislation in almost 30 years. Competence assurance was brought in. Had there been such a component before, with requisite medical education for doctors and compulsory professional development programmes, the Neary situation might never have happened and the damage done to all the women who came under his care in Our Lady of Lourdes Hospital in Drogheda might never have occurred.

Senator Phil Prendergast: I extend a warm welcome to the Minister for Health and Children, Deputy Mary Harney. Health remains and will continue to be the single most important issue for many families. As we get older we become all too aware of our increased need for involvement with the health service in acute hospital settings and in long-term nursing care. Above all, we need to know that when we engage with the health service we do so in a safe manner. 243 Patient Safety: 22 April 2008. Statements

[Senator Phil Prendergast.] With the current staff embargo the Heath Service Executive is working with a reduced pool of employees. As a result, those already employed are suffering from the effects of having reduced staff through unreplaced sick leave. This undoubtedly will result in increased sick leave and burnout among remaining staff. It is a vicious circle and cutting frontline staff is not the answer. Patients will suffer and so will the standard of care. Managers in the HSE must go back to the drawing board on this. The present state of the health service does nothing to reduce the anxiety of families. We hear constantly about the lack of hospital beds and hours spent on trolleys in draughty accident and emergency departments, with accompanying lack of privacy and dignity. Such a situation is full of opportunities for mishap. Patients who are nursed on trolleys are at increased risk of contracting infection because such areas are over-populated. There is a further problem with the dangers of MRSA and other hospital-acquired infections. Frontline staff are vigilant but their proximity to infected people means that it is difficult to reduce the risk of contracting infections, with the constant flow and activity and the increased numbers occupying such hospital areas. Trolley use also reduces access for staff, with the possible worst case scenario of a resuscitation trolley being unable to pass through in an emergency situation. When emergency equipment is needed at a particular location, time is of the essence. This has a direct impact on the outcome for the patient. If beds and trolleys must be moved to facilitate movement of patients it is certain that there will be delay in delivery of vital care. Waiting times and delayed access to mainstream health care continue to be a problem. While the Department of Health and Children prides itself that waiting times are reduced, my experience is that this is not the case. Instead of a long delay inside a hospital setting, the delay now happens between initial referral from a general practitioner and the first appointment within the hospital. I know of a particular lady who urgently needed a hip replacement. Her mobility was severely affected and she was in constant pain. Her GP referred her to Waterford Regional Hospital in July 2006 and by the time she contacted me in April 2007, she had heard nothing regarding an appointment. When I contacted the patient services manager, I was informed that as this lady was categorised as a “routine” patient, she could be waiting up to four years for an initial appointment with the consultant. This is not good enough. It is an insult to people to refer to this inadequate response as a “service”. Service implies that a level of care and standards is being upheld. Again, this is not the case. I am particularly concerned at the level of summer bed closures that are planned. In South Tipperary General Hospital, we will see the loss of gynaecological beds over the summer months, with an associated reduction in surgery. Having worked with women in the hospital setting, I know all too well that many women will plan their surgery around their families’ needs. Many wait until the summer when it is easier to make provisions for the care of their children without the usual school routines. It is dreadful to see that year after year, women’s services are reduced. It is unsafe and unfair to target a particular group and it should be possible to rotate these bed closures between medical, surgical and gynaecological services in a fairer way to ensure that one particular group is not overly disadvantaged. Psychiatric care services also fall far below acceptable standards. On 26 February 2008, a parliamentary question was put to the Minister in respect of the number of psychiatric beds available to adolescents in the HSE system, whether there is a waiting list for such beds, the waiting times if this is the case, the numbers on such waiting lists and the geographical spread of those awaiting beds. It was further asked what plans the HSE has to provide beds and the areas in which these beds will be located. The Minister replied that this was a matter for the HSE, citing the Health Act 2004. The HSE has not yet responded with an answer to this question. Telling people that there is no bed or service available is not good enough. I would 244 Patient Safety: 22 April 2008. Statements like the Minister to tell me who is responsible for giving the information and the reason for the lack of response on such an important issue. I know somebody who cannot let their child out of their sight. They are on 24-hour suicide watch. When a parliamentary question is put to the Minister, there is a specific timeframe after which one is assured of a response. However, there does not seem to be any duty on the HSE to provide a timely response. While I appreciate that the HSE is an independent entity, I assume that since this organisation was created and moulded by the Minister, it is ultimately answerable to her office. If a response is slow in forthcoming in respect of such an important issue, I would expect the Minister to seek a timely and comprehensive response. I would also like to see the provision of stroke units throughout the country given priority by the Department of Health and Children. Each year, of the 10,000 people in Ireland who suffer a stroke, 2,500 people die through the lack of essential stroke services. A recent national audit of stroke care by the Irish Heart Foundation in conjunction with the Department of Health and Children found that an estimated 350 to 500 lives could be saved through the rollout of such units. Dr. Brian Maurer of the Irish Heart Foundation said that:

[T]he report confirmed what is widely known by professionals working in front line services — stroke services in Ireland are appalling. People are dying unnecessarily simply because they cannot access the optimal treatment.

He also stated that “at the moment, people’s survival is determined by chance and location with the virtual non existent service provided”. While the involvement of the Department of Health and Children in this audit is welcome, we need to see it implement the report’s recommendations without delay. Once again, I wish to highlight the plight of cystic fibrosis sufferers in Ireland. We have the highest incidence of this chronic disease in the world, yet it is widely known that the treatment received by such patients in Ireland falls well below the accepted European standards of care. In February 2005, this was highlighted by the publication of the Pollock report. Since then, the Cystic Fibrosis Association of Ireland has been tireless in its efforts to lobby for an improvement in the level and quality of care to patients. It is clear that dedicated beds are needed for these patients, who are highly susceptible to lung infections, with associated facilities to allow for isolation and segregation to, as the Minister stated, reduce the risk of cross infection. Owing to the unique nature of the condition, it is essential that a process be put in place to minimise hospital contacts by arranging for direct admission to the hospital room. This would ensure patients have a reduced risk of acquiring infections which, ultimately, would result in reduced demand on the health care system. I call on the Minister to release the findings of the Pollock report and to implement its recommendations without delay. I would like to know the status of the review of ambulance services that was due for completion last year. In south Tipperary, Carrick-on-Suir is especially disadvantaged through the lack of an ambulance service based in the town. Instead, the people of Carrick-on-Suir have to rely on an ambulance being dispatched from Clonmel, which is a 50-minute round trip, or Waterford, which could be a 58-minute round trip, depending on the time of day, the level of traffic and whether the bridge is up. This timing does not include time spent on the stabilisation and preparation of the patient for transfer on site. It is clear that the halving of this transfer time would support a positive outcome for patients, particularly those suffering from heart attacks or stroke where time is critical Ultimately, addressing each of these issues is inherently associated with improving patient care and safety. The HSE and Department of Health and Children seem to be eternally involved with assessing standards, highlighting problem areas and developing strategies and 245 Patient Safety: 22 April 2008. Statements

[Senator Phil Prendergast.] standards. However, when it comes to translating all of this into providing a safer service to patients, both the Department and the management of the HSE are notably inadequate. I have the highest personal regard for the Minister. I was present on the day when the report on services in Portlaoise was given to us. I could see that the Minister was deeply upset by that. I have no doubt that she is very upset by recent events, including errors that have happened, especially the case we heard about this week and the case of the lady who lost her life. None of my remarks is personal. The embargo is having a serious effect and I continue to be very concerned about psychiatric beds and services, particularly ambulance services, that are not provided fairly throughout the country. I conclude by thanking the Minister for her time and for giving us the opportunity have this debate.

Senator Maria Corrigan: I also welcome the Minister to the House and thank her for the time she so freely makes available to the House. Patient safety and quality of service are central to our health care system. Every patient should feel confident in the service provided to them, whether it is provided in a major regional centre or a local nursing home or whether they are a patient in the community, in the acute hospital setting or in long-term care. The establishment of the Commission on Patient Safety and Quality Assurance and the Health Information and Quality Authority is a vital step undertaken by the Government to ensure quality and safety of care for patients. The implementation of quality and safety standards in nursing homes, the development of infection control standards, the monitoring of symptomatic breast disease standards and the development of core acute hospitals standards, including adverse event responses, are immediate priorities, together with work to be done in intellectual disability and child care. The Com- mission on Patient Safety and Quality Assurance has set out to develop clear and practical recommendations to ensure that quality and safety of care for patients is present. I look forward to its recommendations, which will be reached later this year. One of the commission’s terms of reference is specifically to examine and make recommendations in respect of a statutory system of licensing for public and private health care providers and services. The current system where anyone can open a hospital or a clinic is not in the interests of patient safety and I urge the Minister to establish a system of licensing as soon as it is practicable. As part of the health reform programme, the progression of the Health Information and Quality Authority ensures that there will be a national independent inspectorate for all nursing homes for older people, both public and private, as well as for centres for people with disabilities. This includes centres for children with disabilities who, up until now, had been exempt from the inspectorate for residential facilities for children. A core function of the authority is to set standards on safety and quality of services and to monitor enforcement of these standards in an open and transparent way. The Health Information and Quality Authority is committed to developing a supportive culture for supporting patients, families and clinicians when adverse events involving patients occur. The alleviation of a culture of blame and practical improvements in the reform of the system are paramount in producing a service of quality and safety where trust between the patients and health care provider can be fostered in a healthy way. International research in countries such as the US, Canada, the UK, Australia and Denmark has shown that between 7.5% and 12.9% of patients admitted to the health care settings will experience an adverse event or patient safety incident. Ireland is no different and mistakes do occur but ensuring provisions are in place to prevent or deal with them is where the focus should lie.The recent case involving a young child in Our Lady’s Hospital for Sick Children in Crumlin, which came to light in recent days, is devastating. It is essential that a comprehensive review of this case and the procedures employed from the moment the child left the ward be 246 Patient Safety: 22 April 2008. Statements undertaken to enable us to fully understand what happened and how a mistake of this gravity could occur. As a matter of absolute urgency, we need to ensure lessons are learnt and applied immediately to prevent such an occurrence in the future. On a national level, the Commission on Patient Safety and Quality Assurance and the Health Information and Quality Authority will be invaluable in ensuring the establishment of the necessary frameworks and the accompanying implementation of policies that will ensure the strongest best practice in the interests of every patient’s safety whether he or she be based in a community, hospital or long-term care setting. However, at local level in all these settings, it is essential that attention be paid to issues such as staffing, the environment and adverse incidents. In addressing staffing issues, it is essential that optimum staff mix be achieved, that staff competence be attained, maintained and monitored, that safe practices be undertaken by all clinicians, including adhering to hygiene standards in between contact with patients, and that adequate staff complements be identified and adhered to. Issues in the environment such as the number of beds, space, hygiene, cleaning and maintenance are all necessary factors for the maintenance and enhancement of patients’ safety. As stated previously, research and experience has shown that, on average, 10% of patients will experience an adverse event or patient safety incident. It is essential at a local level that clear procedures exist and are implemented to report and record such incidents, to investigate them and ensure immediate application of all lessons to be learned from them. I ask the Mini- ster to consider extending such procedures beyond hospital settings to community and long- term care settings where such adverse events occur and where patient safety incidents have occurred. An immediate challenge to the safety of patients in the community is the pending withdrawal of services by the pharmacists. I ask the Minister to address that issue if time permits.

Senator Liam Twomey: When it comes to patient safety the Government has been, what could be described as, a very slow learner. Even though a great deal has been said about the Health Information and Quality Authority and the great work it is doing, it should be noted that it was established as a result of a great number of disasters, including that of the Leas Cross nursing home and the cases of P. J. Walsh, Bronagh Livingstone, Susie Long and Rebecca O’Malley, that came to light during the Minister’s tenure of office. All these incidents occurred before HIQA was set up. It was due to be established at exactly the same time as the HSE but because of all those disasters, there was a rush to bring forward its establishment. HIQA was established in response to the number of disasters that were occurring in the health service and not because the Government had any clear commitment to patient safety in the way we understand patient safety. Clinical accidents occur in all our hospitals and in primary care services. As a doctor, I know those who work in the health services and in Government are human, but when it comes to patient safety, we need to be clear about what we want in that respect. Fine Gael published a policy on patient safety more than two years ago. I am sure the Minister has read it. It was clear in pointing out that we need a patient safety authority to act as a counterpoint to the vested interests who have a stranglehold over how the Government reacts. Patient safety and patient issues are not at the centre of our health service. These types of mistakes and exposures will continue to happen until we put the patients at centre of health services. That is not happening at present. Many administrators, the Minister, doctors and nurses hold the same core beliefs when it comes to protecting patients. We want to treat people with dignity, to be compassionate and respectful in how we look after them and to give them proper treatment. However, while we 247 Patient Safety: 22 April 2008. Statements

[Senator Liam Twomey.] continue with a system where health strategies and reports are published and fine words are said about looking after patients’ safety but nothing is done in that respect and no central authority is established with responsibility for protecting patients’ safety, we will continue to find ourselves in the mess we are in. I do not like to demonise those who work in the HSE, as many of the problems in that organisation have occurred because the Minister has not reformed the health services. Most hospitals throughout the country are examining clinical governance issues and such issues are also being examined by most HSE administrators in regard to the services they provide. Will the Minister indicate the number of management or administrative governance issues under examination in the HSE to ascertain if money is being wasted? We are constantly being told by Fianna Fa´il representatives that the HSE is in a mess and that it is top heavy in terms of bureaucracy. Where do those problems exist? How many millions are being wasted in that bureaucracy that should be invested in looking after patients? Those representatives mouth off about something they believe will get them a byline but they are not genuinely interested in providing health services for patients. The Minister has often started off well, as in the case of the Pharmacy Bill and in regard to the Pharmaceutical Society of Ireland and the Medical Council. Although, I disagreed with some of the points she raised during the Da´il debate on that legislation, hopefully, in essence, it will improve matters. A core issue in regard to the Medical Council and the Medical Prac- titioners Act is the issue of competence assurance. The competence assurance process does not focus on the doctors who need it. The process is in place in a general sense in terms of identifying a few doctors who might tick boxes, fill out the forms and send them back to the Medical Council. That does not constitute patient safety; it merely amounts to being seen to do something because there is a problem in this regard. If we are serious about being compassionate and respectful towards patients and ensuring they have proper treatment, we need to have a proper debate on these types of issues. We need to be able to speak about what is happening in, as the Minister said, a “no blame” way. When the Minister experienced problems in negotiating the consultants’ contract in January 2006, I, as the then Opposition spokesperson on health, offered to back her, but for some reason she went all quiet about it for over a year. That contract has still not been finalised, regardless of what the Minister says about it. Has the Minister signed off on the standards for nursing homes about which she spoke? Are they now legally enforceable in public and private nursing homes throughout the country? I do not believe they are. What Senator Feeney said about Dr. Neary is wrong in that people are not afraid to speak out. However, because of the way the system is set up, his practices were identified only by accident by two midwives.

Senator Geraldine Feeney: His colleagues were afraid to speak out. They remained silent.

Senator Liam Twomey: It is important to have these types of debates. Senator Feeney knows my views on Dr. Neary. I was extremely critical of the way some people tried to let him off the hook. We must be fair in acknowledging what people did. When his malpractices were identified, Finbar Lennon, Ambrose McLoughlin and the senior nursing director in Our Lady of Lourdes Hospital went into the hospital one weekend and gathered enough information to make the allegations stick. They acted when they were informed by two midwives working in Our Lady of Lourdes Hospital who were in contact with a solicitor for the health board. That is how it happened. This is the type of debate we need in this House, one in which we give the facts and inform the people about what is happening. While at times I would like the Minister, 248 Patient Safety: 22 April 2008. Statements

Deputy Harney, to be accountable and transparent in her contributions in these debates, we need more such debates. We are not serving the patients of this country. We blather on about money, statistics and how to reduce things. Services have already been restricted in my local hospital in Wexford and community care services in Wexford have been cut back. That also applies to services elsewhere throughout the country. It is not getting any better. We need to be more honest about what we say inside and outside this House.

Senator De´irdre de Bu´ rca: I welcome the Minister to the House. I thank her for addressing the issue of patient safety. There is little disagreement in the House that patient safety must be the top priority for all our health care systems. The importance of the issue of patient safety was recognised in the current programme for Government in which the Government is committed to initiate a periodic review of legislation to improve patient safety, to continue to ensure all new health legislation makes provision for whistleblowers where applicable and to examine the implementation of an advisory charter of patients’ rights similar to the European charter of patients’ rights. The programme for Government also committed the Government to progressively introduce patient guarantees of what people could expect from their health service and to bring forward and implement the recommendations of the Commission on Pati- ent Safety. I did not fully understand Senator Twomey’s remarks on the Health Information and Quality Authority because he seemed to criticise the circumstances in which it was created. The Green Party welcomes the establishment of the HIQA——

Senator Liam Twomey: It did not do so before the general election. I was in the Da´il when it was being debated. Senator de Bu´ rca was obviously not paying attention.

Senator De´irdre de Bu´ rca: It is an independent authority established to drive improvements in the quality, safety and accountability in this country’s health and social care services. The authority’s priorities include establishing a standards framework for health and social care, implementing a comprehensive programme of monitoring, measurement and, where necessary, enforcement, against the standards, as well as providing a comprehensive information framework to support safe and efficient health and social care. It is a matter of concern that the HIQA does not have jurisdiction over private providers but hopefully this will be the case in the near future. Patient Focus, which is one of the leading groups representing patients’ interests obviously shares many of the concerns that were expressed here today about patient safety. It has enunci- ated several important principles concerning patient safety. The group points out that lessons must be learned from the past, a point which has been affirmed by other speakers 6 o’clock here today. I will not mention the cases which have been already mentioned but improvements must be made. Proper safety systems must be put in place and Patient Focus supports the establishment of a patient safety authority. It also suggests that patients need constant reassurance that services are safe, that they will be at the centre of service provision and that their safety is paramount. The group believes that everybody has a role to play in ensuring patient safety and that it is not just the responsibility of risk managers. It also argues that proper communication and record keeping is essential. Patient Focus has called for the establishment of a health service ombudsman. It has also pointed to the need for more education for the general public and staff on the importance of good hygiene. It particularly stresses the need to inform the public as to why good hygiene is so important in hospitals, particularly in the context of hospital-acquired infections such as MRSA and clostridium difficile. 249 Patient Safety: 22 April 2008. Statements

[Senator De´irdre de Bu´ rca.]

In terms of systems reform to achieve higher levels of patient safety, Patient Focus emphasises quality assurance, risk management and advocacy. The group calls for greater investment in ongoing education and training. It urges that peer review procedures become standard practice and calls for the incentivising of clinical audits and research as normal professional activities. In the area of risk management, Patient Focus wants to encourage a risk reporting culture among staff and patients. It has suggested establishing a national risk resource centre for collec- tion, benchmarking and dissemination of data on good practice. The group also encourages the promotion of systems where savings can be negotiated from insurers for implementing risk prevention measures. It has called for the monitoring of medical litigation and the evaluation of all cases for prevention potential. Patient Focus has called for the introduction of advocacy services, which it claims are often needed by members of vulnerable groups and occasionally by even the most articulate, when they find themselves in difficult circumstances as patients. It also emphasises the point the Minister made regarding the importance of promoting a culture of disclosure and of recognition and validation of those who take the difficult step of naming and drawing official attention to some of the problems that can occur in our health care services. In the past, there have been real problems experienced with complaints in our health service. These have often arisen because of an absence of procedures in handling complaints within the service. Another cause has been a form of what has been called “institutional arrogance”, which has been characterised by delayed formalised communication or, in some instances, no communication, an unwillingness to believe a complainant and an unwillingness to accept responsibility for problems which arise. Patient Focus has also pointed to the existence of an approach in the past where complaining has had a negative influence on patient treatment. The group has pointed to the fact that the circumstances and conditions in accident and emergency departments have given rise to problems because of delays and overcrowding. It believes that conditions in these departments have increased the possibility of medical error. Patient Safety has examined proposals for improving regulation in the area of patient safety and has focused on the role of the Medical Council. It has suggested that the new council structures should include at least 50% lay people, as well as those in various sectors of the health professions and those involved in patient advocacy. It has also called for the new council to have new powers and the ability to impose penalties. It wants the council to be enabled to temporarily remove a doctor from the register during its assessment of a case without resorting to the courts. It has also called for those investigating a case to be fully and properly trained to do so. It further suggests that any fitness to practice hearing should be held in continuous session over a maximum of six months from the date of the complaint. It has called for other convictions to be made available for transgressions other than serious professional misconduct and for penalties to reflect these changes and to include fines, further training or limitations on the practice of a doctor. It has also asked that the council be obliged, where appropriate, to refer a case to the Garda Sı´ocha´na or to the Director of Public Prosecutions. Patient Focus has called for the council findings to be made known to the complainant and for appeals to be made available and accessible. If a complaint is rejected, the group believes that the reason for the rejection should be explained to the complainant. In general, the council should become more accountable to the public, provide regular reports and show that it is capable of assessing its own effectiveness and reviewing its procedures regularly. The health care system has been much slower than other information-intensive sectors to exploit the potential of information and communication technologies, especially in support of 250 Patient Safety: 22 April 2008. Statements the direct delivery of patient care. Health information technology has been demonstrated to have a positive impact on patient safety across many areas of health care, for example, in electronic prescribing. There appears to be a need for improved co-ordination and leadership in the implementation of a national strategy for health information technology. I thank the Minister for her presence in the House and look forward to her response to this debate.

Senator Feargal Quinn: I suspect the Minister has a death wish because anybody who under- takes what she has undertaken in the past few years and agrees to go ahead with it is pitting himself or herself against such an impossible task. In recent times in Ireland we have tended to turn the spotlight on the negatives rather than accentuating the positives. An enormous amount of good work is taking place with patients with hospitals. While there are failures — the Minister referred to them earlier — and there probably always will be mistakes and errors made, we must concentrate on the positives, of which there are numerous examples. I was chairman of a hospital at one time and tried to have the use of the term “patient” discontinued because people are not very patient when they go into hospital. They are anxious and concerned. I tried to encourage the use of the term “customers” instead but found it very difficult. Doctors, nurses and other staff found it difficult to call patients “customers”. However, I must admit I always believed that the objective of every enterprise is to ensure the customer comes back again. Then, last year when my own cardiac surgeon released me, shook hands with me and said he hoped he would never see me again, I realised that while that was not very good business, I was very glad to hear him say it. People are stressed when they go into hospital. There is an enormous amount of stress attached to health concerns. When I had a cardiac operation two years ago, the surgeon came to me before I was wheeled in to the operating theatre and said, “I am obliged to tell you that 99% of these succeed and 1% don’t”. I was already nervous and when I heard that, it was a reminder of all of my concerns——

Senator Phil Prendergast: What if one is the 100th patient?

Senator Feargal Quinn: Yes, one is certainly concerned about that. There are many different kinds of patient care we can undertake. In the past, we assumed care had to take place in hospital and I am delighted to see the changes that are taking place in that context. I remember an experience I had in the former Hume Street Hospital. Staff at the hospital realised that large numbers of those patients who were attending for dermatology and cancer treatment did not need to be in hospital for an entire week to receive one or two treatments. The switch to a day care system was an enormous operational success because it meant a patient could plan to go to the hospital in the morning, receive treatment at 10 a.m., leave by 12 p.m. and return to work. In previous times, patients had to stay in hospital all week long, particularly if they lived outside Dublin. I learned of a system that operates in the United States from a man who was a patient there. He had to undergo a very important operation but he did not go into the hospital. He stayed in the hotel beside the hospital and he was brought over by the staff to the hospital for the operation. The cost was much different from what it would have been in Ireland. It also resulted in a hospital bed not being used. There are occasions when good patient care can be provided without necessarily using the traditional costly hospital service. Confidence is very much needed when a patient enters hospital. Many people are afraid to go to hospital because they think they may contract a disease such as MRSA, which is a major concern currently. I am not sure how the Minister will solve this problem.The Health Service 251 Patient Safety: 22 April 2008. Statements

[Senator Feargal Quinn.] Executive and the Minister are doing everything correctly to succeed against MRSA but they have not succeeded to the extent others have elsewhere. I have huge confidence in Professor Drumm. The support given to him by the Minister needs to be backed up. It is easy to knock someone in charge when something goes wrong. I have confidence in him and he needs to be supported with that confidence. Those who work in hospitals should be reminded of another aspect of care. I had an accident which required a hospital stay. The chief surgeon, doctors, matron, nurses and other staff came into the ward and approached each bed before we were released. However, they referred to each patient by the disease he or she had, not by name. Sometimes attention needs to be paid to little details such as that. That is an aspect of patient care because when patients go to hospital, they are concerned, nervous, uptight and stressed and little things like that can help. The Minister is getting the support she needs and the support she is giving Professor Drumm is worthy of everything we can do to support that. I have confidence in her and I have confidence we can achieve what we have set out to do. I welcome her contribution.

Senator Terry Leyden: I am delighted the Minister is present to discuss patient safety. As she will be aware, issues have arisen in County Roscommon again. A report on services at Portiuncula Hospital, Ballinasloe, and Roscommon County Hospital was presented on 10 April at a briefing for members of Roscommon County Council and the Health Service Executive west regional health forum. No courtesy was shown to myself, as an Oireachtas Member, or my colleague, Deputy Michael Finneran, regarding a briefing on this issue. The HSE has issued this report in a cavalier fashion. As a former Minister of State at the Department of Health and former chairman of the Western Health Board, it would have been courteous at least to have been given a copy of the document. I obtained a copy of it which was presented to the management team of the HSE. I hope it will reach the Minister’s desk eventually for a decision on the future of acute services at Roscommon County Hospital and services at Portiuncula Hospital. This issue has gone on for too long. I felt it had been resolved by the Minister in September 2006 when she was well aware of the issues and the proposals that had been put forward. The matter was discussed last night at a meeting of the Fianna Fa´il party attended by senior members of the Da´il ceantar, councillors and Oireachtas Members. Having gone through the document carefully, we felt it was not in the best interests of the continuation of acute services at Roscommon County Hospital. The proposal is that all acute services should cease at the hospital and anaesthetists and surgeons should transfer to Portiuncula Hospital. I was chairman of the health board when we signed a contract for a new state-of-the-art accident and emergency department at Roscommon County Hospital, which was opened by the Taoiseach. Assurances were given by him and other senior political figures at the time that the hospital would be retained as an acute general hospital. The situation is critical. Portiuncula Hospital is between 30 and 50 miles away from most people in Roscommon. It is a fine hospital but it is located close to four hospitals, two of which are private, in Galway thanks to the new national primary route. However, there is an area between Galway and Mullingar which does not have acute services. The report to which I referred was presented by Mr. Alan Moran to the management of the HSE but it would take more time than I have to go through every aspect of it. At the end of the day, arising from the transfer of all acute surgeons and anaesthetists to Portiuncula Hospital, Roscommon County Hospital will not retain its accident and emergency department 24-7. It would put patients and people in the region at risk. The hospital was used recently following road accidents and young people were saved. According to best practice, a patient should be 252 Patient Safety: 22 April 2008. Statements in a hospital within an hour of an accident occurring, which is referred as the golden hour. Relying on ambulances on inadequate roads is not helpful. Of more than 10,000 patients examined in a study by the University of Sheffield, the risk of death for patients who were uncon- scious, not breathing or who had chest pains increased by 1% for every six miles travelled. Portiuncula Hospital is 30 miles from Roscommon County Hospital. Is this a justifiable risk of death due to this proposal? The Minister attended meetings on 12 September 2006 at which she gave commitments on the continuation of acute services at Roscommon County Hospital. In May 2007 the Taoiseach stated services at the hospital would not be downgraded. The statement was confirmed by Professor Drumm at a meeting of the Joint Committee on Health and Children last November. Consultants at Roscommon County Hospital have written to the HSE. The Minister is well aware of the circumstances of the county hospital, the demand for continuation for services, the upgrading of services that has taken place with the provision of a new accident and emergency department, theatres and a CAT scanner, and the investment that has taken place over recent years. I believed the issue had been resolved and the hospital was working efficiently and effectively. It provides an excellent service to the people of County Roscommon. When I served as Minister of State at the Department, the issue was the closure of the hospital. I averted its closure at a cost politically to myself, but nevertheless it was retained as an acute general hospital with surgical, medial and psychiatric services and an accident and emergency department. The decision was made by the Government at the time and I have that decision in writing. The downgrading of Roscommon County Hospital will have to be a Cabinet decision because I have no confidence in the HSE to make it. The decision may be based on the Hanly report but senior politicians stated decisions would be based on location and getting safely to hospital. It is a vital issue everywhere and in my region in particular. I appeal to the Minister to examine the issue. She was elected Minister but I did not elect Professor Drumm. The House did not elect him or the HSE board. The Minister must intervene in these issues and take political decisions in the best interests of the people.

Senator Nicky McFadden: I thank the Minister for attending the House again. The last time she was present I referred to the closure of breast cancer services in Mullingar hospital. While we all accept specialised services and centres are needed, I do not accept we should be discrimi- nated against because we come from the midlands. No transport services have been put in place to make it easy for people from the midlands to access services in Dublin hospitals. For example, the people of Longford and Westmeath have to leave home at 6 a.m. to get to Dublin for chemotherapy. This is inhuman. I spoke previously about a situation where a lady told me she had to get off the train to be sick and then get back on. This is unacceptable. The service that is provided goes halfway around the world picking up patients. The Minister said there would be a revision of transport services. We should have a state-of-the-art, comfortable service that brings patients to Dublin. Will the Minister give me the up-to-date position on that service? I am also concerned about the primary care unit in Athlone. When I asked the Minister about this the last time she was in the House, she said she did not know anything about it. Does she know anything about it now? There have been further developments. This is an ongoing project on the Clonbrusk site in Athlone. I take my hat off to the local manager who is fantastic and is doing his best with the resources he has. The project has been ongoing since 1999. We were told that it would go to planning and construction stage in April 2007.

253 Patient Safety: 22 April 2008. Statements

[Senator Nicky McFadden.]

Last month we were told the situation had changed and that general practitioners were not interested in being involved in the primary care unit. I worked as a medical secretary for ten years and have experience of making health representations for people but I cannot understand how we can have a primary care unit without general practitioners. The project has fallen further behind. The size of the unit will now be reduced and the project must return to the design and planning stage. This seems like delaying tactics. I ask the Minister to use her offices to engage with the general practitioners. The reason they do not want to be involved in the project is because there has been no compromise and the delaying tactics since 1999 have not inspired confidence. I am also concerned about an anorexic adolescent from the midlands whose treatment and care in the UK costs the regional health service \500 per day. We have only six adolescent psychiatric beds in Ireland. Will the Minister comment on this? Can we improve the situation? I can only imagine what it must be like for that young person’s family with regard to visiting her and keeping in contact. The departmental website advertises free dental services for all children under 16 years of age. In the midlands area children up to sixth class are treated free. However, we have had a reduction in the number of dentists in the area this year and are now short of one dentist. When I asked about dental services the manager could only say that is the situation. This is unfair. If we want to encourage good dental care, we should be able to offer those under 16 free care. On the issue of the pharmacists, what will happen in the event the strike goes ahead. I know issues can be resolved at the last minute and I hope this happens. The Minister is very capable——-

Senator Geraldine Feeney: On a point of order, I thought we would have our question and answer session at 6.50 p.m. and that this debate was on patient safety.

Senator Nicky McFadden: The issues I am raising are all relevant.

An Leas-Chathaoirleach: That is not a point of order, Senator Feeney.

Senator Liam Twomey: If someone is given the wrong drug on 1 May, we will know all about patient safety very quickly.

Senator Nicky McFadden: What provisions have been put in place for patients if the strike goes ahead? When I asked the Health Service Executive this question, I was told that Boots would be able to look after 23,000 people in the midlands area. The issue is a matter of grave concern to the people, especially with regard to their safety. One pharmacist to whom I spoke today told me about an epileptic child whose drugs were being brought in from England at a cost of \1,200. She said she was at the loss of \100 in dispensing that one product. What will happen in this situation and how will that child access those drugs next month? There are many other issues. As Senator Quinn said, the Minister has a difficult portfolio. She is doing the best job she can but the area is a quagmire. I hope she will respond as best as she can. I am not, as Senator Feeney suggested, trying to personalise the situation. It is important we get answers for the people we represent.

Senator Pearse Doherty: The theme of these statements is patient safety. I believe the biggest threat to patient safety is the grossly inequitable nature of the health service presided over by the Government for the past 11 years. Patient safety is the biggest issue of concern for everyone 254 Patient Safety: 22 April 2008. Statements and the biggest failure of the Administrations in which Deputy Harney has served as Tańaiste and Minister for Health and Children. There is a tendency to personalise the issue and target the Minister, as if she were solely responsible. That is very convenient for other Members of the Government, especially the Fianna Faíl Members. They, too, bear full responsibility for the disgraceful state of our public health services and for the disastrous policies that have led us to this situation. The members of Fianna Faíl and the Green Party now hide behind the Minister for Health and Children, Deputy Harney, trying to dodge their responsibility for health services. The Minister in turn hides behind the Health Service Executive which is the most unaccountable quango and most monstrous bureaucracy ever established in the State. We all owe a significant debt of gratitude to the late Susie Long and her family because she exposed the reality of the two-tier public private system. As a public patient she was denied timely access to a diagnosis that could have saved her life. She found this out when she talked to a private patient sitting beside her in a hospital waiting room. The Taoiseach and the Mini- ster said the system failed Susie Long. This was not just an unusual error. This is the way the system is built. It is a public-private system of apartheid and the Minister, the Government and their colleagues are reinforcing it. They are pouring public money into privatised health and co-locating for-profit private hospitals on public hospital sites. We will never know how many Susie Longs there have been but there must have been thousands. These are the people who were denied timely diagnosis and hospital care and timely access to a range of services because they were public patients. MRSA and other virulent hospital-based infections are major issues for patient safety. This was thrown into stark relief by the release of the first national hygiene services quality review by the Health Information and Quality Authority last November. It states that the majority of public hospitals need to improve their hygiene standards dramatically. The report states that just seven out of 51 hospitals have good hygiene standards while none was found to have very good standards. Nine hospitals were rated as poor and the remaining 35 rated as fair. The HIQA states the findings show that most hospitals need to take measures to improve standards. The need for more single rooms and isolation units to combat MRSA was identified as far back as 2001, but no action was taken. Accident and emergency units and wards are under constant pressure and the highest standards of hygiene cannot be maintained. As a result of the privatisation of hospital cleaning services, the standards of cleanliness have not been maintained. Cleanliness and hygiene should be an integral part of every hospital’s work, with cleaning staff employed by the hospital and part of the hospital team. Sinn Feín calls for an effective national strategy against MRSA to be delivered locally in every hospital and nursing home and every other care setting. Patients must be fully informed when they have MRSA and deaths attributable to MRSA should be recorded by coroners. The prevalence of MRSA is one of the reasons the promised 3,000 additional hospital beds must be delivered. Single rooms and isolation units should be included in that figure. On the pharmacy dispute, thousands of patients are concerned that from next Thursday they may not be able to get their medication. I ask the Minister, Deputy Harney, to outline plan B. I understand the Minister’s plan B was to take these pharmacies to the High Court. However, many pharmacies have not responded and the deadline passed yesterday. Therefore the Mini- ster’s only option is to take these pharmacies to the High Court. If the Minster fails in the High Court, what will happen next Thursday? The option of Boots providing the service is unlikely as I understand it has informed the Minister that it will not be able to cater for the demand. In Donegal alone there are 55,000 prescriptions every week under the medical card 255 Patient Safety: 22 April 2008. Statements

[Senator Pearse Doherty.] scheme. I ask the Minister in terms of patient safety, what is the plan B that will assure patients they will get their medication after 1 May.

Senator Mary M. White: I wish to speak on two issues. Five years ago I used to visit an elderly man in St. James’s Hospital. I have spoken previously on this issue in the Seanad but I did not name the hospital. This evening I will name St. James’s Hospital and praise the Minister, Deputy Harney, for the transformation I have seen over these five years. When I first visited the hospital, I could sense it was not clean. When a building is thoroughly clean and washed properly with soap and water and whatever is required, it is clear to see. There is no odour in the air, which is what I found there. When the Minister, Deputy Harney, started the programme on the improved cleansing of hospitals, I did not notice a difference in St. James’s Hospital after the first audit. However, by the time of the second audit there was a transformation in the hospital. I compliment the Minister, Deputy Harney, on progress. In my experience of visiting St. James’s Hospital over five years I have seen a transformation in the cleanliness. The Acting Chairman, Senator Feargal Quinn, knows as a businessman and food producer how important cleanliness is. It was said earlier how important hygiene is in the area of health. However, as a food producer I know the standard of cleanliness must be 100%. Although it is not related to patients, the Leader advised me that I could raise the matter of suicide prevention in Ireland. The agreed programme for Government has adopted a target of reducing the rate of suicide by 20% in 2012. The programme says we will implement as a matter of urgency the recommendations of the Oireachtas Joint Committee on Health and Children to deal with the high levels of suicide in Ireland. I presume our mission is to implement the programme for Government. The programme also says we will implement urgently the recommendations of Reach Out, the Government’s national strategy for suicide prevention. I am afraid we will not reach the target of a 20% reduction by 2012 unless we have action locally. The bottom line is there are 11 positions for the post of suicide officer in the country. The job is to integrate with the local communities and do everything possible to prevent suicides happening in communities. At present there are three vacancies for the position of suicide prevention officers throughout the country, one each in Naas, Bray and Ardee. I will meet with Dr. Doorley next week. The Minister, Deputy Harney, knows the man in question. I spoke to him on the telephone and I want to know when the positions will be filled. I do not care whether there is an embargo on filling positions. I want to know, as a business person, the reason he cannot get three people out of the 100,000 people employed in the Health Service Executive and move them into those positions. I will meet him next week and I told him to have his answer ready. I want to see this happen.

Senator Jerry Buttimer: Hear, hear.

Senator Mary M. White: This is common sense and a no-brainer. Surely there are three people in this country working for the HSE who would love to help people locally in the area of suicide prevention. I again compliment the Minister of Health and Children on the progress in St. James’s Hospital. In my experience it is now impeccably clean.

Senator Jerry Buttimer: In the Acting Chairman’s eloquent remarks he said we should accen- tuate the positive. Let us do this. The Minister, Deputy Harney, has had great success. She has billions of euro at her disposal, a committed staff and frontline services run by excellent people who work around the clock on our behalf. However, these people feel let down. They are worried and frustrated but, more importantly, the biggest threat to patient safety is the Health Service Executive. I wonder if the Minister, Deputy Harney, is not on a “mission impossible”. I do not know if she is a James Bond fan, but I do not think the people around her resemble 256 Patient Safety: 22 April 2008. Statements

007, whatever about the Minister. Senator Pearse Doherty is correct to say that the people alongside the Minister are using her. They hide, blame and love to hate her. I hope the future Taoiseach will move the Minister, Deputy Harney, from the Department of Health and Chil- dren and put one of his cronies in there, because they deserve——

Senator Mary M. White: He will not.

Senator Jerry Buttimer: ——to be held to account as they are equally as guilty as the Mini- ster, Deputy Harney. The Fitzgerald report on the HSE paints a poor picture. In 2004 the Minister, Deputy Harney, said that it was “a-once-in-a-generation event ... our generation’s chance to put patients first in the design of the management of health services”. Who will accept responsibility? The former Minister for Health and Children, Deputy Michea´l Martin, sure as heck did not. He ran from everything, commissioned report after report and denied everything when he appeared before the Oireachtas Joint Committee on Health and Children and was asked a straight question about responsibility. This is what the former Minister, Deputy Michea´l Martin has done. Fianna Fa´il members do not want to know anything about health. They are pleased with Deputy Harney as Minister for Health and Children because she is honest and sincere. The Minister should not allow herself to be painted as the bad girl of politics, so to speak. Consider what is happening with the Mercy University Hospital, Cork. A sum of \5 million has been spent on a new accident and emergency department, yet it will only open from 8 a.m. to 8 p.m. There has been a systematic failure by the HSE to address the ongoing concerns of patients, staff and ordinary citizens. This is not make-believe; it is real. When canvassing every day on the streets of Cork, I hear horror stories about MRSA, people getting sick in hospital, lack of patient care and neglect of duty in hospitals. Senator Frances Fitzgerald spoke eloquently of different people. This is all about people. They are not statistics or stories but real people. The HSE is letting people down. Human beings deserving of dignity, treatment of care and respect are not being given these. Errors, systems failures and lack of communication should not happen but they do time and again. Can the Minister explain the reason that after 12 years of this Government and billions of euro spent on health, the common currency used by ordinary people is the quality of our service? Will the Minister say why this is the case? She is far more intelligent than me. Billions of euro have been spent and surely we should have a health service of which we can be proud rather than having people ringing up Joe Duffy or Neil Prendeville in Cork or going to the newspapers and having to raise funds for equipment. Why is this the case? I ask the Minister to answer my question because I certainly cannot figure it out. I ask the Minister to accept the Health Service Executive has been a monumental failure and she should pack it away and start again. She would have cross-party support for this action.

Senator Paddy Burke: The Leader gave the impression on the Order of Business today and last week that the Minister for Health and Children would answer any questions from Members about health issues. I have no doubt the Minister is well qualified and well able to answer any question that is put to her. The Minister has come to this House many times and I compliment her because she always speaks off the cuff. She knows the system inside out and she is familiar with every aspect of the health system. What is wrong with the system? The Minister is much better informed than us to answer that. 257 Patient Safety: 22 April 2008. Statements

[Senator Paddy Burke.]

There is something seriously wrong within the Health Service Executive because it is not working. It has been brought to my attention recently that under the former health board system, when people were going for promotion, the human resources officer or the senior staff nurse would make the recommendation and the chief executive officer for the district would sign off on it, but I understand that now in some cases it can involve up to ten different stages for a person to be granted promotion or for human resource decisions to be made. This is unbelievable and unrealistic. I was informed recently that the Minister for Foreign Affairs and Mark Durkan, MLA, the leader of the SDLP, stated that the centre of excellence in the north east should be situated on the Border. It is outrageous that the Minister for Foreign Affairs should even be associated with this statement. If there were to be any centre of excellence along the Border, it should be placed in the Sligo-Leitrim-Fermanagh area in that blackspot which has no hospital cover. The golden hour is not covered in many cases in the north west. When will the centres of excellence be established and funding put in place? It is quite clear that adequate funding is not being put in place. Everyone agrees Galway should be the centre of excellence in the west. I refer to the problems in Galway, not least of which is parking in the city centre. It is a nightmare for people visiting patients and it is sometimes necessary to park on the Headford Road which is miles away. Even at this late stage the Minister should revisit the issue of Castlebar and Sligo as satellites of Galway and the case has been well made by the people of the west. The pharmacy dispute is heading for disaster on 1 May. Nobody seems to know what will happen. What are the contingency plans in place for County Mayo, the third largest county in the country? Will these be administered from Castlebar General Hospital? How will people get their medicines? I hope the Minister will allay the fears of the people with respect to the pharmacy dispute. The HSE is wrong not to engage in discussions with the pharmacists who have a lot to offer in this dispute. There are many ways in which the HSE and the Department of Health and Children can save money. If the pharmacists were given the opportunity to put their case in a proper fashion to the HSE and if the executive were to listen to them, the dispute could be resolved and there would be substantial savings for the health budget and the Department.

Senator Paul Bradford: I welcome the Minister to the House. We hear from her regularly and we are thankful for her attendance. Unfortunately the problems which she has come to address seem as if they are almost beyond repair and this is not politically acceptable. It is quite extraordinary that notwithstanding the huge economic boom and the significant investment across the length and breadth of the health service, we must report that two decades after the political sloganeering from Fianna Fa´il about health cuts hurting the old, the sick and the poor, the cuts seem greater than ever, the service seems less and we have serious questions to ask. When the Minister set in train the proposals to create the Health Service Executive as a new entity, I would have been a supporter. I saw the significant difficulties associated with the old system of the health boards. I had presumed the new system would be much more effective, cost-effective and efficient. I regret to say my judgment appears to have been misplaced. We now have a monster which appears out of control. The service to the public is certainly dimin- ished and staffing levels have not altered in any sense. I note that a senior grade which formerly had six or eight persons now has hundreds of people at that level. The taxpayer is investing enormous sums in the health service and he or she appears to be getting very bad value for money. Patients and the public are not receiving the service they 258 Patient Safety: 22 April 2008. Statements deserve. The funding of the health service could be a subject for a broader debate. From a European and international perspective we are not spending the proportion of national income on the health service which is needed to put in place an improved system. I concede that the current level of expenditure is substantial but the taxpayer is right to ask where the money is going and the patients are right to ask where the service has gone. I concur with my colleagues’ fears about the outcome of the pharmacists’ dispute. If I may be excused the use of a pun, I cannot prescribe a response. All we can ask for is dialogue. Whether it relates to the politics of Northern Ireland, Europe or any issue facing us, dialogue is necessary and important. We need to re-engage in dialogue with the pharmacists. I wish to make some parochial points. I concur with Senator Buttimer’s remarks about the Mercy University Hospital in Cork city. It makes very little sense that the public has spent so much money and the service is not available. The Minister will be aware of the excellent hospital in Mallow which last year was given the award for the cleanest hospital in the country. There are grave fears in Mallow about the future of the hospital. No one seems to be in charge of the budget or of making decisions fundamental to keeping Mallow as a positive general hospital for the town and the north Cork region. I extended an invitation to the Minister to visit the hospital to see at first hand what a small hospital can do effectively and efficiently. I again ask her to consider a visit to a hospital such as Mallow in the near future. I apologise for straying beyond the issue of patient safety but this debate will need to continue because it is the biggest issue facing the public in this post-Celtic tiger era. Where has the money gone and how do we plan for the future to give the public a service to which it is entitled?

An Leas-Chathaoirleach: As agreed on the Order of Business, I will call each of the leaders of the groups to put a further brief question to the Minister.

Senator Geraldine Feeney: Like other Senators, I welcome this type of debate where the discussion is followed by a question and answer session with the Minister. I am sick and tired of asking on the Order of Business about services for eating disorder sufferers and I am sure Members are fed up listening to me calling for a debate. It is not the Minister’s fault that this urgently required debate has not taken place. I am sure I speak for all Senators in saying we would be pleased to have the Minister return to the Chamber for a debate on eating disorder services that would take the same format as today’s discussion. I have often said in this House that an eating disorder is a matter of life and death for the sufferers and their families. I and other Members have met such people and it is heart-rending to hear their stories. They are effectively going around blindfolded and with their hands tied behind their backs because there are only six adolescent public beds and 12 private beds between St. John of God Hospital and St. Patrick’s. It is not a large lobby group but the work being done behind the scenes by Bodywhys is incredible. It is the most dignified lobbying organisation I have met. Its members do not have much money and do not have loud voices but their hearts certainly are in the right place. They have been very patient as their hopes of receiving support have been disappointed time and again. Will the Minister agree to take part in a debate on this issue? In regard to the pharmacy dispute, I have been contacted by only one member of the public but by several pharmacists. There is undoubtedly misinformation abroad and people feel vulnerable and fearful. I ask the Minister to clarify the pharmacists’ claim that in dispensing a box of insulin, they are now down \8 on the price charged them by the wholesaler. I disputed that figure but one pharmacist offered to send me the invoice from the wholesaler and the 259 Patient Safety: 22 April 2008. Statements

[Senator Geraldine Feeney.] documentation showing the corresponding amount he has received from the Health Service Executive.

Senator Frances Fitzgerald: The Minister has had so many questions that it is clear we need more time for a debate on all the major pillars of the health service.

Senators: Hear, hear.

Senator Frances Fitzgerald: Members on both sides of the House have raised issues of serious concern but the Minister will not be able to address them in the time available. It is clear that the policy pursued by Fianna Fa´il and the Progressive Democrats in the past ten years has failed to deliver adequate health services. I would like to say more about this but there is no time to do so. What action has the Minister taken within her Department to lead reform of the Health Service Executive in light of the Fitzgerald report? What will be the scale of future cutbacks and how will the Minister prioritise the areas in which those cutbacks will occur? Will cutbacks be confined to administration or will they continue to affect frontline services? I urge the Minister to clarify the situation. Members are hearing daily how cutbacks are affecting con- stituents.

Senator Phil Prendergast: My questions relate to specific issues. In response to a question last year on the ambulance service in Carrick-on-Suir, I was told a review of the service would be completed last September or October. What is the status of this review? I also await a satisfactory response to my question about the future of maternity and gynaecological services at South Tipperary General Hospital. In addition, a review of maternity services in the Dublin hospitals was to be completed in December but I understand that report has not yet come to light. I join Senator Feeney in expressing my concern at the lack of adolescent psychiatric beds for persons suffering from any psychiatric disorder, whether an eating disorder, depression or another illness. I receive representations on this every week. The high rate of suicide among young people is a matter of great concern. I apologise for being parochial but my colleagues have addressed the main national issues, namely, the pharmacists’ dispute and the Health Service Executive cutbacks which are affecting people in all areas.

Minister for Health and Children (Deputy Mary Harney): It would take me an hour to answer all the questions posed. Instead, I will make several observations with particular focus on the point made by Senator Quinn and others. Life expectancy is one of the international measures used to compare health systems. Between 1999 and 2003, life expectancy in Ireland increased by three years. A child born in Ireland today will live longer than one born in the United Kingdom, Belgium, the Netherlands, Germany or Denmark. That is a measure of achievement. The numbers dying from heart disease in the State have dropped by 54% in the past eight years. The survival rates for pancreatic cancer have improved by 31%, by 24% for prostrate cancer, 14% for lung cancer, and 9% for breast cancer. The OECD recently described this improvement as one of the fastest in the world. We are top of the class in regard to children’s cancer, ahead of the United States and the rest of Europe. I make these points because one might have an entirely different impression of the health service based on the debates in these Houses. One aspect of the problem in this regard is that some of those working in the public health system like to criticise it. That is quite unusual. One never hears a member of staff in a private hospital criticising that institution in public. However, such criticism is frequently heard in the public health system. It is a great pity. 260 Patient Safety: 22 April 2008. Statements

Criticism was directed at me yesterday in view of the announcement that a private company’s contract to supply hospital in the home services was not being renewed. I am normally criticised because such contracts are being given to private companies. That was mentioned during this debate. The reason the contract is not being renewed is that we have capacity within the public system to provide the service. In regard to the dispute between the Health Service Executive and pharmacists, we all would agree that health care professionals, above all else, take their ethical responsibility seriously and generally put patients first. If there is an industrial relations dispute or, as in this case, a dispute over money between the HSE and pharmacists, the priority must be that patients should not suffer. We are all entitled to expect that. Pharmacists receive \100,000 more per year in dispensing fees than their counterparts across the Border. Furthermore, it costs us \600 million, a margin of 17% to 18%, to take \1.1 billion of drugs from the producers to the patients. I am not an expert on Senator Quinn’s business but I doubt he would pay \600 million to take \1 billion of product to customers. It is a huge margin and double the EU average. We are not reducing the money going to pharmacists. Our objective is to stop the huge rise in the cost of drugs. The cost is rising so rapidly that it has the capacity to consume all the additional money we can make available to the health services. The agreement between the 1,600 pharmacists and the HSE is to get a dispensing fee for the general medical service, GMS, scheme of \3.27, a dispensing fee for the drug payment scheme and a 50% mark-up. There is no agreement between the pharmacists and the HSE to pay a distribution fee for anything. Nor is there any agreement between the wholesalers and the HSE in regard to distribution. When the HSE recently put to tender the contract for the distribution of certain products, the successful company won it on the basis of a 4% margin. I established a three-person group because the Irish Pharmaceutical Union, IPU, representatives made the case to me that the HSE is the procurer of 70% of the service they provide and that an independent process was required. I put in place a group of three led by Mr. Sean Dorgan, former chief executive officer of the IDA and Secretary General in two 7 o’clock Departments. The group also includes Mr. Mark Moran, who previously worked in the pharmaceutical sector and was formerly chief executive officer of a Dublin hospital, and Ms Mary O’Dea, consumer director of the Irish Financial Services Regulatory Authority. These are all highly regarded individuals. They have been given until the end of May to report on this issue. IPU representatives met the group last week, as have other interested parties. I appeal to pharmacists to give that group a chance. We are talking about a matter of four weeks from 1 May. I really hope that can happen.

Senator Fidelma Healy Eames: What about the dispensing after 1 May?

Deputy Mary Harney: I hope the Senator will agree with me that patients should not suffer.

Senator Fidelma Healy Eames: Absolutely.

Deputy Mary Harney: We pay dispensing fees of \100,000 more per pharmacist than they do in Northern Ireland. That cannot be sustained.

Senator Fidelma Healy Eames: Who will dispense?

Deputy Mary Harney: I do not envisage that we will have those issues. I certainly hope we will not.

Senator Fidelma Healy Eames: They are already waiting. 261 Business 22 April 2008. of Seanad

Deputy Mary Harney: The contract of employment requires three months’ notice. The HSE wrote to pharmacists last week. I understand a number of them indicated they are considering whether to dispense. They have not said they are withdrawing their services.

Senator Fidelma Healy Eames: I have the letters.

Deputy Mary Harney: Yes, I know that. I understand the five pharmacists who said they intended to withdraw their services have now said they will not do so. A great deal of dialogue is needed. It is an industrial relations issue. I do not want to add to the difficulties being experienced by both sides. My view is that it would not be professionally or ethically acceptable for patients to suffer. Patient safety is at the heart of what pharmacists do when they dispense medication. I believe that pharmacists take that responsibility very seriously. I have a very high regard for pharmacists. As Senators are aware, I resolved the conflict between pharmacists and general practitioners in the legislation that was passed and welcomed by many pharmacists. We want pharmacists to have an enhanced role.

Senator Fidelma Healy Eames: Does the Minister have any contingency plans?

An Leas-Chathaoirleach: I ask the Senator to allow the Minister to continue. She has many questions to answer.

Deputy Mary Harney: I was also asked about ambulance and maternity services, etc. I understand that Senators are naturally concerned about their individual localities. We are too often obsessed with where things happen rather than what happens. Patient safety has to be paramount. It is a fact that it is not safe for a person who goes to an accident and emergency department at 10 p.m. or 11 p.m. to be seen by a junior doctor. When people talk about the “golden hour”, they are not talking about the time within which one should be brought to a place called hospital but about the need to access expertise as quickly as possible. If one has a stroke, one needs to be given certain medication within three hours.

An Leas-Chathaoirleach: I ask the Minister to conclude.

Deputy Mary Harney: As I have said, I could answer more questions. I will be more than happy to come back to deal with some of the other issues on another occasion.

Senator Terry Leyden: We need more time for this debate.

Senator Mary M. White: More time is needed.

Senator Jerry Buttimer: The Senators on the Government side stayed quiet on the Order of Business.

Business of Seanad. An Leas-Chathaoirleach: I understand the Leader of the House wishes to extend this debate.

Senator Donie Cassidy: With the permission of the House, I propose to extend this debate until 7.10 p.m.

Senator Mary M. White: Hear, hear.

Senator Donie Cassidy: Additional time is needed, with the agreement of the House, to allow the Minister to respond.

An Leas-Chathaoirleach: Is that agreed? Agreed. 262 Patient Safety: 22 April 2008. Statements (Resumed)

Patient Safety: Statements (Resumed). Deputy Mary Harney: A number of issues were raised about services. I do not propose to deal with all of them. I assure Senator Prendergast that discussions are ongoing among clinicians in the south east. I was asked when the cancer control programme that is currently being implemented will be concluded. Half of it will be implemented by the end of this year and between 80% and 90% of it will be implemented by the end of next year. The programme, which is led by Professor Keane, is happening at a remarkable pace. Many clinicians were involved in the drawing up of the control programme and are now involved in the implementation of the programme. That is what delivers success. In the past, many proposals were devised by people at management or administration level who then failed to implement them. Clinical involvement, which is the key to success, is central to the new contract of employment for consultants which we have been negotiating for three years. I know that clinicians, obstetricians and others are involved in discussions about the configur- ation of services between the different hospitals in the south east, which I visited recently. The Government wants to maintain the hospital infrastructure we have as long as services can be provided on the basis of patient safety. Our system has 4,000 junior doctors and 2,000 senior doctors and consultants. We intend to turn that ratio around the other way. Until we do so, it is not safe to provide some acute services in the absence of the appropriate medical expertise. Cases such as that of the Mercy University Hospital in Cork often arise in the context of health expenditure. We have made a capital investment of more than \5 million in the hospital. An increase of 54% in staff numbers was sought as soon as we tried to open the new facility, which is not acceptable. That is why the new facility is open between 8 a.m. and 8 p.m. only. Teachers never demand a 50% increase in staff numbers when spanking new schools are provided. Such demands tend to be made in the health system, unfortunately. It is not possible to provide a 50% increase in staff to serve a fantastic state-of-the-art facility that will see an increase in patient activity of just 15%. When new facilities are opened in the health care system, they should help to improve productivity. They should not demand the huge increases in staff that are usually sought. It has been suggested that cutbacks are being made. The HSE budget for 2008 represents an increase of \1.1 billion on last year’s figure. Like any other health authority in any other country, the HSE has to live within the resources made available to it. One has to live within one’s health care budget and ensure the health care priorities one has set are implemented, regardless of whether one is operating in a publicly funded system, an insurance funded system, a combination of the two or a privately funded system. I often hear people saying how awful the HSE is. I refer to people speaking in this House, for example, or the councillors I meet at the regional forums who ask me for meetings. The HSE was established three years ago as a means of addressing the unsatisfactory nature of the health services being provided under a health board regime that had 273 members. All was not perfect then. Many of the inquiries we have had recently relate to events which occurred when the health boards were in place. That is a fact. The establishment of the new HSE organisation three years ago was an undertaking the scale of which had never been seen in Ireland before. I remind Senator Fitzgerald that a considerable amount of work is being done by Professor Drumm and his team within the organisation’s management structure. A new director of human resources will start work in the HSE shortly.

Senator Jerry Buttimer: Another new one.

Deputy Mary Harney: No. The position in question has never been filled since the HSE was established.

Senator Jerry Buttimer: It is more management. 263 Patient Safety: 22 April 2008. Statements (Resumed)

Deputy Mary Harney: If Senator Buttimer thinks an organisation that employs 111,000 people can be run without a director of human resources, he should think again.

Senator Jerry Buttimer: It is more management.

Deputy Mary Harney: No, it is not. We need appropriate management.

Senator Jerry Buttimer: Correct.

Deputy Mary Harney: We need good management.

Senator Jerry Buttimer: We do not have that.

Deputy Mary Harney: I do not suggest we need administration for the sake of it. We need hands-on management.

Senator Mary M. White: Hear, hear.

Deputy Mary Harney: When I wrote to the HSE after the Portlaoise report was published, I drew its attention to the need to learn from the governance deficiencies that were identified in the report. Regardless of where one works in the HSE, one has to be clear about what one’s job is and to whom one is responsible. Some people think one can press a green button to make change happen, but it takes time. The process is under way and I have every confidence it will be completed quickly. I think the report on the ambulance service has been completed, although I have not seen it. I will get back to Senator Prendergast in relation to that.

Senator Phil Prendergast: I thank the Minister.

Senator Terry Leyden: What about Roscommon?

Deputy Mary Harney: The plan for Roscommon County Hospital was to merge its surgical department with that of Portiuncula Hospital. I have not seen the latest proposals. When the HSE is briefing, it is required, like all Departments, to brief Government and Opposition alike. It seems that the county council and, perhaps, the regional forum were briefed in this instance. Neither the HSE nor the various Departments can be selective when offering briefings. They have to make such services available to Government and Opposition alike. I am more than happy to ask the HSE to brief those who are interested on the Roscommon issue.

Senator Nicky McFadden: I asked about primary care.

Deputy Mary Harney: The HSE recently went to tender for primary care units in 100 different places, including Athlone. I understand from Mr. Brian Gilroy, who is the HSE’s head of capital planning, that many expressions of interest have been received. I cannot give specific details of the expressions of interest for Athlone. I think a major programme of primary care centres will be rolled out over the next few months.

Senator Mary M. White: I asked about the three vacant suicide prevention officer positions.

Deputy Mary Harney: I will respond to the issues raised by Senators White and Feeney. Ten days ago, four beds were opened in Galway to cater for adolescents with psychiatric problems. A number of beds will be opened shortly on the north side of Dublin and in Cork. I understand that 15 of the 120 consultants who are being recruited at present will work in child and adolescent psychiatry. Substantial investment is being made in that area. We are catching up as far as these services are concerned.

An Cathaoirleach: I thank the Minister.

Senator Liam Twomey: Could I ask a question? 264 School 22 April 2008. Accommodation

An Cathaoirleach: That concludes the statements.

Senator Mary M. White: The Minister did not address the point I was making. I asked about the three vacant suicide prevention officer positions.

Deputy Mary Harney: The Minister of State, Deputy Devins, is handling that. I know he has been talking to the National Office for Suicide Prevention. I do not have the details to hand.

Senator Liam Twomey: Will the Minister return to the House at some stage to discuss the reduction in service throughout the country of which each individual has been made aware? I am aware of significant reductions in service in County Wexford. I am sure they must be mirrored in other parts of the country.

An Cathaoirleach: We cannot have supplementary questions.

Senator Liam Twomey: Perhaps the Minister will also address many people’s concerns about the budget for next October.

Deputy Mary Harney: We treat 400,000 more people in our hospitals each year than we did ten years ago. Some 24,000 people with disabilities are getting day services. More than 8,000 people are in residential care. Some 4,000 people are getting respite care. Such services did not exist ten years ago. There is no question of a reduction.

Senator Jerry Buttimer: There is.

Deputy Mary Harney: We are increasing services.

Senator Frances Fitzgerald: Is the Minister saying there are no cutbacks?

Deputy Mary Harney: There are issues that arise, to be honest. I am aware of one service where one third of the staff will go on maternity leave in May. This is an incredible statistic. We have pressure points and I will not pretend for one moment we will not have difficulties and services will have to adapt to budgetary issues. It does not make sense to keep services open if they do not run effectively and efficiently. If a procedure can be done on a day care basis as opposed to an in-hospital basis it should and people should not be called back to outpatients when it is not necessary. As Professor Keane stated, many cancer patients are called back to the consultant as outpatients when they should be going to their general practitioner. Major change is under way. I assure the House that more services will be provided this year in the community and in hospitals than was the case last year. I will be happy to return to the House.

An Cathaoirleach: When is it proposed to sit again?

Senator Donie Cassidy: Ag 10.30 maidin ama´rach.

Adjournment Matters.

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School Accommodation. Senator Alex White: I thank the Cathaoirleach for affording me the opportunity to raise this issue on the Adjournment. It concerns two combined schools on the same site in Knocklyon in Dublin, namely St. Colmcille’s senior and junior schools. They are highly successful schools with exceptional input from their staff and students with a marvellous level of respect and support in the community. 265 School 22 April 2008. Accommodation

[Senator Alex White.] The difficulty is that the schools wish to apply for planning permission but so far the Minister has not seen fit to permit the school to proceed with this application. The schools have slightly fewer than 500 pupils in prefabricated accommodation with a total of 16 prefab classrooms and 14 prefab resource teacher rooms. Most of these prefabs were installed 20 to 25 years ago. Naturally enough, they are in very poor condition. It is vital this project proceeds. The schools have been addressing this matter themselves since as far back as 2000. The two boards of management raised the matter of poor quality accommodation with the Department in April 2000. A feasibility study was carried out in December 2001 and in March 2005 the Minister authorised the schools to proceed to architectural planning. A stage 2 submission was submitted in October 2006 and in November 2007, stage 3 was given technical approval. The boards of management were then requested to wait for further news and permission to apply for planning permission until after the budget in December 2007. They are still waiting for this permission. This project is vital to the schools and it is important to point out to the Minister of State that it will entail no extra cost to the Department of Education and Science. It is purely to afford the schools the opportunity to proceed with their application for planning. The momen- tum exists in the schools and in the local community which provides fantastic support for the schools. A site has been secured for temporary accommodation with the agreement of the local community. All that is required to be done is that the schools are allowed to proceed to apply for planning permission. I do not understand why, in circumstances where costs are not entailed, the Minister could not see her way to giving the green light to the schools to make their application for planning permission so this vital project can be brought to fruition. I look forward to the response of the Minister of State. The schools, pupils, parents and the local community look forward to this project coming to fruition at the earliest possible opportunity.

Minister of State at the Department of Health and Children (Deputy Ma´ire Hoctor): I thank Senator Alex White for raising this matter as it provides me with the opportunity to outline to the House the position on the delivery of a building project to provide two new state-of-the- art buildings to accommodate the schools in Dublin 16. By way of background, the current enrolment in the junior element of the school is 673 pupils. Its staffing comprises a principal, deputy principal and 26 main classroom teachers. The school also has nine special education teachers and four temporary language support teachers. The senior school has 723 pupils on its rolls and it has a staffing complement of a principal, deputy principal, 27 main classroom teachers and seven special education teachers. The accommodation at each of the schools consists of 16 permanent classrooms with additional accommodation being met by prefabricated structures. This project has a band 2 rating under the published prioritisation criteria for large-scale building projects and is in the early stages of architectural planning. The Department of Education and Science will providing a 32-classroom, purpose-built facility for each of these schools. The Senator will appreciate that schools building projects are selected for inclusion in the school building and modernisation programme on the basis of priority of need and this is determined by the band rating assigned to them. The band rating for the project in question is band 2 which reflects the fact that it already has a significant degree of accommodation but still has a shortfall. The Senator will be aware that a school building programme for any given year is rolled out in tranches. This is to ensure a steady flow of projects to underpin the multi-annual nature of the school building and modernisation programme. The first tranche of the Department’s capital programme for 2008 was announced in February. This contained details of projects which will go to tender and construction over the coming months. Further announcements will be made as the budgetary position allows. The project for the schools in question will be con- 266 Pharmacy 22 April 2008. Services sidered for progress in this context and consistent with its band rating. Direct contact will be made with the school authority when approval to proceed further can be given. Over the lifetime of the national development plan, the Government will provide funding of \4.5 billion for school buildings. This will be the largest investment programme in schools in the history of the State and it will enable the Department of Education and Science to ensure school places are available where they are needed and the upgrading and expansion of existing facilities can continue. This level of investment will allow the Department to continue the school building programme which commenced during the lifetime of the last national development plan when considerably more than \2.6 billion was invested in school development, delivering more than 7,800 projects.

Senator Alex White: I believe there will be considerable disappointment at the response given by the Minister of State. Describing the accommodation in these schools as constituting a shortfall is the greatest understatement I have heard recently. It is much more than a shortfall. These schools have serious needs. Does the Minister of State agree that the response represents a deterioration of any prospects the schools have for action? In November, the schools were told to wait until after the budget and now they are told no date is in prospect for confirmation that the project can proceed. Figures are all very well in the national context. However, all parents and a community will understand is an opportunity to proceed.

Pharmacy Services. Senator De´irdre de Bu´ rca: Will the Minister of State clarify what contingency plans the Health Service Executive has in place should pharmacists withdraw from dispensing as part of the community drug scheme, as they have threatened to do from 1 May? I know this issue was raised with the Minister during the previous debate on patient safety, which was appropriate, and during her response the Minister made several references to her belief that it would be unethical and unprofessional of the pharmacists to withdraw from the dispensing of such services, especially given that a number of what can be considered vulnerable people avail of this service, including the elderly, people with disabilities, people with chronic health conditions and people who suffer from drug addiction. While I respect the Minister’s belief that any threatened withdrawal from such a scheme would be unethical, it appears certain pharmacists are determined to proceed. There is much concern among members of the public that this will happen and that there are no contingency plans in place. I put down this Adjournment matter to establish what contingency plans the HSE has, or intends to, put in place so there will not be negative consequences for those to whom I referred who avail of the community drugs scheme and who would be in a very difficult predicament if left without this service.

Deputy Ma´ire Hoctor: I am taking this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. I thank Senator de Bu´ rca for raising this matter as it provides me with an opportunity to outline the current position on this issue. The Health Service Executive has operational responsibility for the management and delivery of health and personal social services under the Health Act 2004, including the provision of medicines under the community drugs schemes. The executive has been reviewing the pharmaceutical supply chain with a view to seeking value for money in the State’s drugs bill to better fund existing and innovative therapies without compromising patient safety or continuity of supply. Following the completion of public consultation, and informed by the independent economic analysis carried out by Indecon Economic Consultants, new wholesale pricing arrangements were announced by the HSE on 17 September last. The report by Indecon was published by the HSE on 13 November 2007. All aspects of the Indecon report were considered by the HSE in making its determination. 267 The 22 April 2008. Adjournment

[Deputy Ma´ire Hoctor.] In response to demands from community pharmacists to address the alleged impact of the new wholesale pricing arrangements, the HSE has offered a voluntary interim contract with a flat rate dispensing fee of not less than \5 for all dispensing under the GMS and community drugs schemes. The Minister has established an independent body to assess an interim fair community pharmacy dispensing fee to be paid for the medical card scheme, the DPS and other community drug schemes. This body is being chaired by Mr. Sean Dorgan, former head of IDA Ireland. It has been asked to make its recommendations by the end of May 2008. Both the HSE, as the contracting body, and the Irish Pharmaceutical Union, as the representative organisation for community pharmacists, along with other stakeholders, are entitled to make submissions to the independent body. I understand the Irish Pharmaceutical Union has made a submission to the independent body. The Government recognises the IPU as the representative body for pharmacists and wishes to maintain its long-standing relationship with the union as a key stakeholder in health care. The HSE has reported that it has, to date, received notification from 400 community pharmacy contractors indicating their intention to either cease providing services from 1 May 2008 or otherwise reserving their right to do so. Community pharmacy contractors are required under the terms of their contract to give three months’ notice of their intention to withdraw. The HSE has written to each of the 400 contractors seeking formal confirmation of their inten- tions and pointing out that three months’ notice of cessation of service is required. At this point only two contractors have given formal notification of termination in accordance with the requirements in the contract. The HSE has developed a national contingency planning framework which will inform and provide direction to local operational management for the development of local area-specific contingency plans. As service provision, geographical and demographic circumstances will vary from area to area, each local health area is developing its own area-specific contingency plan within the context of the overall national framework. Threats of withdrawal from the community pharmacy contract are unjustified and are not in anyone’s interest. The Minister does not wish to see any patient inconvenienced in any way and expects community pharmacists to fulfil their professional obligations under the terms of their contracts.

Senator De´irdre de Bu´ rca: I thank the Minister of State for her response, although I did not find it very satisfactory. I deliberately avoided getting into the substance of the pharmacists’ dispute with the HSE and focused very much on the contingency plans. Only one paragraph in the response dealt with that and it did not provide much information. I suppose it made me aware that the HSE has a national contingency planning framework but that each local health area will develop its own area-specific contingency plan within the context of the overall national framework. I have not been left much the wiser as to what exactly the contingency plans are. I would like a little more reassurance in this regard. Much of the response was dedicated to explaining the HSE’s position in terms of why it made the decision to reduce the dispensing fee for the pharmacists. I would like a little more clarity on the contingency plans.

Deputy Ma´ire Hoctor: I share Senator de Bu´ rca’s concern. We have made this known to the Minister and to the HSE. We are very anxious to see positive negotiation and discussion take place between the IPU and the HSE. I assure the Senator I will keep her informed of developments.

The Seanad adjourned at 7.25 p.m. until 10.30 a.m. on Wednesday, 23 April 2008.

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